---
type: financial
category: finance
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.

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## 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? | — |

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## 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 |

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**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 |