Fillable Printable Customer Account Transfer
Fillable Printable Customer Account Transfer
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
544327 (Rev 18) Page 2 of 2
For Delivering Organization’s Use Only
If this account is a qualified retirement account, I have amended the applicable plan so that it names __________________________________ ___ ( not FCC)
as successor custodian. Unless otherwise indicated in the instructions above, please transfer all assets in my account to ________ _____________________.
I understand that to the extent any assets in my account are not readily transferable with or without penalties, such assets may not be transferred within the
time frames required by NYSE Ru le 412 or similar rule of the FI NR A or other designated exa mining authorit y. I authori ze you to liquidate an y non-transferabl e
proprietary money market fund assets that are part of my account and transfer the resulting credit balance. I authorize you to deduct a ny outstanding fees due
you from the credit balance in my account. If m y account does not contain a credit balance, or if the credit balance in the acc ount 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. 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 n ame for t he pu rp ose of sale, when and as directed b y me. I und er stand that upo n receiving
a copy of this transfer instruction, 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 m y securities account. I understand that you will contact me with respect to the disposition of any
assets in my securities account that are non-transferable.
Receiving Firm Information:
FIRST CLEARING, LLC
ONE NORTH JEFFERSON AVENUE
ST. LOUIS, MO 63103
Tax ID Number:
23-2384840 - FCC Retail and IRA
Delivery Instructions
(All deliveries MUST include the client name and FCC account number.)
Wire Instructions
Wells Fargo Bank
420 Montgomery Street
San Francisco, CA 94104
ABA Routing Number: 121000248
Beneficiary: First Clearing, LLC
Account Number: 4122023377
Further Credit: Your name (must match account re gistration) and your
8-digit brokerage account number
All DTC Eligible Securities
DTC #: 0141
Client Name and Client Account Number
Physical Deliveries
FIRST CLEARING, LLC
Attn: Physical Transfer – H0006-091
One North Jefferson Avenue
St. Louis, MO. 63103
Further Credit to Client Account Number
Book-Entry GNMA Securities – PTC
Or
Fed Book -Entry – Government Securities
BK of NYC/FCCORP.
ABA# 021000018
Further Credit to Client Account Number
Euroclear Eligible Bon ds
(must notify Security Clearance 2 da ys prior to settlement)
EUROCLEAR #10665
Further Credit to Client Account Number
Foreign Equities:
(must notify Security Clearance in order for them to instruct)
JPMorgan Chase Bank A/C # CHASGBZLST
Account of First Clearing, LLC
Further Credit to Client Account Number
Forward Checks* to the Address Indicated
*Must include Client Name and FCCS Account Number.
FIRST CLEARING, LLC
Attn: Cash Management – H0006-085
One North Jefferson Avenue
St. Louis, MO 63103
Further Credit to Client Account Number
ACAT Mutual Fund Registration
Instructions - FCC IRA
FIRST CLEARING, LLC
FBO: Client Name and Client Account Number
One North Jefferson Avenue
St. Louis, MO 63103
Mutual Fu nd Broker-Dealer First Clearing, LLC