EPSTEIN
page 2 / 693 . OCR, unverified
type all information. Return the completed
form to your financial organization.
NOTE: You must attach your most recent statement to process this account
transfer. For an internal transfer (for instance, a transfer of
assets between two introducing broker-dealers who clear through Pershing)
the statement is not required.
I. RECEIVING FIRM INFORMATION (Only one per form)
■ Provide your Pershing account number.
■ Provide your Social Security Number (SSN) or Tax Identification Number
(TIN)
■ If the account is a joint account, provide the SSN or TIN for the joint
owner.
■ Provide the two character account type code that most accurately describes
your account.
II. DELIVERING ACCOUNT INFORMATION
■ Provide the clearing firm number. If there is no clearing firm number,
enter the delivering firm name, contact name, and telephone
number.
■ Provide the original account number of the account you are delivering to
Pershing.
■ Provide the account title as it appears on your statement for the account
you are transferring.
III. TRANSFER TYPE (Chose only one)
Indicate the type of transfer you are requesting by checking the appropriate
box. Pershing will only transfer positions in kind for retail
accounts. For nonretirement accounts, the quickest way to liquidate your
assets is to call your existing financial organization and place a
sell order. In order to ensure that the trade is executed at the time and
price you want, request to have the proceeds check mailed directly
to you. When you receive the check, mail it (including your account number
on the check) to: PERSHING, ONE PERSHING PLAZA, 14TH
FLOOR, JERSEY CITY, NEW JERSEY 07399, ATTENTION: MONEY DESK.
■ A Direct Registration System (DRS)/Direct Reinvestment Plan (DRIP)
transfer is a transfer of a position held
directly at the transfer agent.
■ A direct mutual fund transfer is a transfer in kind of a direct mutual
fund position from the mutual fund company.
■ Bank retirement plan accounts involve transfers of retirement plans at
banks with CDs, checking accounts, or savings accounts. Please
indicate if you want to liquidate immediately or defer these instructions
until maturity date. Please contact your financial organization
to stop any automated rollover reinvestments. (Please read section V and
sign when applicable.)
IV. PARTIAL TRANSFERS, DIRECT MUTUAL FUNDS AND LIQUIDATIONS
If you selected Partial Transfer, use this section to specify the
appropriate assets for a partial transfer. If you selected Direct Mutual Fund
Transfer, use this section to identify the mutual fund positions to transfer.
■ Liquidation instructions will only be accepted from non-National
Securities Clearing Corporation (NSCC) firms.
EFTA01464660
--- PAGE 2 ---
■ Select a dividend and capital gain option for direct, in kind mutual fund
transfers. If a box is not checked, Pershing will process the
transfer as reinvest, for dividend and capital gain options.
V. RETIREMENT PLAN RESTRICTIONS AND CERTIFICATIONS
If you are transferring a retirement account and are over the age of 70 1/2,
read this section carefully. Contact your investment professional
or financial organization if you have any questions.
■ The new custodian must provide the appropriate paperwork.
■ For retirement accounts for which Pershing LLC acts as the custodian or
servicing agent, you must pay all termination fees to your
prior custodian before you can transfer assets. Any deposit made to your
Pershing LLC custodian account to reimburse fees after the
transfer shall be processed as a current year contribution.
NOTE: If you are transferring from a trustee, make the appropriate
selection. If you have selected someone other than Pershing LLC as
custodian, have your investment professional or financial organization
obtain the necessary signatures to accept custodianship.
VI. PARTICIPANT SIGNATURE AND CERTIFICATION
■ Sign and date the form.
■ The form must be signed, dated, and signature guaranteed within 90 days of
its receipt.
09-PWM-0597 (10/09) Page 1 of 3
EFTA01464661
--- PAGE 3 ---
Account Transfer Form
I. RECEIVING FIRM INFORMATION (Only one per form)
RECEIVING FIRM CLEARING NUMBER: 0443
ACCOUNT NUMBER:
N4 G 024935
SOCIAL SECURITY
NUMBER
SECONDARY SOCIAL
SECURITY NUMBER:
ACCOUNT TYPE: (Enter the two character code)
Non retirement:
Retirement:
Other:
CO
SN-(Single) JT—(Joint) TR—(Trust) CT—(Cotrustee) CO—(Corporate) CU--
(Custodian) ES—(Estate)
BC—(Bank Custody) AG—(Agency)
IR—(Traditional IRA) RI—(Roth IRA) DR—(Direct Rollover) BI—(Beneficiary) BR--
(Beneficiary Roth IRA)
4K-(401k) EI—(Education Savings Account) SI-(SIMPLE IRA) QP—(Qualified Plan)
4B—(403b)
7B—(457 Plan) HS—(Health Savings Account) 5P—(529 Plan)
OT—(Other)
II. DELIVERING ACCOUNT INFORMATION
CLEARING NUMBER:
ACCOUNT NUMBER:
FIRM NAME:
ACCOUNT TITLE: (As it appears on your statement)
W60975005
JP Morgan