EFTA01344425.pdf

Account Transfer Form I. RECEIVING FIRM INFORMATION (Only one per form) RECEIVING FIRM CLEARING NUMBER 0443 ACCOUNT NUMBER: or TAXPAYER SOCIAL SECURITY IDENTIFICATION NUMBER NUMBER: SECONDARY SOCIAL r or TAXPAYER 1..1J SECURITY NUMBER: T 1- IDENTIFICATION NUMBER: ACCOUNT TYPE: (Enter the two character code) C O Nonretiremenc SN—ISinglei —I.loint) TR —(Trusti CT —Manumit.) CO —(Corporate) CU —(Custodian) ES —(Estate) BC- (Bank Custody) AG-tAgency) Retirement: IR — (Traditional IRAI RI—IFloth IRA) DR —(Direct Rollover) BI—(Beneficiary) BR —(Beneficiary Roth IRA) 4K —(40Ik) El —(Education Savings Account) SI —(SIMPLE IRA) QP—(Qualdied Plan) 4B —(403b) 7B—(457 Plan) HS—(Heallh Savings Account) 5P-(525 Plan) Other: OT — tOtheri II. DELIVERING ACCOUNT INFORMATION CLEARING NUMBER: ACCOUNT NUMBER. DELIVERING FIRM CONTACT INFORMATION (MANDATORY WHEN CLEARING NUMBER IS NOT PROVIDED) FIRM NAME: JP Morgan CONTACT NAME' ACCOUNT TITLE. (As it appears on your statement) FIRM ADDRESS: (No PO Box) Jeepers Inc. — — — CITY' STATE: ZIP: TELEPHONE NUMBER: statement is necessary to process this form. III. TRANSFER TYPE (Choose only A. ACCOUNT TRANSFER 0 FULL (Check one below) 0 TRANSFER ALL ASSETS IN KIND (Skip to Section VI) 0 LIQUIDATE ALL ASSE I S LISTED IN SECTION IV (Liquidations are not lor brokerage acoounts) 0 TRANSFER AU. ASSETS IN KIND EXCEPT FOR THE ASSETS USIED IN SECTION N. WHICH REQUIRE LIQUIDATION 0 PARTIAL (Complete Section M B. DRS/DRIP U FULL (Check one below) 0 SELL FRACTIONS AND CLOSE ACCOUNT O TRANSFER ALL FULL SHARES ONLY O PARTIAL (List assets in Section N) NOTE: For transfer agents. electronically send positions or issue a certificate for whole shares and redeem tractional shares. C. DIRECT MUTUAL FUND TRANSFER MUTUAL FUNDS FROM THE ACCOUNT HELD DIRECTLY AT THE FUND COMPANY ISee Est in Section IV for exact instructions) NOTE: Only one fund family per form. D. BANK RETIREMENT PLAN ACCOUNTS (Select only one) O UOUIDATE IMMEDIATELY AND TRANSFER CASH I am aware of and acknowledge any penalty I will incur from an early withdrawal, O UOUIDATE AT MATURITY AND TRANSFER CASH Specify maturity date (submit ❑no to three weeks before maturity date). NOTE: Liquidations involving bank CDs. checking accounts. or savings accounts can only be processed from retirement accounts. SIGNATURE SIGNATURE DATE DATE HY 1! !I RPE)-150 ACAT rcear140.40697 11040) Pate: 2 of 3 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0029849 CONFIDENTIAL SDNY_GM_00176033 EFTA01344425