IRA, Roth IRA & SEP IRA Mutual Fund Employee Application

Transcription

1 IRA, Roth IRA & SEP IRA Mutual Fund Employee Application Prudential Mutual Fund Services LLC (PMFS), a Prudential Financial company For assistance: Pruco Financial Professional: (800) Financial Professionals: (888) Clients: (800) Instructions Use this application if you are an active employee of Prudential, an eligible family member of an active Prudential employee, or a person eligible for class Z shares as indicated in the fund s prospectus. Eligible family members generally include an employee s spouse, children and parents. To confirm class Z share eligibility, please contact the Prudential Mutual Fund Service Center. For all eligible accounts, purchases will be made in Class Z funds or selected money market funds. Class Z funds have no sales charges and lower expenses than most other share classes. For more information on our funds, please visit our website at www. prudentialfunds.com. Please print clearly, preferably in capital letters and black ink. Return your completed application to Prudential Mutual Fund Services LLC. See page 13 for complete mailing instructions. With certain limited exceptions, the funds are only available to be sold in the United States, US Virgin Islands, Puerto Rico, and Guam. USA Patriot Act requirements To help the government fight the funding of terrorism and money laundering activities, Prudential Financial is required to obtain, verify, and record information on each person who opens an account. Please be sure to review the Privacy Policy at the end of this application. FATCA reporting - The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specified United States persons. 1 Important The following information is required for each person associated with the account: Name Residence address Date of birth Taxpayer ID number (SSN or EIN) If this information is not provided, we will be unable to open the account. If we are unable to verify your identity, Prudential Financial reserves the right to close your account or take other steps we deem reasonable. Employee Relationship If the new account is being set up for an employee or for an eligible family member of an active Prudential employee, then the Prudential employee s information must be completed. Account Owner s relationship to the employee: Self Spouse Child Parent Other: First name MI Last name Daytime phone number Extension Cell phone number Department / Division Name Employee s Work Location Address City State ZIP code 4-digit ext. MF1030 Ed. 3/2016 Page 1 of 14

2 2 Account Ownership/Associated Person Information (Required for the USA Patriot Act.) All information is required. Important: If a minor IRA account is being setup, then please provide the information of the custodian/ guardian, in the same format, on a separate sheet. First name MI Last name Social Security number Date of birth Account mailing address City State ZIP code 4-digit ext. Residential/Permanent address (We cannot accept a PO Box.) City State ZIP code 4-digit ext. Daytime phone number Extension Cell phone number address (optional) Citizenship U.S. Citizen Nonresident alien* Resident alien Country of residence * Nonresident aliens must attach the applicable Internal Revenue Service (IRS) Form W-8(BEN, ECI, EXP, IMY), which can be obtained at Marital Status Married Single Widowed Divorced Number of Dependents Employment Status Employed Unemployed Retired Prudential employee Occupation Employer Employer address City State ZIP code 4-digit ext. (optional) Employer telephone number Extension Highest education level achieved Post graduate work College graduate Attended college High school graduate Attended primary/high school Technical or vocational school Associated member of a broker/dealer Yes No MF1030 Ed. 3/2016 Page 2 of 14

3 3 Choose your Beneficiaries Tell us who should receive your account balance after your death. For each beneficiary you list by name, check a beneficiary type (primary or secondary) and provide all information. If the Per Stirpes designation is checked and the named beneficiary does not survive the account owner, but leaves surviving descendants, then any share otherwise payable to such beneficiary shall instead be paid to such beneficiary s surviving descendants, by right of representation. Please note, the primary and secondary beneficiary totals must each equal 100%. Spousal Consent If you are a married person and have not designated your spouse as your sole primary beneficiary, your spouse must sign section 14. A. Primary Beneficiaries (check all that apply) Primary Secondary (Please check one) Name: Per Stirpes Percentage: Social Security Number: Date of Birth: Relationship: % Address: Daytime phone number: City: State: Zip Code: 4-digit ext address Primary Secondary (Please check one) Name: Per Stirpes Percentage: Social Security Number: Date of Birth: Relationship: % Address: Daytime phone number: City: State: Zip Code: 4-digit ext address MF1030 Ed. 3/2016 Page 3 of 14

4 3 Beneficiaries (continued) Primary Secondary (Please check one) Name: Per Stirpes Percentage: Social Security Number: Date of Birth: Relationship: % Address: Daytime phone number: City: State: Zip Code: 4-digit ext address Primary Secondary (Please check one) Name: Per Stirpes Percentage: Social Security Number: Date of Birth: Relationship: % Address: Daytime phone number: City: State: Zip Code: 4-digit ext address Please check here if you have attached a separate sheet with additional beneficiary designations. Include the date and your signature. Minor Beneficiaries (optional) If any beneficiary named in this form is a minor, I hereby request that proceeds be paid to as custodian under the (name of state) UTMA (to the extent permitted by named state). Important: The date of birth of the named minor is required in Section 3 (Individuals) for this designation to apply. MF1030 Ed. 3/2016 Page 4 of 14

5 4 Account Type & Contribution Information A. Account Type (Choose only one.) Traditional IRA Rollover IRA Roth IRA*(Establishment date) SEP IRA** (Employer name) * The establishment date is the earliest date you either opened a Roth IRA or originally converted from a traditional IRA to a Roth IRA. If you do not provide this information we will use the date the account is established as the establishment date. This information is requested by the IRS and is needed to determine compliance with the taxable five-year holding period requirement. ** For SEP IRAs, the tax year for employer contributions is for your informational purposes only; all employer contributions are reported in the year received by Prudential Mutual Fund Services LLC (PMFS). B. Inherited IRA Decedent s First name MI Last name Decedent s Date of death Note: Please complete and attach the Request for IRA Beneficiary Distribution (Spouse and Non-Spouse) form (MF1024B) or the Request for IRA Beneficiary Distribution (Entity) form (MF1024C) to establish required minimum distributions (RMD) from your new inherited IRA. C. Contribution/Purchase Instructions Contributions (For SEP IRAs, input employee contributions as a Contribution.) Contribution for tax year Contribution for tax year Employer contribution for tax year Employer contribution for tax year Regular $ Regular $ Amount $ Amount $ Catch-up $ Catch-up $ (SEP IRA only) (SEP IRA only) Rollover Purchase. Within 60 days of your receipt either from another like IRA (e.g. Roth IRA to Roth IRA or Traditional IRA to Traditional IRA) or an eligible rollover distribution from a retirement plan to a Traditional IRA, Rollover IRA or Roth IRA. Rollover check amount $ Direct Rollover from an employer-sponsored retirement plan. Complete the Transfer/Direct Rollover/Conversion Authorization form (MF1012). Estimated amount $ Direct Rollover from a Roth 401(k) plan or Roth 403(b) plan. Complete the Transfer/Direct Rollover/Conversion Authorization form (MF1012). Estimated amount $ Transfer of an existing IRA, Roth IRA, SEP IRA, or SARSEP account from another custodian. Complete the Transfer/Direct Rollover/Conversion Authorization form (MF1012). Estimated amount $ Conversion from an existing Traditional IRA, SEP IRA, or SARSEP IRA account from another custodian into a Roth IRA. Complete the Transfer/Direct Rollover/Conversion Authorization form (MF1012). Estimated amount $ Please make check payable to Prudential Mutual Fund Services. Prudential employee purchases will be purchased into Class A at NAV and will not incur any sales charge. MF1030 Ed. 3/2016 Page 5 of 14

6 5 Mutual Fund Selection & Allocation Please provide your investment selections by checking the box next to the fund number and indicate allocations as either a percentage (%) or dollar amount ($). If a fund offers a share class not listed, then write the fund number or share class in the Other column next to the fund name. Refer to the fund s prospectus for fund minimum and eligibility requirements. Fund Share Class Initial Investment Fund Name Class Z Other % $ ASSET ALLOCA TION FUNDS EQUITY FUNDS Asset Allocation Prudential Balanced Fund 160 Prudential Conservative Allocation Fund 1512 Prudential Growth Allocation Fund 1504 Prudential Moderate Allocation Fund 1508 Prudential QMA Global Tactical Allocation Fund 1135 Equity Prudential Jennison 20/20 Focus Fund 451 Prudential Jennison Blend Fund 403 Prudential Jennison Conservative Growth Fund* ---- Prudential Jennison Equity Income Fund 427 Prudential Jennison Equity Opportunity Fund 425 Prudential Jennison Growth Fund 413 Prudential Jennison Rising Dividend Fund 1103 Prudential Jennison Select Growth Fund 465 Prudential Jennison Small Company Fund 407 Prudential Jennison Value Fund 404 Prudential QMA Large-Cap Core Equity Fund 459 Prudential QMA Mid-Cap Value Fund 499 Prudential QMA Small-Cap Value Fund 171 Prudential QMA Stock Index Fund 165 Prudential QMA Strategic Value Fund 468 Prudential QMA Defensive Equity Fund 456 Specialty Prudential Financial Services Fund 461 Prudential Jennison Global Infrastructure Fund 1092 Prudential Global Real Estate Fund 450 Prudential Income Builder Fund 455 Prudential International Real Estate Fund 1043 Prudential Jennison MLP Fund 1095 Prudential Jennison Natural Resources Fund 416 Prudential Jennison Utility Fund 412 Prudential QMA Long-Short Equity Fund 1106 Prudential Real Assets Fund 1053 Prudential Real Estate Income Fund 1142 Prudential Select Real Estate Fund 1112 Prudential US Real Estate Fund % $ * The Prudential Jennison Conservative Growth fund is only available in class A at Net Asset Value (continued) MF1030 Ed. 3/2016 Page 6 of 14

7 5 Mutual Fund Selection & Allocation (continued) Please provide your investment selections by checking the box next to the fund number and indicate allocations as either a percentage (%) or dollar amount ($). If a fund offers a share class not listed, then write the fund number or share class in the Other column next to the fund name. Refer to the fund s prospectus for fund minimum and eligibility requirements. EQUITY FUNDS FIXED INCOME FUNDS Global/ Internat ional Equity Taxable Fixed Income Tax- Exempt Money Market Fund Share Class Initial Investment Fund Name Class Z Other % $ Prudential QMA International Equity Fund 464 Prudential Jennison Emerging Markets Equity Fund 1117 Prudential Jennison Global Opportunities Fund 1039 Prudential Jennison Intl Opportunities Fund 1085 Prudential Absolute Return Bond Fund 1047 Prudential Core Bond Fund 161 Prudential Corporate Bond Fund 159 Prudential Emerging Mkts Debt Local Currency Fund 1057 Prudential Floating Rate Income Fund 1036 Prudential Global Absolute Return Bond Fund 1149 Prudential Global Total Return Fund 442 Prudential Government Income Fund 406 Prudential High Yield Fund 408 Prudential Short Duration High Yield Income Fund 1088 Prudential Short Duration Multi-Sector Bond Fund 1098 Prudential Short-Term Corporate Bond Fund 434 Prudential Total Return Bond Fund 422 Prudential Unconstrained Bond Fund 1145 Prudential California Muni Income Fund 417 Prudential Muni High Income Fund 418 Prudential National Muni Fund 458 Prudential Short Duration Muni High Income Fund 1109 Prudential Government Money Market Fund % $ Total: (100% or $) % $ Note: The total must equal 100% or the total dollar amount provided in section 4. MF1030 Ed. 3/2016 Page 7 of 14

8 6 Distribution Options All dividends and capital gains will be reinvested if you do not make an election. Dividends: Reinvest in shares Pay in cash* Send by ACH to the bank specified in section 9. Capital Gains: Reinvest in shares Pay in cash* Send by ACH to the bank specified in section 9. * If the dividends and capital gains are to be distributed in cash or sent by ACH, please complete, sign and return IRS Form W-4P with this application. 7 Telephone/Online Exchange and Redemption Option Your account will automatically be coded with the Telephone/Online Redemption and the Telephone/Online Exchange Privileges, unless you check the No box below. I do not want telephone exchange and redemption privileges. Unless otherwise indicated above, you authorize the Fund s distributor, Prudential Investment Management Services LLC (PIMS), to accept telephone exchange and redemption instructions from any person identifying himself/herself as the owner of the account or as the owner s dealer representative conveying instructions of the owner. PIMS and/or the Fund s transfer agent, Prudential Mutual Fund Services LLC (PMFS), will employ reasonable procedures to confirm that such telephone instructions are genuine. Neither the Funds, PIMS nor PMFS shall be liable for any losses due to unauthorized or fraudulent instructions provided that such procedures are followed. Telephone exchanges and redemptions are subject to the procedures and conditions set forth in each Fund s prospectus. 8 Purchase Options (Check all that apply.) A. ACH Purchase Option: Check if you want the capability to make wire purchases, online or by telephone, upon demand, by having the purchase amount debited from your bank account. B. Automatic Investment Plan (AIP): Set up recurring purchases into a fund and have the purchase amount debited from your bank account. Note: All contributions will be processed as current year contributions and the total contributions may not exceed the maximum allowed per tax year. Frequency (The minimum investment amount is $50 per fund.): Weekly on (enter day of week e.g. Monday) Monthly on the (enter a day of the month e.g. 15th) Start date* *If a specific day of the month is not listed above, debits will be made on or about the 15th of the month. Share class $ into the Fund Z $ into the Fund Z $ into the Fund Z $ into the Fund Z $ into the Fund Z $ into the Fund Z $ Total amount (to be debited from bank/credit union account as specified in section 9) MF1030 Ed. 3/2016 Page 8 of 14

9 9 Bank of Record* (Complete only if section 8 is completed.) Bank/Credit union name Bank telephone number Bank routing number Bank account number *To ensure accuracy, verify with your bank or credit union. Name of depositor on bank records (first, middle initial, last name) Bank type: Checking Savings Name of joint depositor on bank records (first, middle initial, last name) Attach voided check here. Ü Ý Name on bank account Check no Street address City, State ZIP DATE PAY TO THE ORDER OF $ FOR Ü ABA number (9 digits) VOID DOLLARS ÝBank account number MF1030 Ed. 3/2016 Page 9 of 14

10 10 e-delivery and Mailing Preferences Consider our e-delivery service as your preferred delivery option. It is a fast, easy, and secure way to get account information at any time. It is environmentally friendly by reducing paper and ink use. If you elect e-delivery, you will receive an informing you when your account documents become available and instructions on how to view them online. Note: Certain entity and institutional accounts are not eligible for e-delivery. FEE WAIVER By selecting the three e-delivery options marked with an asterisk (*) below and completing the enrollment in e-delivery, your account will qualify for a waiver of the $15 account maintenance fee that is assessed annually on each fund balance under $10,000. Document Type Delivery Preference Prospectuses, Shareholder Reports, and Proxy Mailings e-delivery* U.S. mail Quarterly Statements e-delivery* U.S. mail Year-end Statements and Privacy Notice e-delivery U.S. mail Confirmations e-delivery* U.S. mail Tax Forms After account setup, log in online to elect the tax form e-delivery option. address for e-delivery required only if e-delivery is selected above. By enrolling for e-delivery, you consent to receive electronic versions instead of paper copies of materials for your mutual fund accounts. Once your account is established, visit to enroll your account online. PMFS will only use your address to provide you with the material you requested or to send important news about your account. Note: All documents will be sent to you by U.S. Mail if you do not select a delivery preference. 11 Text Message alert for financial transactions on your account If you would like to receive a text (SMS) message when a financial transaction takes place on your account, please check the box below. We will use the cell phone number in section 1 to send you a text message to confirm your financial transactions (purchases, exchanges and redemptions). Please read our alert user agreement below. Yes, I wish to receive text messages regarding financial transactions processed on my account. You are agreeing to receive periodic service alerts from Prudential, each of which may be delivered to your phone using an automated system. Message frequency may vary. Standard Message and Data Rates may apply to any SMS or MMS you send or receive as part of this program. At any time, you may reply to a text with STOP to cancel future notifications. Terms and Privacy Policy at MF1030 Ed. 3/2016 Page 10 of 14

11 12 Account Owner(s) Investment Profile (Incomplete Information may result in delayed processing) If a Prudential Advisor (financial professional )is listed in section 13 then this section must be completed. Otherwise skip to section 14. The information in this section is used to help determine whether the investments you have selected are appropriate, given your financial objectives. Annual Income Owner s income from all sources, before taxes. Household Income Income from all sources, before taxes, from all members of the household contributing income. Net Worth The value of your assets minus liabilities. For an individual it would be the total value of existing assets, such as stocks, bonds, bank accounts, mutual funds, life insurance cash value, annuities, real estate, and other investments minus all outstanding liabilities, such as mortgages, loans, taxes and credit card balances. Liquid Net Worth That part of a person s net worth held in cash or easily convertible to cash, such as money market fund shares, bank deposits, mutual funds or other marketable securities. Ranges Annual Household Net Liquid Income Income Worth Net Worth Up to $24, $25,000 $49, $50,000 $74, $75,000 $99, $100,000 $149, $150,000 $249, $250,000 $499, $500,000 $749, $750,000 $999, $1,000,000 $2,499, $2,500,000 $4,999, $5,000,000 $9,999, $10,000,000 $24,999, $25,000,000 or greater Federal Tax Bracket: 15% or less 25% 28% 33% 35% Investment Time Horizon (Indicate the number of years you intend to hold your mutual fund account.) 0 3 Years 4 7 Years More Than 7 Years What are your monthly expenses (e.g., food, medical expenses, rent/mortgage, revolving debt, property taxes, transportation, utilities, entertainment and other recurring living expenses): $ Years of Investment Experience (Indicate number of years of experience in any of the following that apply.) Equities Bonds Options Other Futures Mutual Funds Variable Annuity/Life None Were the mutual fund selections based on an investment allocation pursuant to a company-approved asset allocation model? Yes No Risk Tolerance Your risk tolerance is your comfort level to withstand risk with respect to investments (e.g., the potential to absorb losses in your investments). For example, an investor whose risk tolerance is conservative seeks securities that are most likely to preserve principal with low risk, while an investor with an aggressive risk tolerance is willing to accept a high degree of risk regarding potential loss of principal. Conservative Prefer little risk and low volatility in return for accepting potentially lower returns. Minimizing exposure of principal to loss or fluctuation is very important. (continued) MF1030 Ed. 3/2016 Page 11 of 14

12 12 Account Owner(s) Investment Profile (continued) (Incomplete Information may result in delayed processing) Moderately Conservative Willing to take some risk to seek enhanced returns. Reduced exposure of principal to loss or fluctuation is important. Moderate Willing to assume an average amount of market risk and volatility or loss of principal to achieve potentially higher returns. Moderately Aggressive Willing to assume an above-average amount of risk and volatility or loss of principal to take advantage of potentially higher return opportunities. Aggressive Willing to sustain substantial volatility or loss of principal and assume a high level of risk in pursuing potentially higher returns. Risk Tolerance (Check one.) Conservative Moderately conservative Moderate Moderately aggressive Aggressive Investment Objectives Your investment objective is how you seek to have your investments achieve your financial goals. For example, a person who chooses growth as a primary investment objective is seeking growth of principal rather than generation of income. Preservation of Capital Seeks to preserve the value of your investments through all market conditions with a preference for holding cash and/or cash equivalents (e.g., money market funds, CDs, Treasury securities with maturities of one year or less). Income Seeks to earn income through holdings of bonds and/or income-yielding securities. Tax-Free Income Predominantly seeks to earn income free from income taxes. Growth Seeks to achieve growth of capital through investment in securities. Short-Term Gain Emphasis on short-term trading practices to capitalize on market fluctuations. This objective is associated with higher-than-normal market risk. Speculation Emphasis on aggressive investments that assume above-average market risk with hope of achieving commensurate gains. Diversified Investment options selected conform with recommendations of company-approved Asset Allocation Model. Investment Objectives Select up to two (2) objectives. Indicate first choice as 1 and second choice, if any, as 2. Preservation of capital Income Tax-free income Growth Short-term gain Speculation Diversified Investment Funding I will pay for my initial investment through my: CDs/Liquid assets/savings Mutual funds Annuities Life insurance (If selected, please specify death proceeds, dividends, cash value, etc.) Rollover (from) o Other Tentatively, I plan on making additional investments. During the first year, my total additional investments planned are $ I will pay for these additional first year investments through my: CDs/Liquid assets/savings Mutual funds Annuities Life insurance (If selected, please specify death proceeds, dividends, cash value, etc.) Rollover (from) o Other MF1030 Ed. 3/2016 Page 12 of 14

13 13 Financial Professional(s) Identification and Signature(s) (if applicable) 1. Financial professional (first name, MI, last name) (Please print.) Financial professional s signature X Broker/dealer name (Please print.) Broker/dealer number Financial prof. # /Contract # Branch office #/Agency code Percent Office phone number Alternate phone number % Ext. Ext. 2. Financial professional (first name, MI, last name) (Please print.) Financial professional s signature X Broker/dealer name (Please print.) Broker/dealer number Financial prof.#/contract # Branch office #/Agency code Percent Office phone number Alternate phone number % Ext. Ext.4 14 Spousal Consent Authorization Special laws apply to the designation of a beneficiary by a married person residing in a community property state. Community property is recognized in AZ, CA, ID, LA, NV, NM, TX, WA, WI and Puerto Rico. If you are married and reside in a community property state and have not designated your spouse as your sole primary beneficiary, your spouse must sign this section. Your spouse s signature represents consent to the beneficiary designation. For Federal tax purposes, the term spouse includes any married individuals (same sex or otherwise), if the individuals are lawfully married under state law. Federal law does not recognize domestic partnerships or civil unions that are not designed as married under state law. There are numerous situations that may affect your beneficiary designation. We suggest you consult an advisor who understands both tax-law and related estate-planning implications of this form. Neither Prudential Mutual Fund Services, LLC nor Prudential Investments, or its affiliates will be liable for any consequences resulting from failure to provide proper spousal consent. First name MI Last name Sign here Signature of spouse X (of IRA owner) Date MF1030 Ed. 3/2016 Page 13 of 14

14 15 Signature and Tax Certification The undersigned warrants that I have full authority and I am of legal age to purchase shares pursuant to this application. Further, I acknowledge receipt of the prospectus(es) for the mutual fund(s) which I have selected, and agree to its/their terms. I acknowledge receipt of the applicable Individual Retirement Custodial Account Agreement and Disclosure Statement and I understand that there may be fees associated with this account. I understand this Agreement contains a pre-dispute arbitration clause. By signing below I agree to be bound by these provisions. I consent to the householded delivery of any mutual fund prospectuses, shareholder reports, or proxy statements. This means Prudential Mutual Fund Services LLC (PMFS) will deliver a single copy of these documents to shareholders who share an address, even if the accounts are registered in different names. My participation in this program will continue indefinitely unless I contact PMFS. According to Federal law and/or state regulations, your account(s) may be subject to escheatment to your state of residency. Escheatment may be based on account inactivity and/or mail being returned by the post office (RPO). Check with your state Controller s office for additional guidance. Under penalties of perjury, I certify that (cross out any item that is not true): (1) The number shown on this form is my correct Social Security/Tax ID number, (2) I am not subject to backup withholding due to failure to report interest or dividend income, (3) I am a U.S. citizen or other U.S. person (including a U.S. resident alien), and (4) I am not subject to FATCA reporting If you crossed out item 3 above, please indicate country of citizenship and attach applicable Internal Revenue Service Form W-8(BEN,BEN-E,EXP, ECI,IMY). To help the government fight the funding of terrorism and money laundering activities, Prudential Financial is required to obtain, verify, and record information on each person who opens an account. This verification process will take place as we open your account. Once verification is completed, Prudential Financial will be able to fully service and maintain the account. Account Restriction: Check here if you would like PMFS to establish a restricted account from which funds shall be disbursed only upon receipt of a valid court order or other document(s), as appropriate. A copy of the restriction (court order or otherwise), signed and dated on has been provided with this mutual fund application. The restriction shall continue until PMFS receives a valid court order or other written instruction as directed by PMFS, expressly authorizing the removal of the restriction. Sign here The Internal Revenue Service does not require your consent to any provision of this document other than the certification required to avoid backup withholding. Owner s signature X Date State of domicile* State where application is signed *Domicile is defined as a person s fixed, permanent, and principal home for legal purposes. Mailing Instructions for Mutual Fund Account Application Standard Prudential Mutual Fund Services LLC Overnight mail to: PO Box 9658 mail to: Providence, RI Prudential Mutual Fund Services LLC 4400 Computer Drive Westborough, MA MF1030 Ed. 3/2016 Page 14 of 14

15 Individual Retirement Accounts Premature Distribution Penalties With some exceptions, monies distributed from your IRA prior to age 59 ½ will be taxed as ordinary income and be subject to a 10 percent early withdrawal penalty. For more details, see the applicable Distributions section(s) of the Custodial Account Agreement and Disclosure Statement. IRA Fees The Prudential Trust Company, the custodian for your IRA, reserves the right to change it fee schedule from time to time without prior notification. Annual Maintenance Fee The annual maintenance fee is $15 per fund, with a $25 maximum for two or more funds. NO FEE will be charged if the value of your IRAs and/or SEP IRAs totals $50,000 or more. Account values are determined on the day of the systematic deduction of the fee, which usually occurs in December of each year.

16 1 Prudential Mutual Fund Services LLC (PMFS), a Prudential Financial company Instructions Submit a separate transfer form for each Resigning Custodian and each unique account type. Account Owner Information First name MI Last name Transfer/Direct Rollover/ Conversion Authorization For assistance: Clients: (800) Pruco representatives: (800) Financial professionals: (888) Social Security number PMFS account number (Required for existing accounts only.) 2 Account(s) to be Transferred to PMFS (Please attach copies of your most recent account statements.) Complete all sections for your request to be processed. Note: Prudential Mutual Fund Services LLC cannot accept stock certificates. A. Account types being transferred to PMFS Traditional IRA Roth IRA SEP-IRA 403(b) Plan Governmental 457 Plan Roth 401(k) Plan Roth 403(b) Plan SIMPLE IRA Employer-Sponsored 401(a) Retirement Plan (i.e., 401(k), pension or profit sharing plan, or defined benefit plan) B. Account number(s) to be transferred C. Resigning Custodian information Name of institution/employer-sponsored retirement plan from which the accounts in section B above will be transferred Attention Mailing address City State ZIP code 4-digit ext. Contact telephone number Extension Name of contact person or department 3 4 Transfer Instructions All liquidations are done immediately unless special instructions are provided below. Check with your sending institution about financial penalties, suspensions, signature guarantees, or other restrictions that could affect the transfer of your account to PMFS. A. Liquidate All $ (estimated value) Partial % or $ B. Special instructions for CDs and certain annuity contracts Transfer immediately. I am aware of and acknowledge Transfer at maturity (month, day, year): any penalty I may incur from an early withdrawal. (Please submit 4 weeks prior to maturity date.) Transfer-in-Kind Instructions Complete this section only if you have existing Prudential mutual funds and want to change your current Trustee/Custodian. Prudential shares will not be sold. Transfer my funds in kind immediately. Important: Section 3 must be completed for any general securities to be liquidated. Otherwise, only Prudential positions will be transferred. MF1012 Ed. 03/2015 Page 1 of 3

17 PMFS Account Type The transferred proceeds will be invested into the following account type. Traditional IRA, Rollover IRA, or SEP IRA Roth IRA or Roth Conversion IRA Establishment date* 403(b) Plan You must have an existing account at PMFS. New accounts will not be accepted. * The date you originally contributed to a Roth IRA or converted from a traditional IRA to a Roth IRA. This information is required by the IRS for compliance with the 5 tax-year holding period requirement. Mutual Fund Selection and Allocation I am opening a new account and have attached a completed application. Allocation instructions are included in section 4 of my new account application. For this transfer request, invest the amount received into my existing account(s) (indicated in section 1) in the funds and allocations listed below. Please provide investment fund selections and indicate allocations. Refer to the fund s prospectus for the fund minimum and eligibility requirements. Note: All allocations by percentage must total 100%. Share class Fund name Fund number Percent Amount A C Other Fund Holding Years. Indicate the number of years you intend to hold your mutual fund Withholding Election and Roth Conversion Disclosure Federal tax law requires that income tax be withheld at a rate of 10% from the total amount of your IRA distribution/conversion unless you elect not to have tax withheld. Depending on your state of residence, state tax withholding may also apply. If you do not want taxes withheld, proceed to the next section. If you would like to have taxes withheld, please check the box below: I would like federal and applicable state income taxes withheld from my IRA distribution being converted to a Roth IRA. I understand that, as a result, the portion of my IRA distribution that is withheld as income taxes will not be converted to my Roth IRA and may result in adverse tax consequences. (Please consult with your tax adviser.) If you would like more than 10% withheld, please indicate below: Federal taxes Mailing Instructions for Resigning Custodian State taxes* (Percentage or Dollars) Percentage: % (minimum 10% distribution), or Percentage: %, or Dollar amount $ (Amount cannot be less than 10% of distribution.) Dollar amount $ *Percentage/dollar amount cannot be less than the minimum required for your state. Checks should be made payable to PMFS for the benefit of (account owner). Checks should be sent to: Standard Prudential Mutual Fund Services LLC mail to: PO Box 9658 Providence, RI Overnight mail to: % or $ % or $ % or $ % or $ % or $ % or $ Total % or $ Prudential Mutual Fund Services LLC 4400 Computer Drive Westborough, MA If you have any questions, please call PMFS at (800) , Monday through Friday between 8 a.m. to 6 p.m. Eastern time. MF1012 Ed. 03/2015 Page 2 of 3

18 9 Authorization For Traditional IRAs, Roth IRAs, SEP-IRAs, and 403(b) accounts. It is my intention to effect a transfer, without inclusion of the amount to be transferred in my gross income. You are directed to transfer all or a portion of the redemption value of the account as identified in section 2 to an account established for me with Prudential Trust Company (PTC) as custodian. Accordingly, you are hereby directed to request on my behalf the transfer of my interest in the account referenced in section 2 for subsequent investment in Prudential Mutual Funds for investment in the custodial account(s) maintained for me. I hereby agree to the terms and conditions set forth in this Transfer/Direct Rollover/Conversion Authorization. For direct rollover. This authorizes the employer-sponsored retirement plan designated in section 2 to distribute my eligible rollover distribution directly from my retirement plan to PTC in accordance with the instructions in section 3. I have received and considered a copy of The Should You Rollover Your Retirement Plan? Challange for applicable IRA rollovers. I understand that the conversion of a traditional IRA to a Roth IRA will result in a taxable event which will be reported to the IRS. If the account owner has attained the age of 70½ or older in the year of this transfer request, the required minimum distribution must be removed prior to the transfer being made. I understand that the Resigning Custodian may charge a closeout fee for IRA accounts. The default election is for the Resigning Custodian to redeem shares to cover charges. I authorize the Resigning Custodian to redeem shares to cover those charges. Owner s signature X I will arrange to cover those charges by other means. Important: If elected, any fees must be paid to the resigning custodian, prior to submitting this form, or they may deny the request. Date Signature Guarantee (If applicable, may be required by Resigning Custodian.) Prudential Trust Company s Acceptance (To be completed by PMFS.) Prudential Mutual Fund Services LLC, as agent for the Prudential Trust Company (PTC) which is custodian of the traditional IRA, Roth IRA, SEP IRA or 403(b) plan, hereby confirms its acceptance of the above mentioned transfer or rollover. Authorized signature of Prudential Mutual Fund Services LLC (as agent for PTC) X Financial Professional Identification and Signature (if applicable) Financial professional s name (first name, MI, last name) (Please print.) Financial professional s signature X Broker/Dealer s name (Please print.) Broker/Dealer number Branch/Agency number Rep./Contract number Branch telephone number Alternate telephone number MF1012 Ed. 03/2015 Page 3 of 3

19 The Should You Rollover Your Retirement Plan? Challenge PRUDENTIAL INVESTMENTS If you are retiring or have changed jobs, it may be challenging to decide what to do with the assets in your company s pension and 401(k) plans. Here are the options available to you: ` 1. Roll over the assets into a Traditional IRA or roll over the assets into a Roth IRA 1 ; ` ` ` 2. Roll over the assets into your new employer s retirement plan; 3. Leave the assets in your old employer s retirement plan, if greater than plan minimum; or 4. Take a lump-sum distribution. DETERMINING WHICH OPTION IS RIGHT FOR YOU depends on your specific situation and financial needs. Benefits of rolling over your plan funds directly to an IRA (Traditional or Roth) may include: ` IRAs generally offer a wider range of investment choices than employer-sponsored retirement plans. ` Consolidating your retirement assets from multiple sources allows for easier account management and control of asset allocation. ` ` IRAs allow a higher degree of control of investment fees associated with your assets. Assets are typically more easily accessible in an IRA than an employer-sponsored plan. (Keep in mind that distributions from a Traditional IRA are subject to current taxes, and a 10% early withdrawal penalty may apply if you are under age 59½.) Benefits of an employer-sponsored retirement plan may include: ` Employer-sponsored plans typically allow loans which are not an option with IRAs. ` ` ` ` Company or Employer stock gets special tax treatment when it s distributed directly. Taxes are paid on original purchase price; earnings are taxed when liquidated at long-term capital gain rates. If rolled over to an IRA it would be taxed upon distribution at current income tax levels. Depending on your state of residence, different creditor protection laws apply to employer plan assets than IRAs. If you separate from service after you turn 55, you can make penalty-free withdrawals before the age of 59½. Required Minimum Distributions (RMD) may not be required if you are still working for that employer over the age of 70½. In order to determine what is right for you, you should review all fees and expenses associated with the different options available. An IRA rollover may have certain tax consequences. You may want to speak with a tax advisor about any specific tax-related questions. There are portability rules that allow you to consolidate various retirement plan balances. They are: ` Your 401(k) (and other qualified plans), 403(b), and 457(b) state or local government plan balances can be rolled into an IRA or they can be rolled into each other (as long as the plan permits such rollovers and is able to separately account for the plan assets). 2 ` ` After-tax employee contributions can be included in rollovers into an IRA, but once rolled over into an IRA they may not be rolled over again into an employer-sponsored plan. In addition, pre-tax Traditional IRA balances can be rolled into a qualified plan, if the plan allows it Ed. 12/2014

20 THE SHOULD YOU ROLLOVER YOUR RETIREMENT PLAN? CHALLENGE There are two ways to roll over your retirement plan assets into an IRA: a direct rollover or an indirect rollover. The following is an overview of each: DIRECT ROLLOVERS The easiest way to roll over your retirement plan assets into a Traditional IRA is a direct rollover, which allows you to transfer eligible assets from your company s retirement plan directly into a Traditional IRA. In doing so, you are not subject to current taxes and potential penalties, and your savings can continue to grow tax-deferred. In addition, you will not be subject to the mandatory 20% federal income tax withholding on retirement plan distributions. You can choose from several methods to transfer your retirement plan assets into your Rollover Traditional IRA. For example, your employer can send a check for your eligible retirement plan distribution directly to the financial institution where you maintain your Traditional IRA. Or your employer can make out the check to the custodian of the Traditional IRA and send it to you for immediate deposit with the custodian. You may also be able to directly transfer mutual fund shares or other securities into your Traditional IRA. 3 INDIRECT ROLLOVERS Another option is to use an indirect rollover. In this case, you receive a distribution in your name and roll all or part of it into a Traditional IRA at a later date. To avoid being subject to tax, and possibly the 10% early withdrawal penalty, you must complete the rollover within 60 days of receiving the distribution. You should also note that 20% of the distribution will be withheld for federal income tax if you receive a distribution check or securities made out in your name. In order to have no current tax liability, you would then need to make up the 20% from other sources to complete the rollover within the 60-day period. *Note: There are often times when an employee must complete paperwork with a previous employer to initiate a rollover. 1 Rollovers into the Roth IRA are subject to ordinary income tax, but the rollover is not subject to early distribution penalties. You may find it beneficial to roll over to a Roth IRA, since after paying the initial tax on the rollover, distributions from the Roth IRA are free of federal income and penalty taxes if taken after you have reached age 59½ and at least five tax years after opening a Roth account. 2 After-tax contributions may be rolled over from one qualified plan to another, but never from an IRA to a qualified plan. In addition, after-tax contributions to a 457(b) state or local government plan may never be rolled over. 3 Because the portability rules may be applied differently by each plan, you should review the options a plan provides before making your rollover decision. Neither Prudential Financial, its affiliates, nor its financial professionals, render tax or legal advice. Clients and prospects should consult with an attorney, accountant, and/or tax advisor for advice concerning their particular circumstances. NOTE: Mutual fund investing involves risk. Some mutual funds have more risk than others. The investment return and principal value will fluctuate and shares when sold may be worth more or less than the original cost and it is possible to lose money. There is no guarantee a Fund s objectives will be achieved. The risks associated with each fund are explained more fully in each fund s respective prospectus. Consider a fund s investment objectives, risks, charges, and expenses carefully before investing. The prospectus and summary prospectus contain this and other information about the fund. Contact your financial professional for a prospectus and summary prospectus. Read them carefully before investing. Mutual funds are distributed by Prudential Investment Management Services LLC, a Prudential Financial company and member SIPC Prudential Financial, Inc. and its related entities. Prudential Investments LLC, Prudential, the Prudential logo, the Rock symbol, and Bring Your Challenges are service marks of Prudential Financial, Inc. and its related entities, registered in many jurisdictions worldwide Prudential Financial, Inc. and its related entities Ed. 12/2014 Securities and Insurance Products: Not Insured by FDIC or Any Federal Government Agency. May Lose Value. Not a Deposit of or Guaranteed by Any Bank or Bank Affiliate.

21 Prudential Mutual Fund Services LLC (PMFS), a Prudential Financial company Authorization to Convert from a Traditional IRA to a Roth IRA For assistance: Clients: (800) Pruco representatives: (800) Financial professionals: (888) Instructions Use this form to request a distribution from your current PMFS traditional IRA and have the proceeds invested in a new or existing PMFS Roth IRA. Note: Conversion from a traditional IRA to a Roth IRA is a reportable, taxable event and may not be suitable for everyone. You should consult with your tax adviser to review the consequences of this conversion. Please follow these steps: Read the statement in section 6 and sign where indicated. Make sure you have received and read a copy of the Roth IRA Custodial Agreement and Disclosure Statement included with the IRA and Roth IRA Application. If you would like to add or to change the beneficiary designation on your Individual Retirement Account (IRA), please complete the MF 1001 Beneficiary Designation form. If you are a customer of a Prudential financial professional of Pruco Securities LLC, you must also complete the Pruco Investment Profile Questionnaire (MF1010) in addition to this form. If this form is not completed your request may be delayed. 1 Mutual Fund Account Ownership Information Name (first, MI, last name) Mr. Ms. Mrs. Mailing address City State ZIP code 4-digit ext Social Security number Date of birth Fund name (Specify portfolio and class of shares, if applicable.) Fund number Account number Daytime telephone number 2 Distribution Direction Prudential Mutual Fund Services LLC is hereby directed to complete this distribution from a traditional IRA and apply the proceeds to a Roth IRA dated: Date Note: The establishment date is the earliest date you either opened a Roth IRA or originally converted from a traditional IRA to a Roth IRA. This information is requested by the IRS for compliance with the 5-year IRS holding period requirement. Please be aware that if you are requesting a conversion into an existing Roth IRA, a separate 5-year holding period applies to each conversion. PMFS will only track the holding period for the initial transaction that established the Roth IRA. It is your responsibility to track the holding period for each subsequent conversion. MF1028 Ed.10/2015 Page 1 of 2

22 3 4 Method of Distribution Please distribute the following amount from my traditional IRA (check one): Full distribution (100%) Partial distribution in the amount of $,. in cash Partial distribution for shares Fund Allocation I want the distribution indicated above to be invested into the following fund: Same fund as indicated in section 1 above New fund Existing account: Fund number Account number 5 Withholding Election and Roth Conversion Disclosure Federal tax law requires that income tax be withheld at a rate of 10% from the total amount of your IRA distribution/conversion unless you elect not to have tax withheld. Depending on your state of residence, state tax withholding may also apply. If you do not want taxes withheld, sign the election form below. By signing this form, you elect not to have taxes withheld. If you would like to have taxes withheld, please check the box below: I would like federal and applicable state income taxes withheld from my IRA distribution being converted to a Roth IRA. I understand that, as a result, the portion of my IRA distribution that is withheld as income taxes will not be converted to my Roth IRA and may result in adverse tax consequences. (Please consult with your tax adviser.) If you would like more than 10% withheld, please indicate below: Federal taxes Percentage: % (minimum 10% distribution), or Dollar amount $ State taxes* Percentage: %, or,. (Amount cannot be less than 10% of distribution.) Dollar amount $,. *Percentage/dollar amount cannot be less than the minimum required for your state. 6 Signature By signing below, I certify that: The information provided on this form regarding my status with respect to the account involved and all other aspects is correct. I understand that converting from a traditional IRA to a Roth IRA is a taxable event which will be reported to the IRS and I will be responsible for paying any income tax which might result from this conversion. I have received and read a copy of the Roth Individual Retirement Custodial Account Agreement, Disclosure Statement and applicable fund prospectuses. Sign here X Date Mailing Instructions for Mutual Fund Account Application Standard Prudential Mutual Fund Services LLC Overnight mail to: PO Box 9658 Providence, RI mail to: Prudential Mutual Fund Services LLC 4400 Computer Drive Westborough, MA MF1028 Ed.10/2015 Page 2 of 2

23 Privacy Notice Prudential values your business and your trust. We respect the privacy of your personal information and take our responsibility to protect it seriously. This privacy notice is provided on behalf of the Prudential family of companies listed at the end of this notice (Prudential), and applies to our current and former customers. This notice describes new ways in which we will share your personal information within Prudential and your right to opt out of such sharing. Protecting Your Personal Information We maintain physical, electronic and procedural safeguards to protect your personal information. The people who are authorized to have access to your personal information need it to do their jobs, and we require them to keep that information secure and confidential. Personal Information We Collect We collect your personal information when you fill out applications and other forms, when you enter personal details on our websites, when you respond to our s, and when you provide us information over the telephone. We also collect personal information that others give us about you. This information includes, for example: name address, address, telephone number, and other contact information income and financial information Social Security number transaction history medical information for insurance applications consumer reports from consumer reporting agencies participant information from organizations that purchase products or services from us for the benefit of their members or employees Using Your Information We use your personal information for various business purposes, including: normal everyday business purposes, such as providing service to you and administrating your account or policy processing transactions and claims business research and analysis marketing products and services of Prudential and other companies in which you may be interested compliance with laws Sharing Your Information We may share your personal information, including information about your transactions and experiences, within Prudential and with other companies who perform services for us or on our behalf, for our everyday business purposes, such as providing services to you and administering your account or policy. We may also share your personal information with another financial institution if you agree that your account or policy can be transferred to that financial company. We may share your personal information within Prudential so that the Prudential companies can market their products and services to you. We may also share consumer report information within Prudential which may include information about you from credit reports and certain information that we receive from you and from consumer reporting agencies or other third parties. For those customers who have one of our products through a plan sponsored by an employer or other organization, we will share your personal information either in a manner consistent with the terms of the plan agreement or in a manner consistent with our agreement with you. We may also share your personal information as permitted or required by law, including, for example, to law enforcement officials and regulators, in response to subpoenas, and to prevent fraud. Unless you agree otherwise, we do not share your personal information with other companies for them to market their products or services to you. We may tell you about a product or service that other companies offer and, if you respond, that company will know that we selected you to receive the information.