Customer Account Transfer

544327 (Rev 18) Page 1 of 2
Customer Account Transfer (Please Use a Separate Form for Each Transfer)
Sub Firm # BR Code FA Code Account Number Contra Clearing Number
(Office Use Only)
(Office Use Only)
Account You are Transferring TO
Full Name or Account Title Social Security Number or Tax ID Number FCC Clearing Number
0141
Account You are Transferring FROM Delivery Organi zatio ns: See Delivery Instruction s on Page 2.
Account Name
Account Number
Name of Firm or Fund Company Currently Holding Your Account
Address of Firm
Check here if this Account is a: Qualified Retirement Plan IRA OTA DRT
Type of Transfer
1 Full Brokerage Account Transfer. (Check one at right)
Transfer all assets or shares in my account as is Liquidate and transfer cash
2 Partial or Non-Brokerage Transfer.
A
Trust Company, Bank, Cre dit Union, Savings & Loan, Annuities, Life Insurance, DRIP Plan Shares or Certificates of Deposit Transfer.
Liquidate and Transfer Cash.
Transfer all assets or shares in my account as is.
Liquidate Certificates of Deposit IMMEDIATELY. (I acknowledge the penalty I may incur from an early withdrawal.)
Liquidate Certificates of Deposit AT MATURITY. (Submit this transfer no earlier than 30 days prior to maturity.) Maturity Date _____________
B
Partial Brokera ge, Trust Company or Annuity Transfer. (Transfer only the assets or shares listed below) Choose One for Each Item
Quantity Description of Asset and Cusip or S ymbol
Liquidate and
Transfer cash
Transfer
Shares As Is
All
All
All
*For additional assets please attach a separate sheet
3 Mutual Fund Company Transfer. (One form per Fund Family. Please send to Mutual Funds, H0006-014 Orange Envelope) Choose One for Each Item
Quantity Full Name of Mutual Fund
Liquidate and
Transfer cash
Transfer
Shares As Is
Dividend and Capital Gains
(Choose One for Each Item)
All
Cash for Both
Reinvest Both
All
Cash for Both
Reinvest Both
All
Cash for Both
Reinvest Both
*For additional assets please attach a separate sheet
Age 70½ Reminder - THE FOLLOWING APPLIE S ONLY TO A RETIREMENT ACCOUNT TRANSFER.
If you will turn age 70½ this year, or you are already over age 70½, please be reminded that you must withdraw your required minimum distribution amount by the
deadline. The deadline for individuals who turn 70½ this year is April 1st of next year and for all others, the deadline is December 31
st
of this year. The IRS penalty for
underdistribution of the mandatory amount by the deadline is 50%. In order to calculate the required amount for this year, the value of this IRA on December 31
st
of las t
year will be needed. In addition, required minimum distributions are not eligible for rollover.
Auction Rate Securi ties: Account Transfer Acknowledgement
You understand and agree to the following in connection with the auction rate securities held in your account:
Your auction rate securities were purchased prior to the transfer of your account to us. As a result, we are not responsible or liable for any prior
recommendations or advice with respect to these securities nor are we under any obligation to provide you with any investment recommendation or advice with
respect to th e dis p osition or co nti nu e d hold in g of t he se sec ur ities in your acc ou nt fol lowing the tran sfer of your acc ou nt.
You also understand and agree that we are not under any obligation to you (i) to provide loans under margin agreements or otherwise secured in whole or part
by the auction rate securities in your account, (ii) to purchase or continue to purchase any auction rate securities in periodic rate sett in g auc ti ons or in sec ond ar y
market transactions, or (iii) to provide liquidity for such securities. Many auctions for these securities are in failed status meaning th at hold ers of th ese secur ities
are not able to sell these securities in the periodic rate setting auctions or in secondary market transactions and as a result, liquidity for these securities currently
is greatly impaired. We provide no assurance that you will be able to sell or otherwise dispose of these securities following the transfer of your account to us.
You understand that we take actions in connection with other customers that we do not offer you in connection with your auction rate securities.
Revocation of Advisory Agreement
When applicable, I authorize the delivering firm to discontinue all account management agreements immediately. The client will have sole responsibility for investment
decisions with respect to the securities, cash and other assets in the client's account until the client hires a new investment manager.
** A COPY OF YOUR MOST RECENT STATEMENT IS REQUIRED TO PROCESS THIS TRANSFER **
Client Signature
X
Date
Joint Account Holder Signature
X
Date
Signature Guaranteed By
Medallion Signature Guara ntee Program
PLE ASE BE ADVISED THAT FIRST CLEARING, LLC ACCEPTS APPOINTMENT AS SUCCESSOR CUSTODIAN.
Successor Custodian Signature
X
Date
Contact Name Phone Number
ACAT (Sections 1 & 2)
Send to H0006-014 Blue Envelope
Mutual Funds (Section 3)
Send to H0006-0 14 Orange Envelope
Accounts carried by First Clearing, LLC
Page 1/2
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Customer Account Transfer PDF

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