EFTA01449437.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 CUSir/SYMSOL 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 J Cash LI Reinvest O Transfer in lend 0 Liquidate 0 Cash 0 Newest U Cash 0 Reinvest 0 Transfer in Kind 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 *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 *rid 0 Liquidate 0 Cash 0 Reinvest j Cash LI Reinvest II you have requested a awidation, your market price is not gusanteed. Yee will receive the current merket 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 !podded. 2 it this is a mutual fund transfer and there is no dividend or capital gain option checked in the section above. Pershing wilt PrOCOS$ 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. It you are at he age of 70 this year and you are transferring or rolling over assets from an IRA. qualified plan or 4030d account. you may be required to take a minimum dstribuhon (HMCo) from your qualified plan or 40310) account before rolling over your assets. It Rollover Certification of Employee: I understand the lutes 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 (Insert Firm Nanw) SUCCESSOR CUSTODIAN'S SIGNATURE: DAT E VI PARTICIPANT SIGNATURE AND CERTIFICATION To the Delivering I urn Named Abon• the trustee listed above. unless moor A try :5.-tre.'er 411 At.if!..2-. .n ri. .1:.<.(tn: :0 re:F.Inp, may be transferred within the time frames required by NYSt Hub 412 or smear rule of the NASD or other deugnated examining authority. Unless otherwise indicated in the instructions above, I author?). yeti to liquidate any nontrandarable propnelary money market fund assets that we part of my account and transfer the reniting credo 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 in my account to the extent necessary lo steely that obligation. II cerelicates or other instruments n my account are in Wit physical possession. I instruct you to transfer them in good deliverable form, inducing affixing any necessary tax waivers, to enable the successor custodian to transfer them in as name nor the purpose of the sale, when. and as directed to me. I understand that upon receiving a copy of the (raider intOrMalKal, you will 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 CCnneCtiOn with my brokerage Scented I understand that you will Contact me With respect to the disposition of any assets in my brokerage account that are nontransferable. 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 P140A 059/ I IOW) Pane 3 of 3 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0104866 CONFIDENTIAL SDNY_GM_00251050 EFTA01449437