EPSTEIN
page 4 / 693 . OCR, unverified
nontransferable proprietary money market fund assets that are part of my
account and transfer
the resulting credit balance to the successor custodian. I authorize you to
deduct any outstanding fees due to you from the credit balance in my
account. If my
account does not contain a credit balance, or if the credit balance in the
account is insufficient to satisfy any outstanding fees due to you, I
authorize you to
liquidate the assets in my account to the extent necessary to satisfy that
obligation. If certificates or other instruments in my account are in your
physical
possession, I instruct you to transfer them in good deliverable form,
including affixing any necessary tax waivers, to enable the successor
custodian to transfer
them in its name for the purpose of the sale, when, and as directed to me. I
understand that upon receiving a copy of this transfer information, 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 to me in
connection
with my brokerage account. 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:
JOINT CLIENT'S SIGNATURE:
DATE:
DATE:
Please attach your most recent brokerage account statement to process this
account transfer.
INVESTMENT PROFESSIONAL'S NAME:
INVESTMENT PROFESSIONAL'S PHONE NUMBER:
09-PWM-0597 (10/09) Page 3 of 3
CUSIP® belongs to its respective owner.
DATE:
does hereby accept appointment as successor custodian.
EFTA01464665
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Account Transfer Form Instructions
Complete all sections according to the instructions below. Please print or
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.
EFTA01464666
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■ 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,