EFTA01449500.pdf

Account Transfer Form I. RECEIVING FIRM INFORMATION (Only one per form) RECEIVING FIRM CLEARING NUMBER. 0443 ACCOUNT NUMBER: {=1..lan or TAXPAYER SOCIAL SECURITY IDENTIFICATION NUMBER NUMBER: SECONDARY SOCIAL - or TAXPAYER SECURITY NUMBER. IDENTIFICATION NUMBER: C 0 Nonreeremere: SN JT —Womb TR —Must' CT —(CotrusteeI CO —(Corporate) CU —(Custodian) ES —(Estate) BC —(Bank Custody) AG-(Agency) Retirement. IR —ITraditional IRAI RI—(Roth IRA) DR —(Carect Rollover) BI—(Beneficiary) BR —(Beneficiary Roth IRA) 4K —(40Ik) El —(Education Savings Account) SI —(SIMPLE IRA) QP—(Qualihed Plan) 4B —(403b) 7B—(457 Plan) HS—(Heallh Savings Account) 5P-(525 Plan) OT—i0ther) 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: NOi! statement is necessary to process this form. III. TRANSFER TYPE (Choose only on,?: A. ACCOUNT TRANSFER 0 FULL (Check one below) 0 TRANSFER ALL ASSETS IN KIND (Skip to Swoon VU 0 LIQUIDATE ALL ASSE I S LISTED IN SECTION IV (Liquidations are not lor brokerage rico:anis) 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 U TRANSFER ALL FULL SHARES ONLY O PARTIAL (List assets m Section N) NOTE: For transfer agents. electronically send positions or issue a certificate for whole shares and redeem fractional shares. C. DIRECT MUTUAL FUND Li TRANSFER MUTUAL FUNDS FROM THE ACCOUNT HELD DIRECTLY AT THE FUND COMPANY (See 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 two to three weeks before maturity date). NOTE: Liquidations involving bank CDs. checking accounts. or savings accounts can only be processed from retirement accounts. Nil FEL SIGNATURE DATE SIGNATURE DATE RPD-150 ACAT arEPWPA-06,97 II0a30) P.yot 2 or 3 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0104938 CONFIDENTIAL SDNY_GM_00251122 EFTA01449500