EFTA01449504.pdf

Account # IV. PARTIAL TRANSFERS. DIRECT MUTUAL FUNDS AND LIQUIDATIONS (If there are more than eight assets, attach a signed list to this form) CAPITAL GAIN ESTIMATED S cosh:Tire ASSET DESCRiPTON CUSIPISYMBOt ILI\,...:fitfich :)ACCGki'.7 TRANSFER INSTRUCTIONS' DIVIDEND CRTION' : OPTIOhF VALUE US Dollar OUSDPRAA7 illTransfer in Kind U Liquidate 0 Cash 0 Reinvest J Cash 0 Reinvest 28366.12 C1 Transfer in Kind 0 Liquidate 0 Cash Ll Reinvest -I Cash U Reinvest O Transfer in 14nd 0 Liquidate 0 Cash 0 Newest U Cash 0 Reinvest 0 Transfer in *net 0 Liquidate 0 Cash 0 Reinvest J Cash U Reinvest O Transfer in 14nd 0 Liquidate 0 Cash 0 Reinvest U Cash 0 Reinvest 0 Transfer in *nil 0 Liquidate 0 Cash 0 Reinvest J Cash U Reinvest O Transfer in Kind 0 Liquidate 0 Cash 0 Reinvest U Cash 0 Reinvest 0 Transfer in *rid 0 Liquidate 0 Cash 0 Reinvest j Cash U Reinvest II you have requested a sndalled, your market pdoe is not gusenteed. YOu will receive the current market price after your transfer request is received. reviewed, and determined to be In good order by the delivering form. Pershing is not responsible for market fluctuations or delays n the review process. DRS items Cannot be liquidated. 2 If this is a mutual fund transfer and there is no dividend or capital gain option checked in the section above. Pershing will PrOOOSS this request as reinvest (FOR OFFICE USE ONLY: All transfers must be added to Pershing's transfer systems) V. RETIREMENT PLAN RESTRICTIONS AND CERTIFICATIONS ui Age 70" restrictions. 11 you are at the age of 70 this year and you are transferring or rolling over assets from an IRA. qualilied plan or 40300 account. you may be required to take a minimum dosibubon (FWD) from your qualified plan or 40310) account before rolling over your assets. II Rollover Certification of Employee: I understand the wise and Conditions and I have met the requirements for making a rollover. Due to the important tax consequences of rolling over lunds or property. I have been advised to see a tax proton:0nel. All information provided by rne is true and correct and may be relied on by Pershing LLC. I assume full responObility for this transaction and will not hold Pershing LLC liable for any adverse consequences that may result I hereby irrevocably designate this contribution in lands or other property as a transfer or rollover contribution. TO THE PRIOR TRUSTEE: U Pershing LLC accepts appointment as successor custodian. U Please be advised that does hereby accept appointment as successor custodian (Input Firm Nave) SUCCESSOR CUSTODIAN'S SIGNATURE: DAT E VI . PARTICIPANT SIGNATURE AND CERTIFICATION To the Delivering f inn Named Abon• the trustee 'ISIS above. unless moo/ A re fnn::er 411 f-1, .1C.C.-tn: :0 re:.r.inp, may be transferred within the time frames required try NYSt Rule 412 or smiler rule of the NASD Cr Other designated examining authority. Unless otherwise indicated in the instructions above, I authorise you to liquidate any nontransferable propnelary money market fund assets that we part of my account and transfer the wailing credit balance to the successor custodian I authorize you to deduct any ouistandng lees due to you from the credit balance in my account. II my account does not contain a CriXlit heists*. or if the credit balance in the account is insufficient to satisfy any outstanding lees due to you. I authorize you 10 liquidate the assets in my account to the extent necessary lo sately that obligation. II cerblicates or other instruments n my account are in Wit physical possession. I instruct you to transfer them in good deliverable tom including affixing any necessary tax waivers, to enable the successor custodian to transfer them in es name nor the purpose of the sale, when. and as directed to me. I understand that upon meowing a copy of the transfer inforMahon, you ail (Lancet all open orders for my account on your books. I affirm that I have destroyed or returned to you credit/debit cards and/or unused checks issued tome n connection with my brokerage acceize I understand Mal you will Contact nu) with respect to the disposition of any assets in my brokerage account that are nontransferable. SIGNATURE GUARANTEED BY: CLIENT'S SIGNATURE: DATE: JOINT CLIENT'S SIGNATURE: DATE- Please attach your most recent brokerage account statement to process this account transfer INVESTMENT PROFESSIONAL'S NAME: INVESTMENT PROFESSIONAL'S PHONE NUMBER: CUSIP' belongs to its respective owner CO I.WPA 059/ I IO:CO) Page 3 of 3 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0104942 CONFIDENTIAL SDNY_GM_00251126 EFTA01449504