BROKERAGE ACCOUNT APPLICATION
15052 Gleason Path, Ste 105 Apple Valley, MN 55124-7199

Your Local Branch Office:

(952) 431-6333, 1-877-455-1980

Primary Applicant / Organization Information

Depending on account type, this may be the minor, protected person, or organization (trust, corporation, partnership, etc.).

Individual / Organization Name

Phone Numbers

for individuals, list first, middle and last names

Mr.
Mrs.
Ms.
Dr.

✔

uma gurumitkal

Email Address

uma0788@gmail.com

Apt./Ste./Fl.

504-289-4035

City

ext.

504-289-4035

Fax

1350 HIGH SITE DR

APT 309

Mailing Address

Work

no P.O. boxes or mail receiving / incorporation services

Street

check preferred

Cell

account notices will be sent here

Primary Physical Address

Home

State

Eagan

MN

ZIP

55121-2151

optional - if a mailing address is not provided, account notices will be sent to the primary physical address

Date of Birth / Effective Date Social Security / Tax ID # Account Type

07/07/1989

626-85-1634

Funding Method for this Account:

Electronic funds transfer

For additional information, visit www.scottrade.com/funding Referral / Promo Code

Individual
Wire funds

Transfer from another brokerage

Deposit check or physical stock certificates

Transfer from another Scottrade account

Investment / Trading Experience
To best match your needs with our solutions, please share how you plan to use this account:
Long-term,
buy-and-hold investing

✔

Timely investing, trading infrequently when I see opportunity in the market

Relatively frequent trading based on market movement

Actively trading on a daily basis

During the past year, how many trades were placed across all of your investment accounts?
✔

25 - 120 trades (3 - 10 per month)

0 - 24 trades (0 - 2 per month)

121 - 249 trades (11 - 20 per month)

Unsure; I am new to investing

250+ trades (21+ per month)

What is the approximate value of all investable assets - excluding real estate - that you currently hold: stocks, bonds, 401(k), cash, etc.?
✔

$0 - $24,999

$25,000 - $49,999

$50,000 - $249,999

$250,000 - $499,999

$500,000+

Individual, Joint & Retirement Account Applicants - complete the section below
All Other Account Types - skip to Page 2
Are You a U.S. Citizen?

✔

No - provide citizenship & residency information

Employment

✔

Status:

Are you a permanent
U.S. resident?

Employed

Homemaker

Self-employed

Student

Unemployed

Retired

Employer Address

IN

Country of citizenship:

Yes - skip to Employment

Yes - Alien Registration Number:
✔

No - visa type:

Occupation

silicon staff it services

1350 High Site Dr , Apt #309 Eagan, MN 55121

1. Are you employed by / affiliated with a securities firm, exchange or FINRA?
2. Are you a control person / affiliate of a public company as defined by the SEC? This generally includes 10% shareholders, members of the Board of Directors, and policy-making officers.
3. Are you or your immediate family member / business associate a senior foreign political official?

SF1000/7-14

If you will be in the U.S. 183 days or less, contact our International Department.

software engineer

Employer

Affiliations:

*SF1000*

F

Account Number:

Internal
Use Only

✔

✔

✔

Yes - provide organization name & compliance department address below in
Affiliation Details.
No
Yes - provide company name & CUSIP / symbol below.
No
Affiliation Details
Yes
No

Application ID:

12504471
Created:

03/02/2015 08:46 PM ET

Printed:

03/02/2015 08:54 PM ET

Complete Page 2 of this Application
Page 1 of 2

Co-Applicant / Authorized Person Information

Depending on the account type, this may be a custodian, trustee, guardian, trading officer/partner, or other authorized representative.
For multiple co-applicants: make additional copies of this page to complete for each co-applicant; all pages must be submitted together with page 1 of this Application.
Name of Individual
First
Middle
Last
Phone Numbers check preferred
Mr.
Ms.
Home
Mrs.
Dr.
Email Address
Date of Birth