CED0105 Amerprse Fnancal Servces, Inc. 70100 Amerprse Fnancal Center Mnneapols, MN 55474 Account Transfer and Drect Rollover Important: Before fnal submsson to the Home Offce you wll need a Reference Number. Return to the eforms Account Transfer workflow and complete all steps to generate a Reference Number. Send ether ths sgned form wth the Reference Number wrtten n the Reference Number feld, or, sgn and send va the workflow. If submttng ths form, the Reference Number must be ncluded. 133 Ths form should be used to transfer nto Brokerage products. If the ntent s to transfer n to an Amerprse Certfcate, RverSource Lfe Annuty or Columba mutual fund product, use Form 200808. For transfers to non-qualfed Amerprse Certfcates, use Form 3057. Drect Rollovers: Always consult your employer or plan admnstrator for requrements pertanng to drect rollovers. Do not submt ths form, f you are workng drectly wth the plan admnstrator. If more than one destnaton account s to be requested, we wll requre (1) form per account, the transfers should be marked as "Partal Transfers" n Part 3. If the transfer contans any Over the Counter (OTC) securty postons consstng of 10,000 or more shares, the Securty Depost Form 402432, s requred to determne the securty's elgblty at Amerprse. For addtonal detals, please refer to Complance Manual 9.2.11 Depostng or Transferrng Securtes. s: Recevng account must be an Amerprse Brokerage 529 account. Ths form s not to be used for transfers or rollovers nto 529 accounts held drectly at a 529 frm. To transfer or rollover nto a 529 account held drectly at a 529 frm, contact the frm drectly for approprate paperwork. ATI Clent ID Reference Number 001 Clearng # 0756 NOTE: Electroncally submttng the followng form(s) may create a follow-up request of an orgnally sgned document. Ths wll only take place f the transferrng frm requres an orgnal sgnature to complete the request. Part 1 Amerprse Account Informaton Account Regstraton Account Regstraton 133 Amerprse Ownershp Type (Select One) "Select an account that corresponds to the account type at Amerprse Fnancal." Non-Qualfed Sngle Jont Other Qualfed Tradtonal IRA Rollover IRA Other Roth IRA SEP IRA SIMPLE IRA Recevng account must be an Amerprse Brokerage 529 account. Plan Name Tax Identfcaton Number (TIN) Non-Qualfed - Other Qualfed - Other Part 2 Delverng Frm Informaton Attach a copy of your most recent statement dated wthn the last 90 days. Current account statements provde crtcal nformaton for the Account Transfer department, and falure to submt a current statement may delay your transfer request. For s a statement or documentaton ssued by the dstrbutng college savngs program that shows the current prncpal and earnngs. In the case of any drect transfer between college savngs programs, the dstrbutng program must provde the recevng program wth a statement settng forth ths nformaton. Delverng Frm Informaton contnued on next page.. Sgn on Page 6 2009-2015 Amerprse Fnancal, Inc. All rghts reserved. Page 1 of 5
CED0205 Delverng Frm Informaton contnued : Provde the delverng account number to be transferred. A separate form should be submtted for each delverng account to be transferred unless the delverng frm s a mutual fund famly. If all the accounts(s) beng transferred have the same owner and regstraton and are currently held drectly wth a mutual fund famly, you can submt up to four accounts on ths form and addtonal copes of page one can be used, f necessary. Account Regstraton: Provde the full name(s) of account owner(s) of the account to be transferred. Socal Securty Number or TIN: Provde the prmary Socal Securty Number or Tax Identfcaton Number (TIN) lsted on the account to be transferred and for accounts wth a Co Account holder, TTEE, Guardan, or Custodan the secondary Socal Securty Number or Tax Identfcaton Number that may be assocated wth the account to be transferred. Name of Delverng Frm: Provde the name of the delverng nsttuton and nclude the address and contact nformaton for the delverng frm. OwnershpType: Select one opton only that corresponds to the account type of the account to be transferred. Note: When transferrng between unlke ownershps, even f all owners of delverng and recevng accounts have sgned the form and checked the box authorzng a transfer between unlke ownershps, the delverng frm may stll reject the transfer and requre that the ownershp of one of the accounts be changed before the transfer can be completed. Account Regstraton Prmary Account Holder Name Tax Identfcaton Number Co Account Holder / TTEE / Guardan / Custodan Name / 529 Benefcary Tax Identfcaton Number Delverng Frm Name Delverng Frm Address Phone Number Cty State ZIP code Ownershp Type (Select One) Non-Qualfed Sngle Jont Other Qualfed Tradtonal IRA Rollover IRA Other Roth IRA SEP IRA SIMPLE IRA Recevng account must be an Amerprse Brokerage 529 account. Current 529 assets are held n: Advsor sold plan - typcally share classes that charge a sales load Drect sold plan - typcally no load share classes Plan Name Non-Qualfed - Other Qualfed - Other Part 3 Transfer Instructons Drect Rollovers: Consult the former employer or plan admnstrator for requrements pror to submttng ths to the corporate offce. Many plans requre ther own dstrbuton paperwork. A Drect Rollover s generally defned as the drect movement of assets from one elgble retrement plan (ncludng an IRA) to another elgble retrement plan. (Note: If both elgble retrement plans are the same type, such as 2 IRAs, then the movement may be defned as a Transfer rather than as a Drect Rollover.). The IRA owner or plan partcpant does not take constructve recept of the proceeds. Instead, they are pad drectly to the new Qualfed Plan or IRA as a company to company transacton. There s no wthholdng requrement snce the clent does not touch the proceeds. A trggerng event must be met before a dstrbuton can be made from a Qualfed Plan. Select one opton from ether 'Brokerage Account', 'Non-Brokerage Account', or ''. From a Brokerage Account Examples of brokerage account: Retal Brokerage, Wrap Products, Separately Managed Accounts, etc. Lqudaton requests not accepted. (ACATS Transfers, f elgble) Full Account In Knd Partal Account In Knd - Complete Table A Note: Each ndvdual asset n Table A must be marked In Knd. Page 2 of 5 Transfer Instructons contnued on next page..
Transfer Instructons contnued From a Non-Brokerage Account CED0305 Examples of non-brokerage account: Fund Famles, Banks, Lfe Insurance/Annuty Companes, Trust Companes, Transfer Agents, etc. Lqudaton requests accepted. (Non ACAT Transfers) Full Account In Knd Full Account Lqudaton Other - Complete Table A, f applcable Note: If an Annuty, penaltes may apply. Note: Each ndvdual asset n Table A must be marked In Knd" or "Sell." The Penalty Free Amount avalable or complete Table A, for a specfc dollar amount (Ths opton s a partal transfer, for Annutes only). If the Clent's request s to surrender the entre Annuty and t s 100% penalty free, ths would be consdered a Full Account Lqudaton. If ths Non-Brokerage Account s a CD (ndcate when the lqudaton s to take place): Note: You must ndcate f ths s a full or partal transfer by choosng ether "Full Account Lqudaton" or "Other" above. Pror to maturty (penaltes may apply) At maturty date: (Maturty date must be wthn 60 calendar days of sgnng ths form) From a If transferrng between dfferent 529 plans, select Full Account Lqudaton and complete the Rollover Investment Allocaton table. If transferrng between the same 529 plans and the plan s offered n Amerprse Brokerage, select ether 'Full Account n Knd', 'Full Account Lqudaton', or 'Other'. If full account lqudaton, complete the Rollover Investment Allocaton table. Full Account In Knd Full Account Lqudaton (Complete the Rollover Investment Allocaton Table) Other - Complete Table A, f applcable (If sellng asset lsted n Table A, complete Rollover Investment Allocaton Table wth nvestment nstructons.) Amercan Funds Class A shares are elgble for transfer nto Wrap Products only f from another Broker Dealer va ACAT, and are nelgble va Manual transfers per the Amercan Funds Polcy. Table A - Attach a separate sheet f addtonal assets Asset Descrpton CUSIP/Tcker Symbol Quantty All or Number of Shares Handlng (Select One) In Knd, Sell Fund (If at Fund Famly) Note to Advsor: Please refer to the lst of ACAT elgble frms on the AdvsorCompass portal. These can be found at: AdvsorCompass >Product Solutons > General Informaton Brokerage Account Transfers > ACAT Elgblty.ACATS pertans only to brokerage accounts. Brokerage accounts are able to hold cash, equtes, mutual funds, etc. If you look at the statement and the account s held wth a mutual fund famly (BlackRock, Oppenhemer, MFS, etc) the account wll not be ACAT elgble. The approprate box to check would be Non- Brokerage Account.If the clent wshes to lqudate a CD or annuty held at a Non ACAT elgble frm, the form wll need to be marked to ether lqudate at maturty or pror to maturty. Page 3 of 5 Transfer Instructons contnued on next page..
CED0405 Transfer Instructons contnued Rollover Investment Allocaton Certan 529 plans may offer to wave applcable sales charges n the nstance of a qualfyng rollover. If the funds assocated wth ths rollover are elgble for such a program Amerprse Fnancal Servces, Inc. wll affect your nvestment electons n class A shares at Net Asset Value (NAV), upon recept of funds per the nstructons below. Asset Descrpton CUSIP/Tcker Symbol Percentage Un Un Un Un Un Un Un Un Un Un No purchase of shares wll occur untl we receve the proceeds of any lqudaton or transfer of exstng assets. Any roundng balances wll be appled to the fnal CUSIP lsted. Part 4 Acknowledgements and Authorzaton to the Delverng Frm "I" refers to the prmary account holder and f applcable, the co-account holder. "You" refers to the delverng frm. I authorze and request ether: a full, partal, or other transfer, as drected n the nstructons, of the assets n my Non-Qualfed accounts or 529 Plan to Amercan Enterprse Investment Servces, Inc. or f a Qualfed account, a full, partal, or other transfer, as drected n the nstructons, of the assets n my qualfed accounts to Amerprse Trust Company and/or Amercan Enterprse Investment Servces, Inc. n ts capacty as agent for Amerprse Trust Company. If physcal certfcates or other nstruments n my account are n your possesson, I nstruct you to transfer them n good delverable form, ncludng affxng any necessary tax wavers, to enable Amerprse Trust Company or Amercan Enterprse Investment Servces, Inc. to transfer them n ts name for the purpose of the sale, when and as drected by me. I understand that to the extent any assets n my account are not readly transferable, wth or wthout penaltes, such assets may not be transferred wthn the tmeframes requred by FINRA or smlar rule of FINRA or other desgnated examnng authortes. I understand that fractonal shares wll be lqudated pror to transfer. If my shares are held n a dvdend renvestment plan, the plan wll cease to exst and fractonal shares wll be lqudated. I authorze you to lqudate any nontransferable propretary money market fund assets that are part of my account and transfer the resultng credt balance, unless otherwse ndcated n the nstructons attached. I understand that upon recevng a copy of a full transfer nstructon, you wll cancel open orders and may restrct new orders untl the transfer s complete. I affrm that I have destroyed or returned to you any credt/debt cards and/or unused checks ssued to me n connecton wth the account I have desgnated for transfer. I understand that a full transfer wll dscontnue all bankng features on my delverng account and that any outstandng actvty may not clear. I understand that dvdend optons may need to be re-establshed upon recept of my assets at Amerprse Fnancal. I authorze you to deduct any outstandng fees due you from the credt balance n my account. If my account does not contan a credt balance, or f the credt balance n the account s nsuffcent to satsfy any outstandng fees due you, I authorze you to lqudate the assets n my account to the extent necessary to satsfy that oblgaton. I understand that you may charge an ext fee and that f my account does not contan suffcent cash to cover that fee, my account wll transfer to Amercan Enterprse Investment Servces, Inc. wth a debt balance. Part 5 Sgnatures All owners/ndvduals wth an nterest n any account dentfed n Part 1 and/or Part 2, must sgn and date below to authorze a drect rollover or transfer transacton. Please allow at least 30 days for recept of assets wth Non-ACAT account transfers. Amerprse generally wll not accept transfers of large holdngs of low prced securtes. You may be requested to fll out a Securty Depost Form for revew pror to acceptance of any securty subject to ths polcy. Amerprse wll determne n ts sole and exclusve dscreton whether or f t wll accept any specfc low-prced securty. Page 4 of 5 Sgnatures contnued on next page..
CED0505 Sgnatures contnued As used below, the word I refers to the applcant who s the taxpayer on the account. Under penaltes of perjury, I certfy that: 1. The number shown on ths form s my correct taxpayer dentfcaton number, and 2. I am not subject to backup wthholdng because: (a) I am exempt from backup wthholdng, or (b) I have not been notfed by the Internal Revenue Servce (IRS) that I am subject to backup wthholdng as a result of a falure to report all nterest or dvdends, or (c) the IRS has notfed me that I am no longer subject to backup wthholdng, and 3. I am a U.S. ctzen or other U.S. person (defned below), and 4. The FATCA code(s) entered on ths form (f any) ndcatng that I am exempt from FATCA reportng s correct. Certfcaton Instructons: As used below, the word You refers to the applcant who s the taxpayer on the account. Check ths box f you have been notfed by the IRS that you are currently subject to backup wthholdng because you have faled to report all nterest and dvdends on your tax return. I understand that account(s) to be opened for me at Amerprse Fnancal Servces, Inc. may be restrcted untl an executed applcaton s receved. I further understand that f an executed applcaton s not receved wthn 45 days of account openng, those restrctons wll nclude a prohbton on new purchase transactons and the depost or transfer n of cash or securtes. I acknowledge recept of and consent to all terms and condtons contaned n the Amerprse Brokerage Clent Agreement and the Other Important Dsclosures documents. I also acknowledge recept of nformaton relatng to the thrd-party cash sweep program offered by Amerprse Fnancal. I understand that requests to sell are dependent on the delverng frm acceptng and processng ths request. Specfc sale tme and prce cannot be guaranteed. I understand that f I wsh to sell at a specfc tme or prce, I should consder sellng drectly wth the delverng frm pror to transfer. I understand that not all delverng frms wll honor wrtten nstructons to sell va transfer forms, and may requre addtonal steps or documentaton. I understand that any specal arrangements (Dvdend Renvestment Optons (DRIP), Systematc Payments, Bank Authorzatons, Benefcary Desgnatons, etc.) establshed at the delverng frm for my account(s) may not transfer wth ths request, and t s my oblgaton to revew my account(s) to make certan that such arrangements have been establshed. I acknowledge that ths transfer request may be between unlke ownershps and I/we understand that ths transfer may change the regstraton on the account, benefcary desgnatons and may affect tax reportng labltes. If ths transfer nvolves Rollover Investment Allocaton electons, I understand that no purchase of shares n a wll occur untl the lqudaton proceeds are receved by Amercan Enterprse Investment Servces, Inc., and credted to the. I understand that untl I or the prevous frm provdes to Amercan Enterprse Investment Servces, Inc. (AEIS) documents dentfyng the prncpal and earnngs of the transfer or rollover, AEIS wll treat the entre amount receved as earnngs n the account that receves the contrbuton. AEIS wll request prncpal and earnngs nformaton from the delverng frm for any transfer or rollover. Please receve my securtes account from the delverng frm dentfed n Part 2 and remt to t the debt balance or accept the credt balance n my securtes account. By sgnng, I authorze the partes to act on the nstructons provded wthn ths form. Prmary Account Holder Name Prmary Account Holder Sgnature Co-Account Holder Name Co-Account Holder Sgnature (f applcable) 403(b) or Qualfed Admnstrator Name 403(b) or Qualfed Admnstrator Sgnature (f applcable) Advsor Name Advsor ID Letter of Acceptance (Corporate Use Only) To the pror trustee or custodan: Amerprse Trust Company s qualfed under applcable regulatons to act as custodan of IRA, or qualfed plan assets and wll depost the assets we receve n ether an IRA account, account or a qualfed plan account, based on the nstructons n Part 1, for the beneft of the ndvdual. Reference Number Drect Rollover Successor Custodan Sgnature Custodal Transfer Page 5 of 5