EFTA Document EFTA01449440

Account Transfer Form I. RECEIVING FIRM INFORMATION (Only one per form) RECEIVING FIRM CLEARING NUMBER. 0443 ACCOUNT NUMBER: SOCIAL SECURITY NUMBER SECONDARY SOCIAL SECURITY NUMBER: T 1- ACCOUNT TYPE: (Enter the two character code) C 0 or TAXPAYER IDENTIFICATION NUMBER: or TAXPAYER IDENTIFICATION NUMBER: 1..1J Nonretiremeni: SN—ISinglei —Womb TR —(Trustl CT —(Canumit.) CO—(Corporate) CU—(Custodian) ES —)Estate) BC- (Bank Custody) AG —(Agency) Retirement: IR — (Traditional IRAI RI—(Roth IRA) DR —(Direct Rollover) BI—(Beneficiary) BR —(Beneficiary Roth IRA) 4K —(40Ik) El—(Education Savings Account) SI —(SIMPLE IRA) OP —(Qualrhed Plan) 4B—(403b) 7B—(457 Plan) HS—(Heallh Savings Account) 5P-(525 Plan) OT—rOther) Other: II. DELIVERING ACCOUNT INFORMATION CLEARING NUMBER: ACCOUNT NUMBER: a DELIVERING FIRM CONTACT INFORMATION (MANDATORY WHEN CLEARING NUMBER IS NOT PROVIDED) FIRM NAME: JP Morgan CONTACT NAME' ACCOUNT TITLE. (As it appears on your statement) FIRM ADDRESS. (No PO Box) — — CITY' STATE: TELEPHONE NUMBER: NOTE It statement is necessary to process this form. Southern Trust Company, Inc ZIP: III. TRANSFER TYPE (Choose only A. ACCOUNT TRANSFER 0 FULL (Check one below) 0 TRANSFER ALL ASSETS IN MND (Skip It/Sedan VI) 0 LIQUIDATE ALL ASSETS LIST ED IN SECTION IV (Liquidations are not lor brokerage accounts) 0 TRANSFER AU. ASSETS IN KIND EXCEPT FOR THE ASSETS USIED IN SECTION N. WHICH REQUIRE LIQUIDATION 0 PARTIAL (Complete Section M B. DRS/DRIP U FULL (Check one below) 0 SELL FRACTIONS AND CLOSE ACCOUNT O TRANSFER ALL FULL SHARES ONLY O PARTIAL (List assets m Section N) NOTE: For transler agents. electronically send positions or issue a certificate for whole shares and redeem tractional shares. C. DIRECT MUTUAL FUND LI TRANSFER MUTUAL FUNDS FROM THE ACCOUNT HELD DIRECTLY AT THE FUND COMPANY ISee Est in Section IV for exact instructions) NOTE: Only one fund family per form. D. BANK RETIREMENT PLAN ACCOUNTS (Select only one) O UOUIDATE IMMEDIATELY AND TRANSFER CASH I am aware of and acknowledge any penalty I will incur from an earty withdrawal, O UOUIDATE AT MATURITY AND TRANSFER CASH Specify maturity date 'submit two to three weeks before maturity date). NOTE: Liquidations involving bank CDs. checking accounts. or savings accounts can only be processed from retirement accounts. SIGNATURE SIGNATURE DATE DATE I! 1 RPC)-150 ACAT CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) CONFIDENTIAL SDNY_GM_00251055 arEPWIA-06.97 NOW) P.yot 2 or 3 DB-SDNY-0104871 EFTA01449440