Grantor Information (Revocable Trusts and Irrevocable Trusts using an SSN)

Transcription

1 DOC0110 Ameriprise Financial Services, Inc Ameriprise Financial Center Minneapolis, MN Certificate of Trust i The Certificate of Trust form is needed under the following conditions: To establish the initial trust account with Ameriprise Financial When the level of authority granted to the trustee(s) changes When a trustee is added or removed To activate a successor trustee If you are completing this Certificate of Trust on behalf of a business entity, a current corporate resolution Form is required, if not already on file. Client ID of Trust 001 Part 1 Trust Information Name of Trust Date Trust Established (MMDDYYYY) What state was your trust created in? State of:! Signatures must be notarized if the trust was created in one of the following states: California; Iowa; Kansas; Michigan; Minnesota; Mississippi; Nebraska; New York; South Dakota; Tennessee; Vermont. Is the trust revocable or irrevocable? Revocable Irrevocable Select one purpose: Establish New Trust Replace / Update Existing Trust Change the Taxpayer ID (attach a signed W9) Part 2 Grantor Information (Revocable Trusts and Irrevocable Trusts using an SSN) How many grantor(s) will be named? More than 5 If there are more than 5 grantors, please complete additional grantor pages of this form and submit as one packet. Provide client ID for the taxpayer/grantor of the trust. Remaining grantors provide name only. Grantor/Taxpayer First Name MI Last Name Client ID Social Security Number Is this grantor also a Trustee? Yes Is this grantor incapacitated or deceased? Yes Grantor First Name MI Last Name Is this grantor also a Trustee? Yes Is this grantor incapacitated or deceased? Yes Part 3 Trustee Information If the trustee has an Ameriprise Financial client ID, only their name and client ID fields are required to be completed in this section. If the trustee does not have a client ID, all fields must be completed More than 5 How many trustee(s) will be named? If there are more than 5 trustees, please complete additional trustees pages of this form and submit as one packet. If more than one trustee is named, can all trustees act independently? Yes If no selection is made, default is to permit each trustee to act independently. If the trustees are not able to act independently, how many trustees must work together to transact business? Sign on Page(s) 7, 9 Fax # Ameriprise Financial, Inc. All rights reserved. Page 1 of 10 Y (01/18) 1

2 DOC0210 Trustee First Name MI Last Name Client ID Social Security Number Will this trustee sign this form? Yes te: Required only for signing electronically. Address City State ZIP Code Date of Birth (MMDDYYYY) Citizenship: Phone Number U. S. Citizen Resident Alien Country of Citizenship (Required if Resident Alien) Second Country of Citizenship Does the trustee have investment experience? Yes 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 n-traded REITs/BDCs and non-traded closed end funds) Options Structured Products Employment Information Employment status of the Trustee: A. Employed B. Self-employed C. t Employed D. Retired E. Other (Homemaker, Minor, Student, etc.) Primary Occupation Information (Required if employed or self-employed) Is the trustee employed, or an associated person of, by a registered broker-dealer, a securities exchange or the Financial Industry Regulatory Authority (FINRA)? If yes, we may be required to send the trustee's employer a duplicate copy of the trust's statements and confirmations. Yes How many companies is the trustee employed by, or an associated person of? Page 2 of 10 Y (01/18) 1

3 DOC0310 Company 1 Company 1 Street Address Company 1 City State ZIP Code Company 2 Company 2 Street Address Company 2 City State ZIP Code Is the trustee an officer, director, 10% shareholder or policy maker of a publicly traded company? Yes How many companies is the trustee an officer, director, 10% shareholder or policy maker of? Same as Company 1 Same as Company 2 Company Ticker Symbol Company Ticker Symbol If the company is not indicated above, enter the following required information: Company 1 Company 1 Street Address Company 1 City State ZIP Code Ticker Symbol Company 2 Company 2 Street Address Company 2 City State ZIP Code Ticker Symbol Page 3 of 10 Y (01/18) 1

4 DOC0410 Trustee First Name MI Last Name Client ID Social Security Number Will this trustee sign this form? Yes te: Required only for signing electronically. Address City State ZIP Code Date of Birth (MMDDYYYY) Citizenship: Phone Number U. S. Citizen Resident Alien Country of Citizenship (Required if Resident Alien) Second Country of Citizenship Does the trustee have investment experience? Yes 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 n-traded REITs/BDCs and non-traded closed end funds) Options Structured Products Employment Information Employment status of the Trustee: A. Employed B. Self-employed C. t Employed D. Retired E. Other (Homemaker, Minor, Student, etc.) Primary Occupation Information (Required if employed or self-employed) Is the trustee employed, or an associated person of, by a registered broker-dealer, a securities exchange or the Financial Industry Regulatory Authority (FINRA)? If yes, we may be required to send the trustee's employer a duplicate copy of the trust's statements and confirmations. Yes How many companies is the trustee employed by, or an associated person of? Page 4 of 10 Y (01/18) 1

5 DOC0510 Company 1 Company 1 Street Address Company 1 City State ZIP Code Company 2 Company 2 Street Address Company 2 City State ZIP Code Is the trustee an officer, director, 10% shareholder or policy maker of a publicly traded company? Yes How many companies is the trustee an officer, director, 10% shareholder or policy maker of? Same as Company 1 Same as Company 2 Company Ticker Symbol Company Ticker Symbol If the company is not indicated above, enter the following required information: Company 1 Company 1 Street Address Company 1 City State ZIP Code Ticker Symbol Company 2 Company 2 Street Address Company 2 City State ZIP Code Ticker Symbol Page 5 of 10 Y (01/18) 1

6 DOC0610 Part 4 Trustee Authorization (Select one) Full Authority: This includes, but is not limited to, the ability to: View account information, including online Trade online Open new accounts and add applicable features Change account ownership Buy, sell and exchange securities Enter into a new options agreement Add, change or remove a trusted contact person Beneficiary Changes: Do you also wish the trustee(s) to be able to change beneficiaries? If no selection is made we will default to no beneficiary changes allowed. Add margin capability Request duplicate statements and confirmations Release information to a third party. Make client information updates Transfer money or shares: between Ameriprise Financial account(s) with the same or different ownership; to an external third party; and/or to themselves Yes Limited Authority: is limited to the following: View account information, including online Trade online Buy, sell and exchange securities within the same account ownership Transfer money or shares within the same account ownership within Ameriprise Financial Request duplicate statements and confirmations Page 6 of 10 Y (01/18) 1

7 DOC0710 Part 5 Grantor(s) Authorizations and Acknowledgements (Revocable trusts only) Each grantor must sign for revocable trusts and each signature must be notarized, if applicable. In the event the grantor(s) is not able to sign, attach the evidence supporting that the grantor's signature is missing. (Proof of incapacitation in the form of a doctor's or hospital's letter on their letterhead or a death certificate.) For irrevocable trusts, a grantor's signature is not required. The undersigned on their own behalf and on behalf of their heirs, executors, administrators, assigns or beneficiaries, agree to indemnify and hold harmless Ameriprise Financial and its affiliated or associated companies and advisors harmless from any and all liability, losses, damages and claims of any kind whatsoever, which may arise out of or in connection with Ameriprise Financial's agreement to accept this certificate. That you have each received and reviewed a copy of this certification and that you agree to be bound by its terms. You further represent and warrant that you have received, read, understand and agree to be bound by all terms of the agreements with Ameriprise Financial, Inc. and its subsidiaries as it relates to specific products purchased, including the requirement in any specific agreement that disputes must be resolved through arbitration. The undersigned grantors, individually and on behalf of the trust, its beneficiaries, heirs, successors and assigns (collectively, "you"), hereby certify, represent and warrant that the trust agreement to which this certification applies is in full force and effect and that the above information is true and complete. Grantor/Taxpayer First Name MI Last Name Grantor Signature Signature X Date (MMDDYYYY) tarization State of: personally appeared before me, On, 20, Month, Date Yr who is personally known to me To be the signer of the above document, and he/she acknowledged that he/she signed it. Signature of tary X tary Seal: County of: whose identity I proved on the basis of whose identity I proved on the oath/affirmation of Sign Date (MMDDYYYY) Text Name of Grantor, a credible witness This notarization must include the tary s official seal to be accepted as complete. The seal must be affixed by inked stamp imprint (preferred), or photocopiable emboss. Electronic notarizations cannot be accepted. Grantor First Name MI Last Name Grantor Signature Signature X Date (MMDDYYYY) Page 7 of 10 Y (01/18) 1

8 DOC0810 tarization State of: personally appeared before me, On, 20, Month, Date Yr who is personally known to me To be the signer of the above document, and he/she acknowledged that he/she signed it. Signature of tary X tary Seal: County of: whose identity I proved on the basis of whose identity I proved on the oath/affirmation of Sign Date (MMDDYYYY) Text Name of Grantor, a credible witness This notarization must include the tary s official seal to be accepted as complete. The seal must be affixed by inked stamp imprint (preferred), or photocopiable emboss. Electronic notarizations cannot be accepted. Page 8 of 10 Y (01/18) 1

9 DOC0910 Part 6 Trustee(s) Authorizations and Acknowledgements If a trustee does not sign the Certificate of Trust at the time the form is submitted, a signature specimen for that trustee may be required prior to any written transaction. In part 3, if you answered no to "can all trustee(s) can act independently?", all named trustees' signatures are required. When trustees are removed from an Ameriprise ONE Financial Account, the existing trustee(s) is responsible for risk associated with existing active cash management features, such as undestroyed checks and bill pay arrangements. Debit cards issued in the name of trustee(s) being removed will be closed. Trustee(s) may request to close this checking account and open a new account to avoid these risks. When all trustees cannot act independently the account is not eligible for Ameriprise ONE Financial Account features. If this request will no longer allow the trustee(s) to act independently your account will be converted to an Ameriprise Brokerage account, all existing cash management features (checking, debit card and bill pay) will be closed. Each trustee's signature must be notarized, if applicable. 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 tice, which can be found at ameriprise.com. As required by federal law, Ameriprise Financial may use the information above to verify your identity. The undersigned on their own behalf and on behalf of their heirs, executors, administrators, assigns or beneficiaries, agree to indemnify and hold harmless Ameriprise Financial and its affiliated or associated companies and advisors harmless from any and all liability, losses, damages and claims of any kind whatsoever, which may arise out of or in connection with Ameriprise Financial's agreement to accept this certificate. The undersigned trustee(s) individually and on behalf of the trust, its beneficiaries, heirs, successors and assigns (collectively, "you"), hereby certify, represent and warrant that the trust agreement to which this certification applies is in full force and effect and that the above information is true and complete. Trustee First Name MI Last Name Trustee Signature Signature X Date (MMDDYYYY) tarization State of: personally appeared before me, On, 20, Month, Date To be the signer of the above document, and he/she acknowledged that he/she signed it. Signature of tary X tary Seal: County of: who is personally known to me whose identity I proved on the basis of whose identity I proved on the oath/affirmation of Sign Date (MMDDYYYY) Text Yr Name of Trustee, a credible witness This notarization must include the tary s official seal to be accepted as complete. The seal must be affixed by inked stamp imprint (preferred), or photocopiable emboss. Electronic notarizations cannot be accepted. Trustee First Name MI Last Name Trustee Signature Signature X Date (MMDDYYYY) Page 9 of 10 Y (01/18) 1

10 DOC1010 tarization State of: personally appeared before me, On, 20, Month, Date To be the signer of the above document, and he/she acknowledged that he/she signed it. Signature of tary X tary Seal: County of: who is personally known to me whose identity I proved on the basis of whose identity I proved on the oath/affirmation of Sign Date (MMDDYYYY) Text Yr Name of Trustee, a credible witness This notarization must include the tary s official seal to be accepted as complete. The seal must be affixed by inked stamp imprint (preferred), or photocopiable emboss. Electronic notarizations cannot be accepted. Page 10 of 10 Y (01/18) 1