EFTA01449445.pdf

Account # N4C-02:O10-1 IV. PARTIAL TRANSFERS. DIRECT MUTUAL FUNDS AND LIQUIDATIONS (If there are more than eight assets, attach a signed list to this form) QUANTITY ASSET DESCRiPTON CUSIPTiSYMEOL FUND ACCOUNT TRANSFER INSTRUCTIONS' DIVIDEND COTTION' CAPITAL GAIN ESTIMATED S NUMBER OPTION VALUE O Transfer in Kind 0 Liquidate 0 Cash 0 Reinvest J Cash 0 Reinvest CI Transfer in Kind 0 Liquidate 0 Cash 0 Reinvest ..I Cash LI Reinvest O Transfer in lend 0 Liquidate 0 Cash 0 Renver U Cash 0 Reinvest 0 Transfer in *net 0 Liquidate 0 Cash 0 Reinvest J Cash LI Reinvest O Transfer in lend 0 Liquidate 0 Cash 0 Reinvest U Cash 0 Reinvest 0 Transfer in *net 0 Liquidate 0 Cash 0 Reinvest J Cash U Reinvest O Transfer in lend 0 Liquidate 0 Cash 0 Reinvest U Cash 0 Reinvest 0 Transfer in Kind 0 Liquidate 0 Cash 0 Reinvest j Cash LI Reinvest II you have requested a iguidellon, your market pilot is not guaranteed. You will receive the current market puce after your transfer request is received. reviewed, and determined to be In good order by the delivering firm. Pershing is not responsible for market fluctuations or delays in the review process. DRS items cannot be liquidated. 2 II this is a mutual fund transfer and there is no dividend or capital gain option checked in the section above. Pershing will PrO0Oss this request as reinvest (FOR OFFICE USE ONLY: All transfers must be added to Pershing's transfer systems) V. RETIREMENT PLAN RESTRICTIONS AND CERTIFICATIONS III Age 70! - restrictions. It you are at the age of 70 this year and you are transferring or rolling over assets from an IRA. qualilied plan or 4030o) account. you may be required to lake a minimum dstributi.on (HMCo) from your qualified plan or 40310) account before rolling over your assets. II Rollover Certification of Employee: I understand the tubs 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:mud. All information provided by rne is true and correct and may be faked on by Pershing LLC. I assume full responsibility for this transaction and will not hold Pershing LLC liable for any adverse consequences that may result I hereby irrevocably designate this contribution in lunds 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 (I111.111 Firm Nanw) SUCCESSOR CUSTODIAN'S SIGNATURE: DATE VI PARTICIPANT SIGNATURE AND CERTIFICATION To the Delivering f am Named Abosi.• the trustee listed above. unless Moo/ re pleyso ityorl'er ri,4:.<.c. .: :0 re:F.Inp ,11(r may he trangerred within the time frames required by NYSt Rule 412 or smear ruie of the NASD or other deugnated examining authority. Unless otherwise indicated in the instructions above, I authorize you to liquidate any nontransferable propnelary money market fund assets that we part of my account and transfer the resalling credit balance to the successor custodian I authorize you to deduct any outstandng lees due to you from the credit balance in my account. II my account does not contain a credit balance. 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 ri my account to the extent necessary I0 satisly that Obligation. II ceitalcales a other instruments n my account are in you physical possession. I instruct you to transfer them in good deliverable form, induchng affixing any necessary tax waivers, to enable the successor custodian to transfer them in es name la the purpose of the sale, when. and as directed to me. I understand that upon receiving a copy of the transfer information, you nil cancel 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 in connection with my brokerage account I understand that you wrap:intact me with respect tO the disposition of any assets in my brokerage account that are nontransferable. =NATURE 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 09 MIA 059/ I IOW) Page 3 of 3 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0104876 CONFIDENTIAL SDNY_GM_00251060 EFTA01449445