EFTA01449451.pdf

Account # IV. PARTIAL TRANSFERS. DIRECT MUTUAL FUNDS AND LIQUIDATIONS (If there are more than eight assets, attach a signed list to this form) ACCOUNT CluAARITV ASSET DESCRIPTON CUSIMPSYNISCA. TuND TRANSFER iNSTRUCTIONS (AMEND OPTION" CAPITAL GAIN ESTIMATES'S NUMBER OPTIOhF VALUE 57,000 Ally pfd o Transfer in Kind 0 Liquidate 0 Cash U Reinvest J Cash 0 Reinvest 1.525mm CI Transfer in Kind 0 Liquidate 0 Cash 0 Reeves! ..I Cash U Reinvest O Transfer in lend 0 Liquidate 0 Cash 0 Newest U Cash 0 Reinvest 0 Transfer in *rid 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 *net 0 Liquidate 0 Cash 0 Reinvest J Cash U Reinvest O Transfer in lend 0 Liquidate 0 Cash 0 Reinvest j Cash 0 Reinvest 0 Transfer in *rid 0 Liquidate 0 Cash 0 Reinvest LI Cash U Reinvest 1 11 you have requested a legislation, your market price is not gusanteed. YOu cos 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 there is no dividend or capital gain option checked in the section above. Pershing will PrOCAlss 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. qualified plan or 40300 account. you may be required to take a minimum distribution HMCo) from your qualified plan or 40310) account before rolling over your assets. le Rollover Certification of Employee: I understand the ROOK 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 funds or other property as a transfer or rollover contribution. TO THE PRIOR TRUSTEE: -I Pershing LLC accepts appointment as successor custodian. -I Please be advised that does hereby accept appointment as successor custodian (Insert Firm Name) SUCCESSOR CUSTODIAN'S SIGNATURE: DAT E VI PARTICIPANT SIGNATURE AND CERTIFICATION To the Delivering Firm Named Aboec the trustee listed above. Unless Otnenz I': :5in er 411 At.if!..2-. .n 1:.<.(t.: :0 re:F.Inp, may be transferred within the time Iremes required by NYSt Hub 412 or smear rule of the NASD or other deugnated examining authority. Unless otherwise indicated in the instructions above, I authorize yeti to liquidate any nontransferable proprietary money market fund assets that we pert 01 my account and transfer the retailing credit balance to the SUCOUSSOI Custodian I authorize you to dedact any outstandng lees due to you from the credit balance in my account. II my account does not contain a credo Delence. 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 to sadly that obligation. II cerelicates or other instruments n my account are in wit physical possession. I instruct you to transfer them in good deliverable tom inducing affixing any necessary tax waivers, to enable the successor comedian to transfer them in es name for Ow purpose of the sale, when. and as directed to me. I understand that upon meowing 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 n connection with my brokerage tiOCOtra I understand that sbu will contact me vnth respect to the disposition of any assets in my brokerage account that are nontranslerable. =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: CA)SiP' hqongs la ot: reqiective owner Roy of 3 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0104882 CONFIDENTIAL SDNY_GM_00251066 EFTA01449451