Section 16.94 Brokerage Firm Nonprobate Transfers (Transfer on Death) Agreement

• Library: Estate Planning 2013 Forms

SUPPLEMENTAL TRANSFER ON DEATH REGISTRATION AND BENEFICIARY DESIGNATION FORM

Use this form to establish a Transfer on Death (TOD) account registration and to designate a beneficiary(ies) for your TOD account. Youmay also this form to change the enisling beneficiary(tes) tor your account. This form supercedes all previous Beneficiary Designations youhave made on your TOO account.

FOR INTERNAL USE ONLY

Registered Rep Signature: _____________

Principal Approval: _______

Section 1 - Account Information
ACCOUNT NUMBER:	PRIMARY OWNER:
SOCIAL SECURITY NUMBER:		DATE OF BIRTH
JOINT OWNER:		SOCIAL SECURITY NUMBER:	DATE OF BIRTH:
JOINT OWNER		SOCIAL SECURITY NUMBER:	DATE OF BIRTH:
JOINT OWNER:		SOCIAL SECURITY NUMBER:	DATE OF BIRTH:

Note: All Securities will be held in Street Name.

Section 2 - Beneficiary Designation

To: ABCD ("You" or "Your" or "ABCD")

I (We) wish to create a transfer on death ("TOD") registration for the account listed above. I (We) hereby designate the personf(s) identified in Section 3 (The Beneficiary(ies)) to receive all monies, securities and other assets held in the account listed above upon my death, or the death of the last surviving account owner in the case of a joint account. I (We) may change the designation of the beneficiary(ies) only by all owners completing a new Supplemental Transfer on Death Account Registration and Beneficiary Designation Form. The Beneficiary Designation may not be revoked or changed by will, codicil, trust documentor other testamentary document. You may rely on the latest Beneficiary Designation in your possession and no change in Beneficiary shall be effective until actually received and accepted by you,

1 (We) understand that you have entered into an agreement with XYZ to execute and clear all transactions on my account. I (We) also understand that because of the complex legal and tax issues involved, neither you nor XYZ will advise whether the TOD designation is appropriate for tax or estate planning. I (We) acknowledge that the ability to register a securities account in TOD form is created by state law and not ail states have enacted such laws. I (We) understand that I (we) should consult my (our) own legal and tax advisers before electing or revoking the TOD account designation. By opening a TOD account, I (We) acknowledge that I (we) have undertaken such consultation as I (We) deemed appropriate. I (We) acknowledge that the TOD provisions of the account are governed by the Nonprobate Transfer Law, Section 461.010, et seq., of the Missouri Revised Statutes, in effect as of the date hereof, and as it may be amended from time to time, or such similar nonprobate securities statute which may be enacted in its place.

Account Carried with XYZ

Section 3 - The Beneficiary(ies)

[ ] AN ORIGINAL TOD BENEFICIARY DESIGNATION

[ ] A CHANGE IN TOD BENEFICIARY DESIGNATION

I (We) hereby designate the persons) named below as the beneficiary(ies) to receive the assets remaining in the account listed above upon my death or the death of the last surviving Account Owner of the account, if owned by more than one person. I (We) designate that the beneficiary(ies) below are Joint Tenants with Rights of Survivorship (JTWROS) unless specifically noted otherwise by the box checked below:

[ ] Per Stirpes

[ ] Tenants in Common

Please note: Total of the beneficiary(ies) share percentages must equal 100%. Do not use fractional percentages or amounts. Please consult with an estate planning attorney regarding the disposition of your account, including the utilization of the Per Stirpes designation. If you check the Per Stirpes box, then you agree that if the specified beneficiary(ies) predecease you, his or her share of the account will pass through to his or her descendants. Per Stirpes will be construed and defined according to the laws of the State of Missouri.

Name:		Social Security Number	Date of Birth/Trust:
Address:	Relationship: [ ] Spouse [ ] Nor-Spouse [ ] Trust		Percentage:
Name:		Social Security Number	Date of Birth/Trust:
Address:	Relationship: [ ] Spouse [ ] Non-Spouse [ ] Trust		Percentage:
Name:		Social Security Number	Date of Birth/Trust:
Address:	Relationship: [ ] Spouse [ ] Non-Spouse [ ] Trust		Percentage:
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