Pd F 5182 New Account Request

RESET
PD F 5182 E
Department of the Treasury
Bureau of the Public Debt
(Revised September 2009)

OMB NO. 1535-0069

NEW ACCOUNT REQUEST

Visit us on the web at www.treasurydirect.gov
1-800-722-2678

IMPORTANT: Follow instructions in filling out this form. You should be aware that the making of any false,
fictitious, or fraudulent claim or statement to the United States is a crime under the laws of the United States.

SEE INSTRUCTIONS – TYPE OR PRINT IN INK ONLY – NO ALTERATIONS OR CORRECTIONS
FOR DEPARTMENT USE

1. Legacy Treasury Direct ACCOUNT INFORMATION
ACCOUNT NAME

DOCUMENT AUTHORITY

APPROVED BY

DATE APPROVED

ADDRESS

EXT REG
FOREIGN
BACKUP
City

State

ZIP Code

REVIEW

2. TAXPAYER IDENTIFICATION NUMBER
CLASS

1st Named Owner
Social Security Number

OR

Employer Identification Number

3. TELEPHONE NUMBERS

Work

Home

4. PAYMENT INFORMATION
ROUTING NUMBER
FINANCIAL INSTITUTION
(Limited to 30 characters/spaces)

NAME ON ACCOUNT
(Limited to 22 characters/spaces)

Checking

ACCOUNT NUMBER
AUTHORIZATION

Savings

(Check One)

I submit this request pursuant to the provisions of Department of the Treasury Circulars, Public Debt Series Nos.
2-86 (31 CFR Part 357) and 1-93 (31 CFR Part 356).

Under penalties of perjury, I certify that:
1. The number shown on this form is my correct Taxpayer Identification Number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I
am no longer subject to backup withholding, and
3. I am a United States citizen (including a United States resident alien).
Instructions. You must cross out Item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return.
I further certify that all other information provided on this form is true, correct, and complete.

Signature
SEE INSTRUCTIONS FOR PRIVACY ACT AND PAPERWORK REDUCTION ACT NOTICE.

Date

INSTRUCTIONS FOR COMPLETING
A NEW ACCOUNT REQUEST

PD F 5182 E
Department of the Treasury
Bureau of the Public Debt
(Revised September 2009)
Visit us on the web at www.treasurydirect.gov
1-800-722-2678

PURPOSE
You may use this form to establish a Legacy Treasury Direct account WITHOUT PURCHASING SECURITIES. The Department of
the Treasury will establish and maintain your book-entry account for the future deposit of securities. This form cannot be used for the
purchase of securities or to request a change to an existing account.
IMPORTANT NOTICES
• If you are submitting a tender, you do NOT need to complete this form. A Legacy Treasury Direct account will be established
on the basis of the information you provide on the tender.
• To avoid delays, read the instructions carefully and either type your answers or print them clearly, using ink.
• REQUESTS WILL NOT BE ACCEPTED WITH ALTERATIONS OR CORRECTIONS.
• This form must be signed. Only original signatures and forms will be accepted (stamped signatures are not acceptable).

1. Legacy Treasury Direct ACCOUNT INFORMATION
ACCOUNT NAME
Enter the name(s) of the owner(s) for whom the Legacy Treasury Direct account will be established. Accounts may be established
in the names of one or two individuals, an estate, a trust, corporation, association, natural guardian, etc. (NOTE: A minor may not
register an account or purchase securities in his or her name alone.) See the table of common registrations on the last page of these
instructions. Because registrations establish clear ownership and survivorship rights, we recommend that you consult your Treasury
Retail Securities Site when you have questions about the proper wording.
ADDRESS
Provide a complete address, including ZIP Code. All mailings (including notices, statements, confirmations, checks [where
permitted], and tax reporting documents) will be sent to this address.

2. TAXPAYER IDENTIFICATION NUMBER
Provide the Taxpayer Identification Number required on tax returns and other documents submitted to the Internal Revenue Service
(IRS). For individuals, this is the Social Security Number (SSN) of the person whose name appears FIRST on the account. The SSN of
a minor or incompetent is required for accounts established in a fiduciary capacity for these individuals. In the case of a partnership,
company, organization or trust, use the Employer Identification Number (EIN) assigned by the IRS. (If you are not a United States
citizen, please attach IRS Form W-8 BEN or W-8 ECI.)
To use Electronic Services for Treasury Bills, Notes, and Bonds, you must have a Legacy Treasury Direct account and a
Taxpayer Identification Number. If you’re not a United States citizen and want to use our electronic services, you need an Individual
Taxpayer Identification Number (ITIN). To apply for an ITIN or just obtain more information, visit the Internal Revenue’s web page at
www.irs.gov­­or call (215) 516-4846.

3. TELEPHONE NUMBERS
Please provide the telephone numbers (including area codes) where you may be contacted if there are questions about this request
or your account.

4. PAYMENT INFORMATION
Enter the following information:
• ROUTING NUMBER (your financial institution’s ABA identifying number)
• FINANCIAL INSTITUTION (the name of the institution to which payments are to be made)
• NAME ON ACCOUNT (the name as it appears on the account at your financial institution)
• ACCOUNT NUMBER (the account number at your financial institution)
Remember to mark your account type (checking or savings).

Try using Pay Direct ®—a secure way
to buy securities without checks.
It’s easy! Just ask your financial institution
to verify if your account can accept debit
transactions. We’ll withdraw the exact
amount from your bank account to pay
for whatever security you’ve bought.

Payments to you will normally be made by direct deposit to the financial institution you designate. (This is also the account that will
be debited when you choose Pay Direct as the method of payment on your tender.) Payments will be made by check if a payment is
due to you before we have confirmed direct deposit arrangements for your account. If both the Legacy Treasury Direct account and
the receiving financial institution account are in the names of individuals, then at least one of the individuals named on the Legacy
Treasury Direct account must also be named on the deposit account at the receiving financial institution. The ROUTING NUMBER
can be obtained at your financial institution or found on the bottom line of a check (see following example). When providing your
ACCOUNT NUMBER, please include hyphens. A hyphen is generally represented on a check by the symbol " .
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PD F 5182 E

INSTRUCTIONS FOR COMPLETING
A NEW ACCOUNT REQUEST

PD F 5182 E
Department of the Treasury
Bureau of the Public Debt
(Revised September 2009)

PAUL MAPLE
LILIAN MAPLE
123 Main Street
Anyplace, NY 10000
PAY TO THE
ORDER OF

VOID
Routing
number

Account
number

1234

$
DOLLARS

We suggest you provide a voided check with this request. This
will enable us to verify your payment routing information—and
prevent delays in your receipt of direct deposit payments.
CAUTION:
Some financial institutions use payment routing information
which is not fully displayed on a check.

ANYPLACE BANK
Anyplace, NY 10000
For

:250250025 :202020

86

1234

Note: The routing and account numbers may appear in different places on your check.

5. AUTHORIZATION
This section must be signed and dated. Requests in the names of two individuals may generally be signed by either. However,
if the second-named owner signs, then an IRS Form W-9 signed by the first-named owner must be submitted with the request.
If the IRS has notified you that you are subject to backup withholding and you have not received notice from the IRS that backup
withholding has terminated, you should strike out the language certifying that you are not subject to backup withholding.

SUBMISSION
Completed forms must be submitted to one of these Treasury Retail Securities Sites:

Treasury Retail Securities Site
PO Box 567
Pittsburgh, PA 15230-0567

Treasury Retail Securities Site
PO Box 9150
Minneapolis, MN 55480-9150

CONTACT
Call us toll-free in the United States at 1-800-722-2678. Outside the U.S.? Call us at (304) 480-6464.

CONFIRMATION OF ESTABLISHED ACCOUNT
You will receive a Legacy Treasury Direct® Statement of Account confirming the establishment of your account.
Enjoy the convenience of our Electronic Services for Treasury Bills, Notes, and Bonds from the comfort of your home
using your computer (www.treasurydirect.gov) or a touch-tone phone (1-800-722-2678).
Great hours! 8 am - 12 midnight ET, Monday through Friday, except for federal holidays (24 hours a day for Reinvest Direct®!)
Here is what you can do:
Buy a security • Request a duplicate interest income statement • Reinvest maturing securities • Order a Statement of Account
Get your overall account par balance (Web users get even more details) • Change your address and phone number, too. (Web users only)

NOTICE UNDER THE PRIVACY AND PAPERWORK REDUCTION ACTS
The collection of the information you are requested to provide on this form is authorized by 31 U.S.C. Ch. 31 relating to the public
debt of the United States. The furnishing of a social security number, if requested, is also required by Section 6109 of the Internal
Revenue Code (26 U.S.C. 6109).
The purpose of requesting the information is to enable the Bureau of the Public Debt and its agents to issue securities, process
transactions, make payments, identify owners and their accounts, and provide reports to the Internal Revenue Service. Furnishing
the information is voluntary; however, without the information Public Debt may be unable to process transactions.
Information concerning securities holdings and transactions is considered confidential under Treasury regulations (31 CFR, Part 323)
and the Privacy Act. This information may be disclosed to a law enforcement agency for investigation purposes; courts and counsel
for litigation purposes; others entitled to distribution or payment; agents and contractors to administer the public debt; agencies or
entities for debt collection or to obtain current addresses for payment; agencies through approved computer matches; Congressional
offices in response to an inquiry by the individual to whom the record pertains; as otherwise authorized by law or regulation.
We estimate it will take you about 10 minutes to complete this form. However, you are not required to provide information requested
unless a valid OMB control number is displayed on the form. Any comments or suggestions regarding this form should be sent to
the Bureau of the Public Debt, Forms Management Officer, Parkersburg, WV 26106-1328. DO NOT SEND completed form to the
Bureau of the Public Debt; instead send it to your Treasury Retail Securities Site listed above.
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PD F 5182 E

INSTRUCTIONS FOR COMPLETING
A NEW ACCOUNT REQUEST

PD F 5182 E
Department of the Treasury
Bureau of the Public Debt
(Revised September 2009)

COMMON REGISTRATION OPTIONS
Investors in marketable Treasury securities have a broad choice of registration options under Legacy Treasury Direct® which
are designed to address their needs and ownership situations. These options establish clear ownership and survivorship rights.
Other options for natural guardians, custodians, IRAs, and government entities are available—for guidance, consult your
Treasury Retail Securities Site.
TO REGISTER YOUR SECURITY LIKE THIS:

SELECT THIS OPTION:

PROVIDE THIS:

An account in the name of one individual.
Your name should appear the way you usually use it
(with at least one full given name).

Single Ownership
Mary Benson Doe

SSN

An account in the names of two people, joined by the
word “and” and ending with “with right of survivorship.”
This creates a conclusive right of survivorship. Both owners
must authorize transaction requests.

Joint Ownership with
Right of Survivorship
Elizabeth Black and Jane Brown,
with right of survivorship

SSN of the first-named
owner

An account in the names of two people, joined by the
word “and” and ending with “without right of survivorship.”
This does not create a right of survivorship. If one owner dies,
his or her share passes on to the estate, not to the other owner.
Both owners must authorize transaction requests.

Joint Ownership without
Right of Survivorship
John B. Butte and Mary B. Doe,
without right of survivorship

SSN of the first-named
owner

An account in the names of two people, joined by the word “or.”
This creates a conclusive right of survivorship. Either owner may
authorize transaction requests.

Coownership
James Black or Carolyn Black

SSN of the first-named
owner

An account in your name, followed by the words “payable
on death to” or “POD” another individual or the United States
Treasury (proceeds would then be used to reduce the public debt).
The beneficiary has no ownership rights prior to the owner’s
death. You must identify the beneficiary’s status in the registration if he or she is a minor or incompetent. The owner authorizes
transaction requests. No consent from the beneficiary is needed.

Beneficiary
Jane Investor, payable on death
to Junior Investory, a minor

SSN of the owner

Jack S. Jones, payable on death
to Ellen H. Jones

SSN of the owner

An account in the name of an executor, administrator, legal
guardian, conservator or other representative of an estate.
You must make sure the name of the estate is adequately identified in the registration. If there are several representatives, you
may omit some by using language that indicates they exist.
You may need to provide evidence when you open this type of
account. Contact your Treasury Retail Securities Site.

Estate Representative
John Smith and Joseph Jones,
Executors of the
Will of James Brown, deceased

EIN or SSN of the decedent

An account in the name of the trustee(s) of a trust.
Trusts may be created by wills, agreements, indentures, deeds,
declarations of trust, or similar instruments. You must include
language that adequately identifies the authority or document by
which the trust was created. If there are several trustees, you may
omit some names as long as you include language that indicates
they exist. You may need to provide evidence when you open this
type of account. Contact your Treasury Retail Securities Site.

Trustees
Robert C. Jones and
Mary E. Doe, Trustees
under declaration of trust
dated 9/2/76

EIN or SSN of the firstnamed owner

An account in the name of a private corporation,
unincorporated association or partnership.
You must include the full legal name and status (corporation,
unincorporated association or partnership). You may reference a
particular account or fund, other than a trust fund.

Private Organizations
The Standard Manufacturing
Corporation

EIN

4

PD F 5182 E