EFTA01344426.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 CUSiriSvMSOL FUND ACCOUNT TRANSFER INSTRUCTIONS' DIVIDEND OPTION" CAPITAL GAIN ESTIMATED S NUMBER OPTION VALUE O Transfer in Kind 0 Liquidate CI Cash D Reinvest J Cash LI Reinvest CI Transfer in Kind D Liquidate CI Cash 0 Reinvest ..I Cash U Reinvest O Transfer in lend 0 Liquidate 0 Cash D Remises, U Cash LI Reinvest 0 Transfer in *net D Liquidate CI Cash CI Reinvest J Cash U Reinvest O Transfer in lend 0 Liquidate 0 Cash D Reinvest U Cash LI Reinvest 0Transfer in Kind 0 Liquidate CI Cash CI Reinvest J Cash U Reinvest O Transfer in lend 0 Liquidate 0 Cash D Reinvest U Cash CI Reinvest 0 Transfer in Kind 0 Liquidate 0 Cash LI Reinvest LI Cash J Reinvest II you have requested a iguidatIon, your market price is not guaranteed. YOu will receive the current matte 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 MOMS'S this request as reinvest (FOR OFFICE USE ONLY: All transfers must be added to Pershing's transfer systems) V. RETIREMENT PLAN RESTRICTIONS AND CERTIFICATIONS ui Age 70' - restrictions. It 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 dstribution (HMCo) from your qualified plan or 40310) account before rolling over your assets. It Rollover Certification of Employee: I understand the !Ube 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 (I111.111 Firm Name) SUCCESSOR CUSTODIAN'S SIGNATURE: DAi E VI PARTICIPANT SIGNATURE AND CERTIFICATION To the Delivering Firm Named Aber... the trustee listed above. Unless Wrier./ A I': I :fine.'er 411 At.if! 2-. .F1 rit .1:.<.(tn: :0 re:F.Inc.; may be IranSterred within the time ImMe$ required try 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 prop glary money market fund assets that we part of my account and transfer the retailing credo balance to the successor custodian I authorize you to deduct any ouislandng 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 outialanding lees due to you. I authorize you 10 liquidate the assets in my account to the extent necessary to steely that obligation. II certificates or other instruments n my account are in Wit ptiyeail possession, I instruel you 10 transfer them in good deliverable form, inducing affixing any necessary tax wavers, to enable the successor comedian to transfer them in as ranee la the purpose of the sale, when. and as directed to me. I understand that upon receiving a copy of the transfer 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 connection with my brokerage aCCOtin I understand that yOu well Contact me with respect to the disposition of any assets in my brokerage account that are nOntranslemble. SIGNATURE 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/ !IOW) Page 3 of 3 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0029850 CONFIDENTIAL SDNY_GM_00176034 EFTA01344426