Case File
efta-01449438DOJ Data Set 10OtherEFTA01449438
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01449438
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
Account #
46-023812
IV. PARTIAL TRANSFERS. DIRECT MUTUAL FUNDS AND LIQUIDATIONS
(If there are more than eight assets, attach a signed list to this form)
CluAFETITY
ASSET DESCRIPTION
CUSIPISYMBOT FUND ACCOUNT
Nt eaBER
TRANSFER INSTRUCTIONS'
CAPITA_ GAIN
DIVIDEND CeTION'
OPTOhe
ESTimATED S
VALVE
2,200
US Dollar
OUSDPRAA7
al Transfer in Kind 0 Liquidate CI Cash D Reinvest J Cash LI Reinvest
HtLeRS.S7
-1
-19 I
US Dollar
0USDPRAA7
S Transfer in Kind D Liquidate CI Cash Ll Reeves! ..I Cash U Reinvest
PS LIS Gold Put 74347%119Di
El Transfer in lend CI Liquidate 0 Cash 0 Renew, j Cash LI Reinvest
PS US Gold Put 74347W9DI
S Transfer in Kind D Liquidate CI Cash CI Reinvest J Cash U Reinvest
O Transfer in Kind D Liquidate 0 Cash 0 Reinvest U Cash LI Reinvest
0 Transfer in Kind 0 Liquidate CI Cash CI Reinvest J Cash U Reinvest
O Transfer in lend 0 Liquidate 0 Cash 0 Reinvest U Cash LI Reinvest
0 Transfer in Kind 0 Liquidate 0 Cash 0 Reinvest LI Cash J Reinvest
II you have requested a legs0on, your market price is not gusanteest. You will 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
in 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
PrOCAlS$ thus request as reinvest
(FOR OFFICE USE ONLY: All transfers must be added to Pershing's transfer systems)
V. RETIREMENT PLAN RESTRICTIONS AND CERTIFICATIONS
ui Age 70" restrictions. II you are at areal the age of 70 this year and you are transferring or rolling over assets from an IRA. qualilied plan or 40300
account. you may be required to take a minimum dstributi.on (HMCo) from your qualified plan or 40310) account before rolling over your assets.
II Rollover Certification of Employee: I understand the lutes and conditions and I have met the requirements for making a rollover. Due t0 the important
tax consequences ol rolling over lunds or property. I have been advised to see a tax proton:out. 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 properly as a transfer or rollover contribution.
TO THE PRIOR TRUSTEE:
J
Pershing LLC accepts appointment as successor custodian.
J
Please be advised that
does hereby accept appointment as successor custodian
(Insert Firm Name)
SUCCESSOR CUSTODIAN'S SIGNATURE:
DAT E
VI . PARTICIPANT SIGNATURE AND CERTIFICATION
To the Delivering Firm Named Aboer
the trustee listed Above. Unless 0tneoz
re
411
.n ri.
.1:.<.(tn: :0 re:F.Inp,
may be transferred within the time frames required by NYSt Hub 412 or smear rule of the NASD or other deegnated exernming authority. Unless otherwise
indicated in the instructions above, I authorize you to liquidate any nontransferable proprietary money market fund assets that we part ol my account and transfer
the malting credit balance to the successor custodian I authorize you to deduct any ouistandng lees due to you from the credit balance in my account. II my
account does not contain a credit Delence. or if the credit balance in the account is insufficient to satisfy any outstanding lees due to you. I authorize you to
liquidate the assets ri my account to the extent necessary to sately that obligation. II cerelicates or other instruments n my account are in Wit physic-al
possession, I instruct you to trends: them in good deliverable Men including affixing any necessary tax wavers, to enable the successor custodian to transfer
them in es name for Be purpose of the sale, when. and as directed torus. I understand that upon receiving a copy of ths kanslor information, you val 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 men connection
with my brokerage aCCOtan I understand Mel you well CallaCt 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.
Please attach your most recent btokerage account statement to piocess this account transfer
INVESTMENT PROFESSIONAL'S NAME:
INVESTMENT PROFESSIONAL'S PHONE NUMBER:
CUSIP' belongs to its respective owner
CO PVIM 059/ I IOW) Rigor 3 ol 3
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0104869
CONFIDENTIAL
SDNY_GM_00251053
EFTA01449438
Technical Artifacts (6)
View in Artifacts BrowserEmail addresses, URLs, phone numbers, and other technical indicators extracted from this document.
SWIFT/BIC
DESCRIPTIONSWIFT/BIC
DIVIDENDWire Ref
TRANSFER INSTRUCTIONSWire Ref
transfer
INVESTMENTWire Ref
transfer requestWire Ref
transfer systemsForum Discussions
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