EFTA Document EFTA01449461

Account # IV. PARTIAL TRANSFERS. DIRECT MUTUAL FUNDS AND LIQUIDATIONS (If there arc more than eight assets, attach a signed list to this form) auAWRY ASSET DESCRIPTION CUSIPISYMBOt. FUND ACCOUNT PABER TRANSFER INSTRUCTIONS' CAPITA_ GAIN DrviDEND OPTION" OPTIOhF ESTIMATED S VALUE 2,200 US Dollar OUSDPRAA7 le Transfer in Kind 0 Liquidate 0 Cash 0 Reinvest J Cash LI Reinvest 96,uRR.117 -1 -19 US Dollar 0USDPRAA7 S Transfer in Kind 0 Liquidate 0 Cash 0 Reinvest ..I Cash LS Reinvest PS LIS Gold Put 74347W9D1 e Transfer in Kind CI Liquidate 0 Cash 0 Newest j Cash 0 Reinvest I PS US Gold Put 74347WOW S Transfer in Kind 0 Liquidate 0 Cash 0 Reinvest J Cash U Reinvest O Transfer in Kind 0 Liquidate 0 Cash 0 Reinvest U Cash 0 Reinvest 0 Transfer in Kind 0 Liquidate 0 Cash 0 Reinvest J Cash U Reinvest O Transfer in lend 0 Liquidate 0 Cash 0 Reinvest U Cash 0 Reinvest 0 Transfer in Kind 0 Liquidate 0 Cash 0 Reinvest LI Cash Ll Reinvest It you have requested a iquidellon, your market price is not gusanteed. YOu will receive the current market price alter your transfer request is received. reviewed, and determined to be In good order by the delivering fem. 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 PrO0Oss thus request as reinvest (FOR OFFICE USE ONLY: All transfers must be added to Pershing's transfer systems) V. RETIREMENT PLAN RESTRICTIONS AND CERTIFICATIONS Hi Age 7D - restrictions. It you are at eau the age of 70 this year and you are transferring or rolling over assets from an IRA. qualified plan or 40300 account. you may be required to lake a minimum distribution (FIMD) from your qualified plan or 40303) account before rolling over your assets. It Rollover Certification of Employee: I understand the rules 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 prolevuonal. 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: J Pershing LLC accepts appointment as successor custodian. J Please be advised that does hereby accept appointment as successor custodian Omen Firm Name) SUCCESSOR CUSTODIAN'S SIGNATURE: PA1 f VI . PARTICIPANT SIGNATURE AND CERTIFICATION To the Delivering Firm Newry(' Abe... the trustee listed above. Unless other./ e I': I :fine.'er 411 At.if! 2-. .n ri.4:.<.a. .. .O re:F.Inp, may be Irandeired within the time Irames required by NVSL Rule 412 or smiler ruie of the NASD or other dengnated examining authority. Unless otherwise indicated in the instructions above, I authorise you to liquidate any nontransferable prop glary money market fund assets that we pert ol my account and transfer the reaitmg 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 credo balance. or if the credit balance in the account is insufficient to satisfy any outstanding lees due t0 you. I authorize you to liquidate the assets ri my account to the extent necessary to saintly that Obligation. II certercates or other instruments n my account are in Wit physical possession, I instruct you to transfer them in good deliverable loon induchng affixing any necessary tax waivers, to enable the successor comedian to transfer them in es name for the purpose of the sale, when, and as directed torus. I understand that upon Waving a copy of the transfer information, you nil 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 aCCOtin I understand that yOu will contact nu) with respect tO the disposition of any assets in my tsokerage account mat are nontranslemble. SIGNATURE GUARANTEED BY: CLIENT'S SIGNATURE: DATE: JOINT CLIENT'S SIGNATURE: DATE. Please attach your most recent brokerage account statement to piocess this account transfer INVESTMENT PROFESSIONAL'S NAME: INVESTMENT PROFESSIONAL'S PHONE NUMBER: CUSIM belongs to its respective owner 09 PVIM 059/ I iOar) Paue 3 ol 3 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0104894 CONFIDENTIAL SDNY_GM_00251078 EFTA01449461