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documents/finance/scottrade_account_application_2016.md

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+---
+type: financial document
+category: brokerage account application
+person: Xuewei Jiang
+date: 2016-11-12
+source: scottrade_account_application_2016.jpg
+---
+
+# Scottrade Brokerage Account Application
+
+**Branch:** 4301 W William Cannon Dr, Ste B114, Austin, TX 78749-1478
+**Phone:** (512) 370-1980, 1-877-801-1980
+**Account Type:** Joint - Tenants in Entirety. Applicants are not Refer/Promo
+
+**Form:** SF10008-15 | Page 1 of 2
+
+---
+
+## Primary Applicant / Organization Information
+
+Depending on account type this may be the minor, protected person or organization (trust, corporation, partnership, etc.)
+
+| Field | Value |
+|---|---|
+| Name of Individual/Organization | Xuewei Jiang |
+| Suffix | — |
+| Phone Number - check preferred: Home | 254-214-8150 |
+| Email Address | xueweigp3116@gmail.com |
+| Date of Birth / Effective Date | 03/18/— |
+| Social Security / Tax ID # | 092-99-3215 |
+
+### Primary Physical Address
+
+No P.O. Boxes or mail receiving / corporation addresses
+
+| Field | Value |
+|---|---|
+| Street | 1652 W 6TH ST APT R |
+| City | Austin |
+| State | TX |
+| ZIP | 78703-5043 |
+| Work | — |
+| Fax | ext |
+
+**Mailing Address:** include city, state & ZIP - if a mailing address is not provided, account notices will be sent to the primary physical address.
+
+---
+
+## Individual, Joint, Retirement & Minor Account Applicants
+
+### Citizenship
+
+| # | Question | Answer |
+|---|---|---|
+| 1 | Are you a U.S. citizen? | Yes - proceed to question 2 |
+| 2 | Are you a citizen of any other non-U.S. countries? | Yes - list below |
+| | Country | China |
+| | Are you a permanent U.S. resident? | Yes - Permanent Resident Card Number |
+| | | No - Visa type |
+| | Visa Expiration Date (MM/DD/YYYY) | 06/24/2020 |
+
+### Employment Status
+
+| Field | Value |
+|---|---|
+| Employment Status | Self-employed business owner |
+| Employer Industry Code | E11 |
+| Occupation Code | R71 |
+| Job Title | — |
+| Job Description | *See p.3 for a code list or contact us for assistance |
+| Employer | — |
+| Employer Address | — |
+
+### Financial Information
+
+Please provide the following information to help us understand your financial status. Scottrade will not use this information to supervise the suitability of any transaction in your account.
+
+| # | Question | Answer |
+|---|---|---|
+| 1 | What is your annual income? | Options: $0 - $24,999 / $25,000 - $49,999 / $50,000 - $99,999 / $100,000 - $249,999 / $250,000+ — in your account |
+| 2 | What is your household net worth (excluding residence)? | Options: $0 - $24,999 / $25,000 - $49,999 / $50,000 - $249,999 / $250,000 - $499,999 / $500,000+ |
+
+### Affiliations
+
+This information is to comply with requirements mandated by the U.S. Government and other regulatory agencies, and to better understand your intentions for your brokerage account.
+
+| # | Question | Answer |
+|---|---|---|
+| 3a | Are you employed by / affiliated with a securities firm, exchange or FINRA? | Yes - Scottrade will inform the securities firm, exchange or FINRA of your intention to maintain this account and provide copies of confirms, statements & other requested information. Provide organization name & compliance address in the field below. / No - |
+| 3b | Are you or a member of your household a control person/affiliate of a public company as defined by the SEC? | Yes - provide company name & CUSIP number in the "Required Information" space below. This generally includes 10% shareholders, members of the Board of Directors and policy-making officers. |
+| 3c | Are you currently, or have you ever been, a higher-level elected / appointed government official? | Yes - select from the following: U.S. Federal Govt Official / U.S. City Mayor / U.S. State Governor / Senior Executive Director of a Govt/Non-U.S. Govt / Non-U.S. Govt Official - provide country & title here |
+| 4 | Do you have an immediate family member or close associate who is or was a high-level elected / appointed government official? | Yes - provide name, country, relationship / No — ship & position in space below |
+| 5 | Do you receive compensation, directly or indirectly, from a business related to or engaged in the growth, sale or distribution of marijuana or products containing marijuana? | — |
+
+---
+
+## Expected Account Activities
+
+| # | Question | Answer |
+|---|---|---|
+| 1 | Do you plan to trade low-priced, over-the-counter securities ('penny stocks')? | Yes ☐ / No ☐ |
+| 2 | Do you plan to deposit or transfer in low-priced, over-the-counter securities? | Yes ☐ / No ☐ |
+| 3 | What best describes the major funding source for this account? | Employment Wages / Inheritance Trust / Investments / Other: Spouse/Parent Support / Unemployment / Disability |
+| 4 | What best describes the source of funds for this account? | Employment Wages / Savings / Spouse/Parent Support / Settlement / Lottery / Gaming |
+| | | Retirement Funds / Insurance / Investment Trust / Unemployment / Disability |
+| 5 | Do you anticipate initiating/receiving international ACH or wire transfers? | Yes - list non-U.S. countries to be involved in these transfers (below) to Page 2 / No - proceed |
+
+### International Transfer Details
+
+| Field | Value |
+|---|---|
+| What is the expected frequency of these international transfers? | Once or twice per year / Once every few months / Once a month / Several times per month |
+| What is the expected annual international transfer total? | $0 - $9,999 / $10,000 - $49,999 / $50,000 - $99,999 / $100,000 - $249,999 / $250,000 - $499,999 / $500,000+ |
+| Indicate purpose(s) for these international transfers | Charitable Payment / Personal Remittance |
+| | Commission / Payroll / Investment / Real Estate Opportunity / Personal Purchase of International Goods |
+| | Business Expense / Income / Other - describe |
+
+---
+
+**Internal Use Only**
+
+| Field | Value |
+|---|---|
+| Acct # | 13443343 |
+| Last Online Entry Date | 11/12/2016 12:24 AM ET |
+| Paper Use Print Date | 11/12/2016 12:32 AM ET |