N4C-02:O10-1 Account # IV. PARTIAL TRANSFERS. DIRECT MUTUAL FUNDS AND LIQUIDATIONS (If there are more than eight assets, attach a signed list to this form) QUANTITY ASSET DESCRiPTON CUSIPTiSYMEOL FUND ACCOUNT NUMBER TRANSFER INSTRUCTIONS' DIVIDEND COTTION' CAPITAL GAIN OPTION ESTIMATED S VALUE O Transfer in Kind 0 Liquidate 0 Cash 0 Reinvest J Cash 0 Reinvest CI Transfer in Kind 0 Liquidate 0 Cash 0 Reinvest ..I Cash LI Reinvest O Transfer in lend 0 Liquidate 0 Cash 0 Renver U Cash 0 Reinvest 0 Transfer in *net 0 Liquidate 0 Cash 0 Reinvest J Cash LI Reinvest O Transfer in lend 0 Liquidate 0 Cash 0 Reinvest U Cash 0 Reinvest 0 Transfer in *net 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 j Cash LI Reinvest II you have requested a iguidellon, your market pilot is not guaranteed. 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 PrO0Oss this request as reinvest (FOR OFFICE USE ONLY: All transfers must be added to Pershing's transfer systems) V. RETIREMENT PLAN RESTRICTIONS AND CERTIFICATIONS III Age 70! - restrictions. It you are at the age of 70 this year and you are transferring or rolling over assets from an IRA. qualilied plan or 4030o) account. you may be required to lake 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 tubs and conditions and I have met the requirements for making a rollover. Due to the important tax consequences of rolling over lunds or propert