KYC Information Form LLC

KYC Information Form LLC

Account Transfer Instruction Form

Use this form to transfer securities and/or funds from another financial institution to Deutsche Bank Trust Company Americas (DBTCA). Please use a separate form for each account you are transferring and attach a copy of your most recent statement

DBTCAAccount (Receiving Custodian)
Account Holder Name: / Account Number:
Account Type: / Taxpayer Identification Number: / Daytime Telephone Number
DBTCA Contact Name: / Phone:
Account Being Transferred (Delivering Custodian)
Account Title (as it appears on your statement) / Account Number at Delivering Firm
Name and Clearing Number of Delivering Firm / Address of Delivering Firm
Delivering Firm Contact Name / Daytime Phone Number

Account Transfer Instructions

A. Account Type

Individual / Joint / Corporation / Estate / Trust / Custodian
IRA / IRA Rollover / Roth IRA / 401 (K) / Bank Custody / Qualified Plan
Agency / Other: ______

B. Type of Transfer

Select oneSelect one

ACATSTotal Transfer (Cash and Securities)

Non-ACATSPartial Transfer (Transfer only the assets and quantities indicated below)

Other Instructions (as specified below)

C. Method of transfer

Please select one of the following options:

 / Transfer all assets in-kind (liquidate money market funds and transfer assets in kind as per delivery instructions on page 2) /  / Liquidate Certificates of Deposit at Maturity (Maturity Date: ____/____/______)
 / Liquidate all assetsand wire the proceeds (see wire instructions) /  / Liquidate Certificates of Deposit Immediately. I am aware and acknowledge penalty I will incur for an early withdrawal
 / Transfer my entire account after liquidating the assets listed below
 / Transfer only the assets and quantities indicated below
Instructions for Dividends and Capital Gains
Shares / Asset description** / CUSIP®/Symbol / Fund Account Number / In-kind* / Liquidate / Re-register / Reinvest both / Cash for both*
 /  /  /  / 
 /  /  /  / 
 /  /  /  / 
 /  /  /  / 
 /  /  /  / 
 /  /  /  / 
 /  /  /  / 
 /  /  /  / 

*Unless indicated otherwise, DBTCA will default to this option for executing your transfer and establishing your assets at DBTCA

**Attach additional sheets as necessary

Account Holder Signature and Certification

To the delivering firm named above:

If this account is a qualified retirement account, I have amended the applicable plan so that it namesDBTCA as successor custodian. Unless otherwise indicated in the instruction above, please transfer all assets in my account to DBTCA without penalties. I authorize you to deduct any outstanding fees due 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 you, I authorize you to liquidate the assets in my account to the extent necessary to satisfy that obligation. I understand that if I choose a method of disposition of assets in a retirement account other than liquidation and transfer, I may become liable for the payment of taxes and penalties with respect to such assets. 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 by 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 securities account. I authorize you to liquidate any nontransferable proprietary money market fund assets that are part of my account and transfer the resulting credit balance to DBTCA. I understand that you will contact me with respect to the disposition of any assets in my securities account that are nontransferable.

To the Successor Custodian:

I acknowledge that DBTCA reserves the right to review all assets being transferred prior to acceptance as successor custodian. If I am over 70 1/2, I attest that none of the amount to be transferred will include the required minimum distribution for the current year pursuant to Section 410 (a)(9) of the Internal Revenue Code. I have had the opportunity to review the plan document and understand the conditions noted therein, including the execution of a valid adoption agreement prior to signing this transfer request.I am the legal owner of the shares clear of any liens, claims or encumbrances.I hereby acknowledge that the information and instructions on this form are complete and accurate and that DBTCAwill rely on such information and instructions, which shall be binding on the undersigned.I understand that DBTCA, in acting on the instructions herein, has no duty to me with respect to the transfer or delivery of the assets identified herein, other than to make a reasonable effort to carry out my instructions.In consideration of your accepting these instructions, I hereby release and discharge DBTCA from any liability or claim in connection with the foregoing instructions and agree to indemnify and hold DBTCA harmless against loss from any action, claim or demand of any person as a result of DBTCAcomplying with these instructions, except where due to the gross negligence on the part of DBTCA.

Account Holder’s Signature
X / Date / Medallion Signature Guarantee
Joint Account Holder’s Signature
X / Date

Letter of Acceptance

To the prior custodian/trustee of the retirement account designated for transfer:

Please be advised that DBTCA does hereby accept appointment as successor custodian.

Authorized Signature (DBTCA) / Date

Information for Delivering Firm

USD DELIVERY INSTRUCTIONS – CLIENT WIRES ONLY / EUROCLEAR
Client Wires Only
FED Wire
State Street Bank
ABA # 011-0000-28
DDA # 00041178
I/N/O Deutsche Bank Trust Co Americas
F/B/O Account #: Global Plus Account Number and Name / USD sent from outside U.S. Bank
SWIFT Payment
State Street Bank & Trust Co.
BIC: SBOSUS3N
Account #CH334291
Nostro # 40414401
Global Plus Account Number (must be in field 21A)
FFC: BJ60 (must be in field 42) /
  • ONSHORE / US TAXABLE CLIENT
State Street Bank and Trust Co.
Participant #: 93793
Account: State Street Bank and Trust Company
FFC NJD1 - DB Onshore Custody
Global Plus Account Number and Name
Note: Use transaction code 03C or 07C and Code 93793 (State Street Bank and Trust Company)
USD DELIVERY INSTRUCTIONS - SECURITY RELATED ACTIVITY
FED Wire
State Street Bank
ABA # 011-0000-28
DDA # 00041194
I/N/O Deutsche Bank Trust Co Americas / SWIFT Payment
State Street Bank
BIC: SBOSUS3NXXX
Account Name: BIC SBOSUS3FXXX
Cash Account: 40414401
FFC: DDA # 00041194
I/N/O Deutsche Bank Trust Co Americas /
  • OFFSHORE / US TAXABLE CLIENT
State Street Bank and Trust Co.
Participant #: 93793
Account: State Street Bank and Trust Company
FFC NJD2 - DB Offshore Custody
Global Plus Account Number and Name
Note: Use transaction code 03C or 07C and Code 93793 (State Street Bank and Trust Company )
DTC - DVP/RVP - ID
State Street Bank and Trust Co.
DTC# 987
Internal A/C#: Global Plus Account Number
AGENT #: 59136
Institutional ID #: (59136 or Various per External Investment Advisor) / DTC Non-ID or FREE DELIVERY
State Street Bank and Trust Co.
DTC# 987
FFC: BJ 60 for A/C#:Global Plus Account Number and Name / ACATS INSTRUCTIONS
STATE STREET BANK & TRUST COMPANY
DTC #987
Internal A/ C # G+
FFC: BJ60
PHYSICAL
DTCC/New York Window
55 Water Street
New York, NY10041
Attn: Robert Mendez
ACCOUNT: State Street
FFC: BJ60
I/F/O: Global Plus Account Number and Name /
FED BOOK ENTRY SECURITIES
STATE STREET BOSTON /SPEC / BJ60
ABA # 011-00-0028
I/F/O: Global Plus Account Number and Name

Created on 07/20/2007