Tax Advisor Account
Resume:
TRANSFER ON DEATH REGISTRATION AND
DESIGNATION OF BENEFICIARY
AGREEMENT
(Transfer on Death)
Instructions for Transfer on Death Registration and Designation of Beneficiary
1. Download the Transfer on Death Registration and Designation of Beneficiary Agreement (the “Agreement”), and print the Agreement. 2. Once you have provided the requested information in the Agreement, review the Agreement to ensure it is complete. 3. For individual account holders, you may view whether you have uploaded an Agreement in your BlockFi account. For more information on your Agreement, please contact BlockFi at https://blockfi.com/contact/. 4. In section 3 of the Agreement, married residents of community property/marital property states (including AZ, CA, ID, LA, NV, NM, TX, WA, WI), community property territories (PR, GU), or countries with similar spousal property rights must complete section 3 if you are naming someone other than your spouse as primary beneficiary. If you live in a state that permits you to affirmatively classify your property as community property/marital property and you have affirmatively classified your property as community property/marital property, you must also complete section 3. Please discuss with your legal or tax advisor before completing. 5. The creation of Transfer On Death accounts may affect your estate and tax planning. We recommend that you consult your attorney or tax advisor to determine if Transfer On Death Registration is available in your jurisdiction of residence, is appropriate for you or if any change should be made with respect to an existing Transfer On Death Registration or similar non-probate transfer laws. 6. Sign, date, and notarize your Agreement.
7. Upload your completed Agreement in the Beneficiaries section of your BlockFi Account. Page 1 of 12
Address:
DESIGNATION OF BENEFICIARY –
BLOCKFI ACCOUNT (Transfer on Death “TOD”)
Use this form to register your existing BlockFi Interest Account or BlockFi Wallet, as applicable (“Account”) as a TOD account and designate beneficiaries to receive your assets upon your death. Please consult with your legal or tax advisor before electing TOD registration.
• Important: Please submit all pages upon completion of the form even if Section 3 (Spousal Consent) is blank.
1. ENTER INFORMATION ABOUT YOUR ACCOUNT
Account Holder
First name M.I. Last Name
Social Security Number or Passport Number
Date of Birth (mm/dd/yyyy)
Account Holder Marital Status Single
Married Divorced
Widowed
Upon the death of the account holder of the Account, assets will be distributed to the primary beneficiary(ies) listed below. If the beneficiary you designate is currently a minor, you may identify a custodian under the Uniform Transfer to Minors Act (not the Uniform Gifts to Minor Act), e.g., John Doe UTMA of NY. UTMA designations may not be made by clients residing outside of the US unless either the custodian or minor is a US resident. If the beneficiary is a trust, you must identify all the trustees e.g. John Doe and James Doe, Trustees of the Jane Doe Trust UAD January 1, 2001. If the beneficiary is a testamentary trust, the Will must be probated before BlockFi can recognize the existence of the testamentary trust. Primary Beneficiaries: receive individual account assets upon the account holder’s death Contingent Beneficiaries: receive assets if the primary beneficiary(ies) do not survive the account holder All sections are required, unless otherwise indicated. The sum of all primary designations must total 100% and the sum of all contingent designations must total 100%. A contingent beneficiary may not be designated without designating or indicating the primary beneficiary. If only one beneficiary is indicated, and a share percentage is not indicated, then it will be deemed 100% primary. Beneficiaries can’t be added if the total allocation per beneficiary type does not add up to 100% (e.g. allocation for three primary beneficiaries could be 34%, 33%, 33%).
Check this box if you want to cancel your TOD beneficiary designations. A. BENEFICIARIES
a.
Primary Beneficiary’s Full Name or Entity
Percentage %
Is the beneficiary your spouse? Passport # (Non-US Resident) SS#/TIN: Address Line 1 Address Line 2
City State/Province Zip/Postal Code Country
Telephone (optional):
If this primary beneficiary dies before me, pay his/her portion (must check only one): to the remaining living beneficiaries named on this form- choose one: Proportionately Equally Page 2 of 12
2. DESIGNATE YOUR BENEFICIARY(IES)
to the Account Owner’s estate
to the contingent beneficiary(ies) named below (percentages for all contingent beneficiaries named for each primary beneficiary must total 100%)
If you selected contingent beneficiary(ies)
(i)
Contingent Beneficiary’s Full Name or Entity
Percentage %
Is the beneficiary your spouse? Passport # (Non-US Resident) SS#/TIN: Address Line 1 Address Line 2
City State/Province Zip/Postal Code Country
Telephone (optional):
(ii)
Contingent Beneficiary’s Full Name or Entity
Percentage %
Is the beneficiary your spouse? Passport # (Non-US Resident) SS#/TIN: Address Line 1 Address Line 2
City State/Province Zip/Postal Code Country
Telephone (optional):
b.
Primary Beneficiary’s Full Name or Entity
Percentage %
Is the beneficiary your spouse? Passport # (Non-US Resident) SS#/TIN: Address Line 1 Address Line 2
City State/Province Zip/Postal Code Country
Telephone (optional):
If this primary beneficiary dies before me, pay his/her portion (must check only one): to the remaining living beneficiaries named on this form- choose one: Proportionately Equally to the Account Owner’s estate
to the contingent beneficiary(ies) named below (percentages for all contingent beneficiaries named for each primary beneficiary must total 100%)
If you selected contingent beneficiary(ies)
Page 3 of 12
(i)
Contingent Beneficiary’s Full Name or Entity
Percentage %
Is the beneficiary your spouse? Passport # (Non-US Resident) SS#/TIN: Address Line 1 Address Line 2
City State/Province Zip/Postal Code Country
Telephone (optional):
(ii)
Contingent Beneficiary’s Full Name or Entity
Percentage %
Is the beneficiary your spouse? Passport # (Non-US Resident) SS#/TIN: Address Line 1 Address Line 2
City State/Province Zip/Postal Code Country
Telephone (optional):
c.
Primary Beneficiary’s Full Name or Entity
Percentage %
Is the beneficiary your spouse? Passport # (Non-US Resident) SS#/TIN: Address Line 1 Address Line 2
City State/Province Zip/Postal Code Country
Telephone (optional):
If this primary beneficiary dies before me, pay his/her portion (must check only one): to the remaining living beneficiaries named on this form- choose one: Proportionately Equally to the Account Owner’s estate
to the contingent beneficiary(ies) named below (percentages for all contingent beneficiaries named for each primary beneficiary must total 100%)
If you selected contingent beneficiary(ies)
(i)
Contingent Beneficiary’s Full Name or Entity
Percentage %
Is the beneficiary your spouse? Passport # (Non-US Resident) SS#/TIN: Address Line 1 Address Line 2
Page 4 of 12
City State/Province Zip/Postal Code Country
Telephone (optional):
(ii)
Contingent Beneficiary’s Full Name or Entity
Percentage %
Is the beneficiary your spouse? Passport # (Non-US Resident) SS#/TIN: Address Line 1 Address Line 2
City State/Province Zip/Postal Code Country
Telephone (optional):
d.
Primary Beneficiary’s Full Name or Entity
Percentage %
Is the beneficiary your spouse? Passport # (Non-US Resident) SS#/TIN: Address Line 1 Address Line 2
City State/Province Zip/Postal Code Country
Telephone (optional):
If this primary beneficiary dies before me, pay his/her portion (must check only one): to the remaining living beneficiaries named on this form- choose one: Proportionately Equally to the Account Owner’s estate
to the contingent beneficiary(ies) named below (percentages for all contingent beneficiaries named for each primary beneficiary must total 100%)
If you selected contingent beneficiary(ies)
(i)
Contingent Beneficiary’s Full Name or Entity
Percentage %
Is the beneficiary your spouse? Passport # (Non-US Resident) SS#/TIN: Address Line 1 Address Line 2
City State/Province Zip/Postal Code Country
Telephone (optional):
Page 5 of 12
(ii)
Contingent Beneficiary’s Full Name or Entity
Percentage %
Is the beneficiary your spouse? Passport # (Non-US Resident) SS#/TIN: Address Line 1 Address Line 2
City State/Province Zip/Postal Code Country
Telephone (optional):
Page 6 of 12
3. SPOUSAL WAIVER
If you are a married resident of a community property state or territory (including AZ, CA, ID, LA, NV, NM, TX, WA, WI, GU and PR), a state or territory that permits you to affirmatively classify your property as community property/marital property and you have affirmatively classified your property as community property/marital property, or a country that has the same or similar community property/marital property laws to the aforementioned U.S. states and territories and are not naming your spouse as 100% primary beneficiary, YOU MUST COMPLETE THIS SECTION. I am the spouse of the above-mentioned account holder. I acknowledge that I have received a fair and reasonable disclosure of my spouse’s property and financial obligations. Due to the important tax and legal consequences of giving up my interest in this account, I have been advised to see a tax professional and a legal advisor. I hereby give the account holder any interest I have in the funds or properties deposited in this account and consent to the beneficiary designation indicated above. I assume full responsibility for any adverse consequences that may result. No tax or legal advice was given to me by BLOCKFI. By signing below, I consent to the terms and conditions of this Agreement.
4. SIGN AND DATE THE FORM
By signing below, I (we), acknowledge and agree to be bound by all of the terms and conditions for the TOD service at BlockFi, and that I have received and read a copy of the Transfer on Death Registration and Agreement: Account Owner’s Full Name Signature Date
You must sign this form in the presence of a notary public or other officer. A standard notary page is provided on the next page, but you may also attach a notary page provided by your notary. Your beneficiary designations will not be effective if your signature is not notarized.
Printed Name of Account Holder’s Spouse Date
Signature of Account Holder’s Spouse
Page 7 of 12
Special instructions for California notaries: California notaries must obtain satisfactory evidence that the person making the acknowledgement is the individual who is described in and who executed the document, and may not notarize solely on the basis that the notary knows the person making the acknowledgement. State of
County of
On this day of, 20, before me,
personally known to me or who proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me and whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I am a notary under the laws of, and by signing below I certify under PENALTY OF PERJURY under the laws of that the foregoing paragraph is true and correct. Notary Public Name Notary Public Seal or Stamp (as required by State) Notary Public Signature
A Notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy or validity of that document. Page 8 of 12
Terms and Conditions of Transfer on
Death Service
Definitions
Throughout this agreement, "Account Owner", “Account Holder” and "you" mean you as a Client of BlockFi. "Account Owner" also means the last surviving Account Owner in the case of an Account with multiple Account Owners.
"BlockFi", "we" and "us" mean BlockFi Inc., a Delaware corporation, its subsidiaries, affiliates, successors and assigns.
"Beneficiaries" mean the persons or entities you designate above, or in the last Transfer On Death Registration and Agreement accepted by BlockFi for the Account(s).
"TOD Account Assets" mean the assets of the Account(s) that are eligible for distribution upon the death of the Account Owner, in accordance with this Agreement.
"Account" means the BlockFi Interest Account(s) or BlockFi Wallet(s), as applicable, for which a TOD Registration and Agreement has been accepted by BlockFi in accordance with this Agreement.
"Transfer On Death Agreement" or "TOD Agreement" or "Agreement" shall mean the last Transfer On Death Registration and Agreement accepted by BlockFi.
"Death of an Account Owner" means the death of the individual Account Owner or the death of the last surviving Account Owner in the case of an Account with multiple Account Owners.
Effect of TOD Registration
This Transfer on Death Registration and Agreement supersedes all of your wills, trusts and other instruments, regardless of when they were executed, as well as any previous TOD Agreements accepted by BlockFi which provide for the contrary disposition of the TOD Account Assets.
Transfer on Death registrations may not be available in your place of residence. If you move to a new place of residence which does not have a Transfer on Death Registration statute, this Agreement may not be enforceable. You agree to notify BlockFi if you change your residence to a place which has not adopted the Uniform Transfer on Death Act or does not permit the use of similar non-probate transfer laws. If BlockFi is first notified of such a change in your residence after your death, you agree that BlockFi is not obligated to transfer the TOD Account Assets pursuant to this Agreement. Transfer on Death Registration is only available for individually owned accounts. A change by BlockFi of the account number designating this Account shall have no effect on this Agreement or the TOD designation established pursuant to the terms of this Agreement. BlockFi shall deem that the words "Transfer on Death" or "TOD" and the name of the beneficiaries are included in the Account title pursuant to this Agreement regardless of whether or not they actually appear in the Account title. Changes to this Agreement are only effective if offered in writing and signed by BlockFi. You acknowledge and agree that this Agreement does not constitute a trust, constructive or otherwise, and BlockFi has no fiduciary duty as a trustee under this Agreement. Should you become incapacitated, a duly appointed guardian or conservator, or an agent acting under durable power of attorney that is satisfactory to BlockFi, may effect transactions within the Account(s), but may not change the designation of Beneficiaries or revoke the TOD ownership unless expressly authorized by the governing document, law of your residence or court order. Likewise, BlockFi will establish a TOD Account only upon the written request of the Account Owner personally and no guardian, conservator or agent may establish a TOD Account for the principal or ward in the first instance without express authorization by the governing document, law of your residence or court order.
This Agreement does not replace any of the terms and conditions of any other agreements between you and BlockFi. However, if any of the terms and conditions of this Agreement should conflict with any of those agreements, the terms of this Agreement shall control. BlockFi may amend this Agreement at any time by sending you a written notice of the change, and the changes will be effective on the date of the notice unless we specify a later date. The continued registration of the Account(s) under TOD designation constitutes your acceptance of the new terms and conditions.
At your request, BlockFi will apply a transfer on death (“TOD”) registration to your Account in accordance with the terms of this agreement and any other agreements between you and BlockFi. Consequently, upon your death, as the account holder (“Account Holder”), ownership of the assets in the Account will vest in the beneficiaries you have designated, in the proportion(s) you have indicated. BlockFi does not provide tax or legal advice and, therefore, encourages you to consult with an attorney and/or review the relevant laws of your place of residence concerning the impact of this registration on your estate and the distribution of your property after death.
You may remove or change any part of this designation at any time prior to your death by completing and submitting a new form. BlockFi will, however, only process a TOD removal or change that is received from you by BlockFi in good order prior to your death. In the event you open a new account that is eligible for a TOD registration, you will be required to execute a new TOD Registration for that account. Page 9 of 12
Designations made at a different firm are not recognized at BlockFi. Execution of this form and timely submission will revoke and replace all previous beneficiary designations for the Account. For Non-US Residents
You acknowledge that BlockFi makes no representations regarding the legal effect of this Agreement under the laws of your residence or the registration of the Account(s) in TOD form and you agree that BlockFi shall have no responsibility or liability for the legal effect
(or any failures thereof) resulting from the execution of this Agreement and the establishment and maintenance of the Account(s). BlockFi makes no representation that any particular property will or will not be permitted to transfer under the applicable laws of your country.
TOD provisions may not be tax exempt in your country. Receipt of any portion of the Account or any income from the Account by a non- US resident as a beneficiary under a TOD provision may be subject to taxation in your country. You should consult with your tax and legal advisors for additional information. Beneficiary Designations and TOD Account Assets Distribution Your instructions for the transfer of all the TOD Account Assets are set forth in the "Beneficiary Designations" section of this Agreement, or the last beneficiary designation accepted by BlockFi for the Account(s). You may change your named beneficiaries, change the percentages that you wish to distribute or revoke your entire TOD Agreement at any time in writing. A subsequent beneficiary designation automatically revokes a prior designation of beneficiaries when it becomes effective. In order to change your named beneficiaries or change the percentages to be distributed to the beneficiaries, you must execute a new TOD Registration and Agreement. A TOD registration or re-registration is effective only when a Transfer on Death Agreement in good order is actually received and accepted by BlockFi prior to the Account Owner's death. A revocation must be made in writing, signed by all Account Owners and be accepted by BlockFi to be effective. Acceptance will be evidenced when BlockFi updates its books and records.
In order to transfer TOD Account Assets to the Beneficiary(ies) of a U.S. resident Account Owner, BlockFi will require the Beneficiaries to undergo identity verification procedures and to provide us with the following documentation: (1) BlockFi Beneficiary Distribution Forms in good order signed by all named Beneficiaries; (2) a death certificate for the Account Owner; (3) inheritance or estate tax waivers and/or affidavits of domicile (for states that require such a waiver or where BlockFi deems such waivers and/or affidavits advisable to relieve it of liability for such tax); (4) any other additional necessary documents or information that BlockFi may require. BlockFi may rely conclusively upon instructions from the Beneficiaries in completing a transfer of the TOD Account Assets, and is fully released thereby from liability to any third party for completing such a transfer. In order to transfer TOD Account Assets to the Beneficiaries of a non-U.S. resident Account Owner, BlockFi will require the Beneficiaries to provide us with the following documentation: (1) BlockFi Beneficiary Distribution Forms in good order signed by all named Beneficiaries; (2) a death certificate for the Account Owner; (3) a Transfer Certificate from the Internal Revenue Service (“IRS”) (see https://www.irs.gov/businesses/small-businesses-self-employed/transfer-certificate-filing-requirements-for-the-estates-of- nonresidents-not-citizens-of-the-united-states ); (4) inheritance or estate tax waivers and/or affidavits of domicile (for places of residence that require such a waiver or where BlockFi deems such waivers and/or affidavits advisable to relieve it of liability for such tax); and (5) any other additional necessary documents or information that BlockFi may require. BlockFi may rely conclusively upon instructions from the Beneficiaries in completing a transfer of the TOD Account Assets, and is fully released thereby from liability to any third party for completing such a transfer. Please consult the IRS website for the latest, detailed information regarding Transfer Certificate filing requirements.
If BlockFi has reason to believe Account Owner is deceased but BlockFi does not have proof of Account Owner’s death in a form satisfactory to BlockFi, Account Owner authorizes BlockFi to make inquiries, whether directly or through third parties, that BlockFi considers necessary to ascertain whether Account Owner is deceased. If the Beneficiaries do not survive the Account Owner and the Account Owner has not designated a legal representative to administer the Account Owner’s estate, then BlockFi reserves the right to
(i) treat as Account Owner’s legal representative any person entitled to inherit Account Owner’s Account, as determined by BlockFi upon receipt and review of the documentation BlockFi, in its sole and absolute discretion, deems necessary or appropriate, including
(but not limited to) a Will, a living trust, a Small Estate Affidavit or Transfer Certificate provided by the IRS, or (ii) require an order designating a legal representative from a court having competent jurisdiction over Account Owner’s estate. In the event BlockFi determines, in its sole and absolute discretion, that there is uncertainty regarding the validity of the legal representative designation, BlockFi reserves the right to require an order resolving such issue from a court of competent jurisdiction before taking any action relating to Account Owner’s Account.
You are responsible for notifying us in the event of the death of any Beneficiary. In the event of the death of one of multiple Beneficiaries, BlockFi will transfer the TOD Account Assets in accordance with your election in the Beneficiary Designation section of this Agreement. In that section "proportionately" means the deceased Beneficiary's share will pass to the surviving Beneficiaries in proportion to their allocated interests, calculated by taking the stated percentage for each Beneficiary divided by the sum of the percentages allocated to all of the surviving Beneficiaries.
If all Beneficiaries predecease the last surviving Account Owner, the TOD Account Assets shall pass to the Account Owner's estate. In the event that a Beneficiary predeceases the Account Owner, BlockFi will require a copy of the death certificate for the deceased Page 10 of 12
Beneficiary to be submitted by the surviving Beneficiaries or the representative for your estate. Should a Primary or Contingent Beneficiary disclaim his or her share of the TOD Account Assets, in whole or in part, then the disclaimed TOD Account Assets shall be transferred in accordance with your election in Section 2 of this Agreement as if the disclaiming Primary or Contingent Beneficiary predeceased you. Should all Primary and all Contingent Beneficiaries disclaim the TOD Account Assets, the property disclaimed shall pass to the Account Owner's estate. The disclaimer, which must meet applicable federal and state law requirements, or other applicable legal requirements, must be provided to BlockFi. If a distribution pursuant to this Agreement is payable to a person known by BlockFi to be a minor or otherwise under a legal disability, BlockFi may, in its absolute discretion, make all or any part of the distribution to (1) such person's parent, guardian, conservator or other legal representative, wherever appointed; (2) a custodial account established under the Uniform Transfer to Minors Act; (3) any person having control or custody of such person (any of which is referred to as a "Beneficiary's Nominee") and be fully released thereby. If, after a reasonable time following the death of the Account Owner, the Beneficiary's Nominee is unable or refuses to accept delivery of the assets, or no Beneficiary's Nominee or appropriate substitute can be found, BlockFi may distribute the assets to the estate of the Account Owner and be fully discharged from its obligations under this Agreement. If provided in the "Beneficiary Designation" section above, a custodial designation for a minor Beneficiary is effective only until the Beneficiary has reached the legal age of majority. After such date, and at the time of transfer pursuant to this Agreement, BlockFi will transfer that Beneficiary's share of the TOD Account Assets to him or her outright.
If a distribution pursuant to this Agreement is payable to a testamentary trust, the Account Owner's will must be probated to establish the validity and existence of such testamentary trust before BlockFi can recognize it as a beneficiary. If you name your spouse as a Beneficiary of the Account, some jurisdictions will automatically revoke your spouse’s designation upon divorce. In some jurisdictions, you will need to complete a new TOD Agreement to keep your former spouse as a Beneficiary. You should discuss this with your attorney and/or tax advisor. However, if you and your spouse do get divorced and you do not file a new TOD Agreement removing your former spouse, BlockFi is not responsible for investigating into the status of your marriage at the time of your death, and BlockFi will distribute the property to the Beneficiary(ies) listed in this TOD Agreement after the Beneficiary(ies) has complied with BlockFi’s requirements for distributions to the Beneficiary(ies). Furthermore, if you were divorced at the time of your death and failed to file a new TOD Agreement removing your former spouse, BlockFi is not responsible for determining whether the applicable local law prohibits the distribution to your former spouse. You agree that BlockFi has no obligation to (1) identify or locate any beneficiary, the spouse or legal heirs of an Account Owner or the personal representative of the estate of any Account Owner; (2) notify any person of any proposed or completed transfer of TOD Assets; or (3) determine the marital status of the Account Owners(s) at any time; (4) independently verify any information submitted by any person claiming an interest in the TOD Account; or (5) determine any other facts which may have the effect of varying the transfers directed in this Agreement.
You agree that BlockFi, in its sole discretion, may restrict the TOD Account(s) as it deems appropriate, and may require the parties to adjudicate their respective rights in the TOD Account Assets, or to require an indemnification satisfactory to BlockFi before making any transfer pursuant to this Agreement in the event that:
• BlockFi cannot determine the person or persons entitled to receive a transfer pursuant to this Agreement, or the proper percentages to be applied to such transfer, or
• Before BlockFi makes a transfer pursuant to this Agreement a dispute arises between any persons as to the proper transfer, or between or among any creditors of the Account Owner, or
• Any other person makes any claim upon the TOD Account Assets. After your death, if any part of the beneficiary designation is unclear as to the portion of the Account that any such Beneficiary(ies) shall be entitled to receive, or there is any other ambiguity or uncertainty as to identity of your designated beneficiary(ies), then BlockFi shall rely conclusively upon, and shall be fully protected and relieved of liability in acting upon, the written statement of the legal representative of your estate, or the legal representative of any Beneficiary's estate, if applicable, as to any matter relating to the interpretation, construction or application of your beneficiary designation, including, without limitation, the identity of the Beneficiary(ies), the amounts to which they are entitled and the terms and provisions of any document referenced in this Agreement. If no legal representative exists, then with respect to any matter described in this Agreement where BlockFi would otherwise be entitled to rely on the legal Representative, BlockFi shall instead be entitled (but not obligated), in its sole judgment, to bring a proceeding to resolve such matter in a court of competent jurisdiction, the costs of which proceeding, including attorneys' fees, shall be borne by the Account(s). Alternatively, BlockFi may, in its sole judgment, require the legal Representative or any Beneficiary named on the attached beneficiary designation to provide a court order from a court of competent jurisdiction identifying the proper beneficiary(ies) of the Account(s). You agree that BlockFi may liquidate and transfer the proceeds of any TOD Account Assets that cannot be divided into amounts which may be properly transferred, or it may divide or liquidate fractional shares in any manner it deems appropriate so as to best conform with the percentages set forth in
Contact this candidate