EFTA01345092.pdf

Account Transfer Form Instructions Complete all sections according to the instructions below. Please print or type all information. Return the completed form to your financial organization. NOTE: You must attach your most recent statement to process this account transfer. For an internal transfer (for instance, a transfer of assets between two introducing broker-dealers who clear through Pershing' the statement is not required. I RECEIVING FIRM INFORMATION (Only one per form) W Provide your Pershing account number. ■ Provide your Social Security Number (SSN) or Tax Identification Number (TIN). ■ If the account is a icnnt account, provide the SSN or TIN for the joint owner. ® Provide the two character account type code that most accurately describes your account. II. OFT IVFRING ACCOUNT INFORMATION ■ Provide the clearing firm number. II there is no clearing firm number, enter the delivering firm name, contact name, and telephone number. ■ Provide the onginal account number of the account you are delivering to Pershing. ■ Provide the account title as it appears on your statement for the account you are transferring. III TRANSFER TYPE (Chose only oriel Indicate the type of transfer you are requesting by checking the appropriate box. Pershing will only transfer positions in kind for retail accounts. For nonretirement accounts, the quickest way to liquidate your assets is to call your existing financial organization and place a sell order. In order to ensure that the trade is executed at the time and pnce you want, request to have the proceeds check mailed directly to you. When you receive the check, mail it (including your account number on the check) to: PERSHING. ONE PERSHING PLAZA, 14TH FLOOR, JERSEY CITY, NEW JERSEY 07399, ATTENTION: MONEY DESK. ■ A Direct Registration System (DRS)/Direct Reinvestment Plan (DRIP) transfer is a transfer of a position held directly at the transfer agent. ■ A direct mutual fund transfer is a transfer in kind of a direct mutual lund position from the mutual fund company. ■ Bank retirement plan accounts involve transfers of retirement plans at banks with CDs, checking accounts, or savings accounts. Please indicate if you want to liquidate immediately or defer these instructions until maturity date. Please contact your financial organization to stop any automated rollover reinvestments 'Please read section V and sign when applicable.' IV. PARTIAL TRANSFERS, DIRECT MLITUAl FUNDS AND I ICUIDATIONS If you selected Partial Transfer, use this section to specify the appropriate assets for a partial transfer. If you selected Direct Mutual Fund Transfer, use this section to identify the mutual fund positions to transfer. ■ Liquidation instructions will only be accepted from non-National Securities Clearing Corporation (NSCC) firms. ■ Select a dividend and capital gain option for direct, in kind mutual fund transfers. If a box is not checked, Pershing will process the transfer as reinvest, for dividend and capital gain options V. RETIREMENT PLAN RESTRICTIONS AND CERTIFICATIONS II you are transferring a retirement account and are over the age of 70 112, read this section carefully. Contact your investment professional or financial organization if you have any questions. U The new custodian must provide the appropriate paperwork. ■ For retirement accounts for which Pershing LLC acts as the custodian or servicing agent, you must pay all termination fees to your prior custodian before you can transfer assets. Any deposit made to your Pershing LLC custodian account to reimburse fees after the transfer shall be processed as a current year contribution. NOTE: If you are transferring from a trustee, make the appropriate selection. If you have selected someone other than Pershing LLC as custodian, have your investment professional or financial organization obtain the necessary signatures to accept custodianship. VI PARTICIPANT SIGNATURE AND CERTIFICATION ■ Sign and dale the form ■ The form must be signed, dated, and signature guaranteed within 90 days of its receipt. 09 PWIA -059/ 00/09) Par 1 o13 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0031205 CONFIDENTIAL SDNY_GM_00 177389 EFTA01345092