Establishing a New Fiduciary

Transcription

1 DOC Ameriprise Financial Services, Inc Ameriprise Financial Center Minneapolis, MN Establishing a New Fiduciary i A fiduciary is one who has been appointed to work on behalf of another person or entity. The fiduciary must be of legal age, a U.S. citizen or U.S resident alien and must have a U.S. permanent address. Client ID 001! This form is not needed when submitting the following Ameriprise Financial forms: Certificate of Trust Form Corporate or Entity Resolution Form Durable Power of Attorney for Ameriprise Financial Accounts and Products Form To change a fiduciary's name, complete and submit Client Data Update Form To update a fiduciary's contact information, complete and submit Client Address and Phone Number Update Form 518 Part 1 Account Owner Information Account Owner Name Part 2 Type of Fiduciary Select the reason to establish the fiduciary: (Select one) For a fiduciary appointed by a court order (Attach the court order paperwork to this form) To invoke a springing power of attorney that is currently on file with Ameriprise Financial (Attach a doctor's or hospital's letter on their letterhead as evidence of incapacitation of the principal) To invoke a successor attorney in fact (AIF) for a power of attorney that is currently on file with Ameriprise Financial (Attach a letter of resignation signed by the current AIF, a doctor's or hospital's letter on their letterhead as evidence of incapacitation or a death certificate for the current AIF) To establish an administrator/trustee for a Qualified 401(a) Plan (Attach a letter of instruction) Part 3 Fiduciary Information If the fiduciary has an Ameriprise Financial client ID only their name and client ID fields are required to be completed. If the fiduciary does not have a client ID, all additional fields are required to be completed. How many fiduciary(ies) will be named? 5 More than 5 If there are more than 5 fiduciaries, please complete additional fiduciary pages and submit all forms as one packet. Sign on Page 7 Fax # , 2015, 2017 Ameriprise Financial, Inc. All rights reserved Page 1 of 7

2 DOC Fiduciary First MI Last Client ID Social Security Number Residential Address City State ZIP Code Telephone Number Gender Male Female Birth Date (MMDDYYYY) Citizenship: Country of Citizenship (Required if Resident Alien) Second Country of Citizenship U. S. Citizen Resident Alien Does the fiduciary have investment experience? Yes No i Select all asset type(s) for which the client has experience. For each asset type, select the Years of Investment Experience and Average Number of Buy or Sell Trades per Year. Investment experience should account for years of active participation, rather than the number of years since the first purchase. (Example: If client purchased options actively in 2007 and 2008, but hasn't since that time = 2 years) If years of experience has not crossed the minimum of the range, select the lower range, with the exception of anything greater than none falling into 1-2 years. (Examples: 8 months = 1-2 years; 2.5 years = 1-2 years, 5.5 years = 3-5 years) Do not include DRIP arrangements for Equities (includes ETFs) or systematic arrangements for Mutual Funds/529s when selecting the average number of buy or sell trades per year. Asset Type: Years of Investment Experience: Avg. # of Buy and Sell Trades per Year: Alternative Investments (includes managed futures/fund of hedge funds) Annuities/Variable Life Certificates/CDs Commodities Equities (includes ETFs) Fixed Income (includes UITs) Limited Partnerships Mutual Funds/529s Non-Traded REITs/BDCs and non-traded closed end funds) Options Structured Products Employment Information Employment status of the fiduciary: A. Employed B. Self-employed C. Not Employed D. Retired E. Other (Homemaker, Minor, Student, etc.) Primary Occupation Information (Required if employed or self-employed) Is the fiduciary employed, or an associated person of, by a registered broker-dealer, a securities exchange or the Financial Industry Regulatory Authority (FINRA)? If the Fiduciary answers yes, we may be required to send their employer a duplicate copy of your statements and confirmations. Yes No How many companies is the fiduciary employed by, or an associated person of? Page 2 of 7

3 DOC City State ZIP Code Street Address City State ZIP Code Is the fiduciary an officer, director, 10% shareholder or policy maker of a publicly traded company? Yes No How many companies is the fiduciary an officer, director, 10% shareholder or policy maker of? Same as Same as If the company is not indicated above, enter the following required information: City State ZIP Code Ticker Symbol Street Address City State ZIP Code Ticker Symbol Fiduciary First MI Last Client ID Social Security Number Residential Address City State ZIP Code Telephone Number Gender Male Female Birth Date (MMDDYYYY) Citizenship: Country of Citizenship (Required if Resident Alien) Second Country of Citizenship U. S. Citizen Resident Alien Does the fiduciary have investment experience? Yes No Page 3 of 7

4 DOC i Select all asset type(s) for which the client has experience. For each asset type, select the Years of Investment Experience and Average Number of Buy or Sell Trades per Year. Investment experience should account for years of active participation, rather than the number of years since the first purchase. (Example: If client purchased options actively in 2007 and 2008, but hasn't since that time = 2 years) If years of experience has not crossed the minimum of the range, select the lower range, with the exception of anything greater than none falling into 1-2 years. (Examples: 8 months = 1-2 years; 2.5 years = 1-2 years, 5.5 years = 3-5 years) Do not include DRIP arrangements for Equities (includes ETFs) or systematic arrangements for Mutual Funds/529s when selecting the average number of buy or sell trades per year. Asset Type: Years of Investment Experience: Avg. # of Buy and Sell Trades per Year: Alternative Investments (includes managed futures/fund of hedge funds) Annuities/Variable Life Certificates/CDs Commodities Equities (includes ETFs) Fixed Income (includes UITs) Limited Partnerships Mutual Funds/529s Non-Traded REITs/BDCs and non-traded closed end funds) Options Structured Products Employment Information Employment status of the fiduciary: A. Employed B. Self-employed C. Not Employed D. Retired E. Other (Homemaker, Minor, Student, etc.) Primary Occupation Information (Required if employed or self-employed) Is the fiduciary employed, or an associated person of, by a registered broker-dealer, a securities exchange or the Financial Industry Regulatory Authority (FINRA)? If the Fiduciary answers yes, we may be required to send their employer a duplicate copy of your statements and confirmations. Yes No How many companies is the fiduciary employed by, or an associated person of? City State ZIP Code Street Address City State ZIP Code Page 4 of 7

5 DOC Is the fiduciary an officer, director, 10% shareholder or policy maker of a publicly traded company? Yes No How many companies is the fiduciary an officer, director, 10% shareholder or policy maker of? Same as Same as If the company is not indicated above, enter the following required information: City State ZIP Code Ticker Symbol Street Address City State ZIP Code Ticker Symbol Fiduciary First MI Last Client ID Social Security Number Residential Address City State ZIP Code Telephone Number Gender Male Female Birth Date (MMDDYYYY) Citizenship: Country of Citizenship (Required if Resident Alien) Second Country of Citizenship U. S. Citizen Resident Alien Does the fiduciary have investment experience? Yes No i Select all asset type(s) for which the client has experience. For each asset type, select the Years of Investment Experience and Average Number of Buy or Sell Trades per Year. Investment experience should account for years of active participation, rather than the number of years since the first purchase. (Example: If client purchased options actively in 2007 and 2008, but hasn't since that time = 2 years) If years of experience has not crossed the minimum of the range, select the lower range, with the exception of anything greater than none falling into 1-2 years. (Examples: 8 months = 1-2 years; 2.5 years = 1-2 years, 5.5 years = 3-5 years) Do not include DRIP arrangements for Equities (includes ETFs) or systematic arrangements for Mutual Funds/529s when selecting the average number of buy or sell trades per year. Asset Type: Years of Investment Experience: Avg. # of Buy and Sell Trades per Year: Alternative Investments (includes managed futures/fund of hedge funds) Page 5 of 7

6 DOC Annuities/Variable Life Certificates/CDs Commodities Equities (includes ETFs) Fixed Income (includes UITs) Limited Partnerships Mutual Funds/529s Non-Traded REITs/BDCs and non-traded closed end funds) Options Structured Products Employment Information Employment status of the fiduciary: A. Employed B. Self-employed C. Not Employed D. Retired E. Other (Homemaker, Minor, Student, etc.) Primary Occupation Information (Required if employed or self-employed) Is the fiduciary employed, or an associated person of, by a registered broker-dealer, a securities exchange or the Financial Industry Regulatory Authority (FINRA)? If the Fiduciary answers yes, we may be required to send their employer a duplicate copy of your statements and confirmations. Yes No How many companies is the fiduciary employed by, or an associated person of? City State ZIP Code Street Address City State ZIP Code Is the fiduciary an officer, director, 10% shareholder or policy maker of a publicly traded company? Yes No How many companies is the fiduciary an officer, director, 10% shareholder or policy maker of? Same as Same as If the company is not indicated above, enter the following required information: Page 6 of 7

7 DOC City State ZIP Code Ticker Symbol Street Address City State ZIP Code Ticker Symbol Part 4 Acknowledgement Acknowledgement (applicable only to individuals acting as an attorney in fact pursuant to the Ameriprise Financial standard power of attorney form). When authorized person authority is removed or they can no longer act independently on an Ameriprise ONE Financial Account, the client or new authorized person is responsible for risk associated with existing active cash management features, such as undestroyed checks and debit cards. Debit cards issued in the name of authorized person being removed or if they can no longer act independently will be closed. Client or authorized person may request to close this checking account and open a new account to avoid these risks. If you are signing as an attorney in fact ( AIF ) pursuant to the authority granted by the Durable Power of Attorney for Ameriprise Financial Accounts and Products Form , you acknowledge that you have received and read the Authorization and Agreement for Ameriprise Financial Accounts and Products Durable Power of Attorney ("Authorization and Agreement"), and all related agreements disclosures and notices; you also agree that your actions as an AIF are governed by the authorization and agreement, including its predispute arbitration clause. Note: If you are acting as an AIF pursuant to a non-ameriprise Financial power of attorney form, this acknowledgment does not apply to you. You will however be held to the terms of the client and account agreements signed by the principal, including the predispute arbitration provision contained therein. Part 5 Fiduciary Signature (Required) Ameriprise Financial is concerned with your privacy and will only collect and use your personal information to meet the requirements of federal law and within the provisions of the Ameriprise Financial Privacy Notice, which can be found at ameriprise.com. As required by federal law, Ameriprise Financial may use the information above to verify your identity. Fiduciary Signature : X Fiduciary Signature : X Fiduciary Signature : X Date (MMDDYYYY) Date (MMDDYYYY) Date (MMDDYYYY) Page 7 of 7

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