DocuSign Envelope ID: EE3D6CB2-9DBB-4C62-8526-752B8088F294

NAME CHANGE AUTHORIZATION

COMPLETE YOUR E*TRADE NAME CHANGE AUTHORIZATION FORM IN

THREE EASY STEPS
The Name Change Authorization Form you
requested begins on the following page.

To complete your application, simply:

1. SCROLL DOWN AND FILL OUT EACH FIELD BY TYPING IN THE

APPROPRIATE INFORMATION.

If you’d like to complete the application by hand, skip this step and move on to
Step 2.

2. ONCE YOU HAVE PROVIDED THE REQUESTED INFORMATION, REVIEW

YOUR APPLICATION TO ENSURE IT IS COMPLETE AND PRINT IT BY
CLICKING THE BUTTON ON THE TOP TOOLBAR.

3. SIGN AND DATE YOUR APPLICATION, AND MAIL IT TO THE APPROPRIATE

ADDRESS:

By overnight mail: By regular mail:

E*TRADE Financial Corporation E*TRADE Financial Corporation
Harborside 2 P.O. Box 484
200 Hudson Street, Suite 501 Jersey City, NJ 07303-0484
Jersey City, NJ 07311

General Fax Number: 1-866-650-0003

From Outside the US: +1-678-624-6950

Note: Please include a Fax Cover Sheet when submitting documents by facsimile.
*Notarized documents, Stock Certificates, and other forms for which the original document is needed cannot be submitted by facsimile.
3323107.1
NAME CHANGE AUTHORIZATION
Page 1 of 3 1120-NCA-B66702
DocuSign Envelope ID: EE3D6CB2-9DBB-4C62-8526-752B8088F294

NAME CHANGE AUTHORIZATION

• Complete this form to notify us that your name has changed due to
marriage, divorce, or other reasons.
• This form will update your name on all of your E*TRADE
account(s).
• Need Help? Send us a Secure Message through www.etrade.com
or call 1-800-ETRADE-1 (1-800-387-2331).

1. ENTER ACCOUNT HOLDER INFORMATION (PLEASE PRINT)

E*TRADE Account Number(s): 51050337

Full Name as it currently appears on

your account (First, Middle, Last): Virginia Villca

New Name (First, Middle, Last): Virginia Villca Guzman

Suffix (Optional): Jr. Sr. I II III IV V

Social Security/Tax ID Number: Date of Birth (mm/dd/yyyy):

987741265 10/28/1972

2. CASH MANAGEMENT FEATURES

E*TRADE Debit Card

Check Writing
Note: Important Checkbook Reorder Information
Brokerage Account Holders: A charge of $8.25 will be debited from your brokerage account pertaining to the checkbook.
Bank Account Holders: Please view the E*TRADE Bank Rate and Fee Schedule based on the type of E*TRADE Bank checking
account that you have.

3. ADDRESS CHANGE (IF APPLICABLE)

Complete the section below if your address has changed.

Home Street Address

(cannot be a P.O. box):

City, State, ZIP:

Mailing Address (if different from

above; P.O. box may be used):

City, State, ZIP:

4. AUTHORIZATION

I hereby certify that the information provided in this form and the enclosed supporting documentation is true and correct in all material
aspects, and I herby authorize E*TRADE to change my name on ALL my E*TRADE accounts in accordance with the enclosed
supporting documentation.

I UNDERSTAND THAT THIS ACCOUNT IS GOVERNED BY A PREDISPUTE ARBITRATION CLAUSE. I ACKNOWLEDGE THAT I HAVE
RECEIVED AND READ A COPY OF THE E*TRADE CUSTOMER AGREEMENT WHICH CONTAINS A PREDISPUTE ARBITRATION
AGREEMENT AT SECTION 12 (AVAILABLE UPON REQUEST BY CALLING 1 (800) ETRADE-1).

O Virginia Villca Guzman

Signature of Account Holder Date Print Name
3323107.1
NAME CHANGE AUTHORIZATION
Page 2 of 3 1120-NCA-B66702
DocuSign Envelope ID: EE3D6CB2-9DBB-4C62-8526-752B8088F294

Required Documentation:

CASE REQUIRED DOCUMENTS

If you are changing your name due to a marriage • Copy of certified marriage certificate

• Copy of certified divorce decree

If you are changing your name due to a divorce
• Divorce decree must state name change

If you are changing your name due to a court decree • Copy of certified court decree of name change

If you are changing your name due to an adoption • Copy of certified court decree of adoption

* Note: Original documents are not required. Photocopies of originals will be accepted..

PLEASE READ THE IMPORTANT DISCLOSURES BELOW

System Response and account access times may vary due to a variety of factors, including trading volumes, market conditions, and
system performance.

The E*TRADE Financial family of companies provides financial services including trading, investing and related banking products and services.

Securities products and services are offered by E*TRADE Securities LLC, Member FINRA/SIPC.

© 2020 E*TRADE Financial, LLC, a business of Morgan Stanley. All rights reserved.
NC-1076 3323107.1
NAME CHANGE AUTHORIZATION
Page 3 of 3 1120-NCA-B66702
Certificate Of Completion
Envelope Id: EE3D6CB29DBB4C628526752B8088F294 Status: Delivered
Subject: Cover Sheet - Selection and Upload of the Trailing Doc Attachment
Source Envelope:
Document Pages: 3 Signatures: 0 Envelope Originator:
Certificate Pages: 2 Initials: 0 E*TRADE API
AutoNav: Enabled etwf@etrade.com
EnvelopeId Stamping: Enabled IP Address: 12.153.224.5
Time Zone: (UTC-08:00) Pacific Time (US & Canada)

Record Tracking
Status: Original Holder: E*TRADE API Location: DocuSign
5/24/2021 9:39:20 AM etwf@etrade.com

Signer Events Signature Timestamp

ET Sent: 5/24/2021 9:39:21 AM
noreply@etrade.com Viewed: 5/24/2021 9:39:44 AM
Security Level:
Etrade Customer Portal.Password
ID: 1234567890
6/22/2016 11:32:52 AM
Electronic Record and Signature Disclosure:
Accepted: 5/24/2021 9:39:44 AM
ID: 5e9a7580-24b8-43cf-b4b5-57202e06eb92

In Person Signer Events Signature Timestamp

Editor Delivery Events Status Timestamp

Agent Delivery Events Status Timestamp

Intermediary Delivery Events Status Timestamp

Certified Delivery Events Status Timestamp

Carbon Copy Events Status Timestamp

Witness Events Signature Timestamp

Notary Events Signature Timestamp

Envelope Summary Events Status Timestamps

Envelope Sent Hashed/Encrypted 5/24/2021 9:39:21 AM
Certified Delivered Security Checked 5/24/2021 9:39:44 AM

Payment Events Status Timestamps

Electronic Record and Signature Disclosure
Electronic Record and Signature Disclosure created on: 12/13/2017 10:57:23 AM
Parties agreed to: ET

By checking the box near “I agree to use electronic records and signatures” and clicking “
Continue”, I hereby agree and acknowledge that:
• I am of legal age to agree to the terms herein and will be providing an electronic signature
which legally binds me in the same manner as if I had provided a written signature.
• My electronic signature is effective and I will not dispute the legally binding nature,
validity or enforceability of this document based on the fact that the terms were accepted
by me with an electronic signature,
• My electronically signed document may be retained electronically by E*TRADE as the
original record thereof, and may be admitted into evidence in any proceeding concerning
the subject matter therein.
• E*TRADE may, in its sole discretion, decline to accept, or request further verification of,
any attempted electronic signature but shall be entitled to rely on such electronic signature
without further verification.
• I have read and understood the relevant disclosures, notices, and agree to be bound by
terms and conditions set forth in this document and any applicable E*TRADE product
agreement, the E*TRADE Customer Agreement, and any applicable supplements
contained therein, as may be amended from time to time in accordance with the terms
thereof (collectively, “E*TRADE Account Agreement”).
• I have the ability to access, retain, and print the E*TRADE Account Agreement.
If you do not agree with the terms and conditions in the E*TRADE Account Agreement, please
exit this process. If you proceed you will create an electronic record of your agreement.