EFTA01449458.pdf

Account # 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 CUSIPUSYMSOL FUND ACCOUNT TRANSFER INSTRUCTIONS' DIVIDEND OPTION" 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 14nd 0 Liquidate 0 Cash 0 Renver U Cash 0 Reinvest 0 Transfer in Kind 0 Liquidate 0 Cash 0 Reinvest J Cash LI Reinvest O Transfer in 14nd 0 Liquidate 0 Cash 0 Reinvest U Cash 0 Reinvest 0 Transfer in Kind 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 Kind 0 Liquidate 0 Cash 0 Reinvest j Cash LI Reinvest II you have requested a iquidellon, your market gnosis not gusanteed. YOu will receive the current market price 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 theta is no dividend or capital gain option checked in the section above. Pershing wilt PrOCOSS this request as reinvest (FOR OFFICE USE ONLY: All transfers must be added to Pershing's transfer systems) V. RETIREMENT PLAN RESTRICTIONS AND CERTIFICATIONS is Age 70' - restrictions. 11 you are at he 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 dstribubon (HMO) from your qualified plan or 40310) account before rolling over your assets. It Rollover Certification of Employee: I understand the rules 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 me is true and correct and may be relied 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: J Pershing LLC accepts appointment as successor custodian. —1 Please be advised that does hereby accept appointment as successor custodian (Intent Firm Nanw) SUCCESSOR CUSTODIAN'S SIGNATURE: DATE VI PARTICIPANT SIGNATURE AND CERTIFICATION To the Delivering I urn Named Abrade the trustee IISIS above. unless moor A try fin:: 411 At.ifr:,. .n ri. .-s:.<.(tn: :0 re:F.Inc.; may be transferred within the time frames required by HYSt Hub 412 or smiler ruie of the NASD or other deugnated examining authority. Unless otherwise indicated in the instructions above, I author?)e yeti." liquidate any nontransferable propnelary money market fund assets that we part CO my a unt and transfer the retailing Credo balance 10 the SUCCilusct 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 in my account to the extent necessary lo sahsly that Obligation. II certificates or other instruments n my account are in Wit physic-al possession, I instruct you to transfer them in good deliverable form, inducing affixing any necessary tax wavers, to enable the successor custodian to transfer them in OS name lor the purpose of the sale, when. and as directed to me. I understand that upon receiving a copy of this 1r:titter inforMalton, 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 n CtnneCtiOn with my brokerage aCCOisil I understand that you will Contact me vnth respect to the disposition of any assets in my brokerage account that are nontransferable. siONaauttE GUARANTEED 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 P140A 059/ il0.(0) Page 3 of 3 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0104891 CONFIDENTIAL SDNY_GM_00251075 EFTA01449458