EFTA Document EFTA01345088

Account Transfer Form I. RECEIVING FIRM INFORMATION (Only one per TONT) RECEIVING FIRM CLEARING NUMBER 0443 ACCOUNT NUMBER SOCIAL SECURITY NUMBER SECONDARY SOCIAL SECURITY NUMBER: - FF1- ACCOUNT TYPE: (Enter the two character code) C 0 or TAXPAYER IDENTIFICATION NUMBER: or TAXPAYER IDENTIFICATION NUMBER: Nonratuemeni. JT-1-lornil TR —(Trustl CT-ICoitustee) CO—(Corporate) CU—(Custodian) ES —(Estate) BC —(Bank Custody) AG—(Agency) Retirement. IR —I Iraditional IRA' RI—(Roth IRA, DR —(Direct Rollover) RI —IBeneliciary) BR —Weneficiary Roth IRA) 4K —(401k) El—(Education Savings Account) SI —(SIMPLE IRA) QP—(Qualified Plan) 4B—(403b) 78—(457 Plan) HS-114eallh Savings Account) 5P-(529 Plan) OT—tOthen Other. II. DELIVERING ACCOUNT INFORMATION CLEARING NUMBER. ACCOUNT NUMBER- FIRM NAME JPMergan Char. Bank, N.A. ACCOUNT TITLE: (As it appears on your statement) Jeepers Inc. NOTE: A complete copy of yet. DELIVERING FIRM CONTACT INFORMATION (MANDATORY WHEN CLEARING NUMBER IS NOT PROVIDED) CONTACT NAME: FIRM ADDRESS. (No PO Box) CITY: STATE: ZIP. TELEPHONE NUMBER: —It statement is necessary to process this form. III. TRANSFER TYPE (Choose only one) A ACCOUNT TRANSFER U FULL 'Check one below) K TRANSFER ALL ASSETS IN KIND (Skip to Section VII U LIQUIDAI E ALL ASSETS LISTED IN SECTION IV (Lou's:Moons are not for brokerage accounts) U TRANSFER ALL ASSE IS IN KIND EXCEPT FOR THE ASSETS USTED IN SECTION N. WHICH REQUIRE LIQUIDATION U PARTIAL (Complete Section M B. DRS/DRIP U FULL (Check one below) U SELL FRACTIONS AND CLOSE ACCOUNT 0 TRANSFER ALL FULL SHARES ONLY U PARI IAL (List assets in Section NI NOTE: For transler agents. electronically send positions o issue a certificate for whole shares and redeem Tractional shares. C. DIRECT MUTUAL FUND LI TRANSFER MUTUAL FUNDS FROM THE ACCOUNT HELD DIRECILY AI THE FUND COMPANY ISee list in Section IV for exact instructions) NOTE: Only one fund family per form. D. BANK RETIREMENT PLAN ACCOUNTS (Select only one) K LIQUIDATE IMMEDIATELY AND TRANSFER CASH I am aware of and acknowledge any penalty I will incur from an early withdraws. O LIQUIDATE Af MATURITY AND TRANSFER CASH Sootily maturity dale (submit two to Three weeks before maturity date). NOTE: Liquidations involving bank CDs. checking accounts, or savings accounts can only be processed Irom retirement accounts. SIGNATURE SIGNATURE DATE DATE ul J 111 :TPD 150 ACAT 39 IViM-0697 110091 Page 2 of 3 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0031200 CONFIDENTIAL SDNY GM_00177384 EFTA01345088