EFTA Document EFTA01345089

Account # IV. PARTIAL TRANSFERS, DIRECT MUTUAL FUNDS AND LIQUIDATIONS (If there are more than eight assets, attach a signed list to this form) u...AN'irY cc,sLT DESCRiPTON CUSirc,,ratior ruND ACCOUNT ranARER TRANSFER INSTRUCTIONS' 04ViDENDCPTION, CAPITAL GAIN OPTiote ESTimATED S VALUE 0 Transfer in Kind U Liquidate CI Cash 0 Reinvest 0 Cash 0 Reinvest - 0 Transfer in Kind 0 Liquidate 0 Cash LI Reinvest LI Cash LI Reinvest O Transfer in Kind CI Liquidate 0 Cash 0 Reinvest J Cash 0 Reinvest 0 Transfer in Kind U Liquidate 0 Cash 0 Reinvest ..I Cash U Reinvest 0 Transfer in Kind CI Liquidate CI Cash 0 Reinvest J Cash 0 Reinvest 0 Transfer in Kind 0 Liquidate U Cash U Reinvest 0 Cash U Reinvest O Transfer in Kind CI Liquidate ()Cash 0 Reinvest 0 Cash 0 Reinvest 0 Transfer in Kind 0 Liquidate CI Cash 0 Reinvest 0 Cash U Reinvest If you have requeSted a KifirdatiOn. yOUr market price M not guaranteed. YOu receive the current market 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 n 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 prOCess this request as reinvest. (FOR OFFICE USE ONLY: All transfers must be added to Pershing's transfer systems) V. RETIREMENT PLAN RESTRICTIONS AND CERTIFICATIONS 11; Age 70 restrictions ',co are al ern; the age at 70 • this year and ',Cu are transferring or rolling over assets from an IRA. qualified plan or 403(b) account. you may be required to lake a minimum distribution IRMO) from your qualified plan or 403(b) account before rolling over your assets. Is Rollover Certification of Employee: I understand the rules and conditions and I have met the requirements for making a rollover. Due to the important tax consequences of rolling over funds or property. I have been advised to see a tax professional. All information provided by me is True and correct and may be relied On by Pershing LLC. I assume lull 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: Z1 Pershing LLC accepts appointment as successor custodian. J Please be advised that does hereby accept appointment as successor custodian (Insert Fern Name) SUCCESSOR CUSTODIAN'S SIGNATURE: DATE: VI. PARTICIPANT SIGNATURE AND CERTIFICATION To the Delivering Firm Named Above: II this account is a qualified retirement account. I have amended the applicable plan SO that it naves as SuCCeSSOI Custodian the trustee listed above. Unless otherwise indicated in the Instruction above, please transfer all assets in my account to Pershing without penalties, such assets may be transferred within the time Irarnes required by NYSE Rule 412 or similar rule ol the NASD or other designated 'sunning authority. Unless otherwise indicated in the instructions above. I authorize Won) liquidate any nontransferable proprietary money market fund assets that are part 01 my account and transfer the feuding credit balance to the successor custodian. I author°e you to deduct any outstaring fees due to you Dorn the credit balance in my account. If my account does not contain a credit balance, or if the credit balance in the account is intsillicient to satisfy any outstanding lees due to you. I authorize you to liquidate the assets m my account to the extent necessary to safely that obligation. If oerblicates or other instruments n my account are in your physical possession. I instruct you to transfer them in good deliverable form, including affixing any necessary tax wavers, 10 enable the successor custodian 10 transfer them in its name for the purpose of the sale, when, and as directed to me. I understand that upon receiving a copy et this transfer information, you vat 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 accouit I understand that r3u well contact me with respect to the disposition of any assets in my brokerage account that are nontransferable. CLIENT'S SIGNATURE: DATE: JOINT CLIENT'S SIGNATURE: DATE: Please altach your most recent brokerage account statement to process this account transfer INVESTMENT PROFESSIONAL'S NAME: Taxis Smith INVESTMENT PROFESSIONAL'S PHONE NUMBER: SIGNATURE GUARANTEED BY: CUSIP" belongs to its respective owner. CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) CONFIDENTIAL 09 PWM 059/ I10/C0) Patio 3 of 3 DB-SDNY-0031201 SDNY_GM_00 177385 EFTA01345089