Brokerage Transfer-on-Death Beneficiary Authorization Form

Brokerage Transfer-on-Death Beneficiary Authorization Form
Use this form to authorize and document transfer-on-death beneficiary instructions for a brokerage account, including primary and contingent beneficiary details and final authorization.
Account Owner Information
Full Legal Name
First NameMiddle NameLast Name
Preferred Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Mailing Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Brokerage Account Details
Brokerage Firm Name
Account Type
Account Registration Name
Account Number Reference
Existing TOD Designation or Prior Beneficiary Notes
Primary Beneficiary Designation
Primary Beneficiary
Total Primary Allocation
Allocation Validation
Primary Beneficiary Contact Method
Total Primary Beneficiary Share (%)
Contingent Beneficiary Designation
Complete this section only if you are naming contingent beneficiaries.
Contingent Beneficiary Full Name
First NameMiddle NameLast Name
Relationship to Account Owner
Beneficiary Type
Contingent Beneficiary Contact Information
Contingent Beneficiary Allocation (%)
Special Instructions and Authorization
Special distribution instructions
Distribution preference
Acknowledgment statement
Account owner signature
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Date of signature
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: