EFTA01344010.pdf

Account $ IV PARTIAL TRANSFERS. DIRECT MUTUAL FUNDS AND LIQUIDATIONS If there are more than eight assets, attach e signed list to this form) titiaMIY ASSET CESCPaPrid/i i ctrarPSYS480J-" °ACC" r " . ' . '. arefiatii: i' ASTIMA220 S idkriddrIghidap" 051,1i1gr 0 Tender In Vied 0 Ugukhat• 0 Cash 0 Reknit CI Carib CIRanee 0 Treader In Kind CI ~date CI Cash 0 Reinvest Cleve& CIReines" O Tender in Kind (31.1quidate CI Caelt 0 Reinvest 0 Caen 0 ~et 0 Wender In rand 0 Linklata CI Cash 0 Reinvest 0 Cash 0 ~wet CI Tend« In Kind CI Utica CI Cash 0 Reline 0 CaaliUReline CI Timed« In Ifired 0 tinkle 0 C•sh CI Reeve, 0 Cash 0 Riekevest CI Think/ In Vind 0 ~Mete 0 Cat 0 Reknit 0 Cab CI~et O Tender by Kind 0 Lleeklete 0 Care 0 Reimer 0 Coe 0 Reline If you have requested a ktuldatIon, your market price la not guaranteed. You will receive the currant market price after your render rogues received. reviewed, and determined to be in good order by the delivering arm. PerehIng la not responsible for market fluctuation or delay* in the rent process. ORS items cannot be liquidated. 2 If the is • mutual fund transfer and there is no ~0 or capital gain option checked in the section above. Pershing will process this request es reinvest. (FOR OFFICE USE ONLY: All transfers must be added to Pershing's transfer systems) V RLI DLMENT PLAN RESTRICTIONS AND CERTIFICATIONS ■ Apo 70" restrictions: II you ere al least the age of 70a this year and you are veneering of roiling over assets from en IRA, qualdied plan or 403(b) account, you may bo required to take a minimum distribution (RMD) from your qualified plan or 403(b) account before rolling over your easels. ■ Rollover Certification of Employee: I undersond the rules end conditions and I have mat the requirements for making a rollover. Due to the important inconsequence* of rolling over fund* or property. I have been advised to mount profeseronai All *Owlet») provided by nye is tees and correct and may be relied on by Pershing LIC. I resume full rape:entity for tie transaction and will not hold Pershing LIC liable for any adverte consequences that may result. 1 hereby irrevocably designate this contrintion in funds or other property ae a trainee a rollover contribution. TO THE PRIOR TRUSTEE: O Pershing LLC accepts appointment es successor custodian. O Please be advised that does hereby accept appointment as successor custodian Men Ann Name SUCCESSOR CUSTODIAN'S SIGNATURE: DATE: VI PARTICIPANT SIGNATURE AND CERTIFICATION To the Delivering Firm Named Above II this account is a quailed retirement socount. I hew amended the rooked* plan so that it names es successor custodian the trustee lewd above. Unless *therein indicated in the IflebLIC9041 above, phase II'S« all macs in my account to Pershing without gnarls,. ouch emote may bo transferred within the time frames required by NYSE Rule 412 or simile nee of the NASD a other designated examining euthonty. linkriaa otherwise Indiestod in the instructions above. I authorize you to Nude% any nornmurferable proprietary many market fund seems dat are part of my account and transfer the resulting cmcit balance to the successor tustoden. I authorize you to deduct any outstanding fen due to you from the crock( balance in my account. It my account does not contain a credit blame or if the credit Imlence in the a000unt b insufficient to satisfy any outstanding fees due to you. I authorize you to liquidate the assets in my ettomt to the extent necessary to satisfy that obligation. II ~Rioter* c< other Instruments in my account era in your physical possession. I Instruct you to transfer them in good dekverabb form. included affixing any Mousy tax maws. lo enable the successor mete:~ to triage them in he name for the purpose of tha sab, whedarAert draged to me. I onderäind diet upon reoeiving • copy of this transfer information, MI cancel all open orders for my account on your books. harfem I have distroyetb:R.naturned to you creditIdebit cards andfor unused checks issued to ma In connection with my brokerage account. I undentand)stif you will panic* n wflerospQct to the ~Ron of any assets in my brokerage •ccount that are nontrensferable. AMNATUfrE gUldtturAdD eT CLIENT'S SIGNATURE:. DATE' Alin JOINT CLIENT'S SIGNATURE' DATE: Please attach your most recent brokered* account statement to process this amount trawler. INVESTMENT PROFESSIONAL'S NAME- INVESTMENT PROFESSIONAL'S PHONE NUMBER: CUSIP• belongs to he respective owner 4/4.0597 (10109) Page 3 of 3 09-PW11 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0029043 CONFIDENTIAL SDNY_GM_00175227 EFTA01344010