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IM-11870. Sample Transfer Instruction Forms

This rule is no longer applicable. NASD Rule 11000 Series has been superseded by FINRA Rule 11000 Series. Please consult the appropriate FINRA Rule.

(a) Customer Account Transfer

CUSTOMER SECURITIES ACCOUNT TRANSFER INSTRUCTION
 
  ................................................
  (Date)
 
RECEIVING FIRM ...................................... CARRYING FIRM ..............................................
 
RECEIVING FIRM
ACCOUNT NUMBER .................................
CARRYING FIRM
ACCOUNT NUMBER ........................................
 
ACCOUNT TITLE .........................................................................................................................
....................................................................................................................................................
 
ACCOUNT TYPE ........................ (C = CASH, M = MARGIN)
 
TAX ID OR SS NUMBER .............................................................................................................
 
TO .............................................................................................................................................
(Receiving Firm Name and Address)
 
Please receive my entire securities account from the below indicated carrying firm and remit to it the debit balance or accept from it the credit balance in my securities account.
 
TO .............................................................................................................................................
(Carrying Firm Name and Address)
 
Please transfer my entire securities account to the above indicated receiving firm, which has been authorized by me to make payment to you of the debit balance or to receive payment of the credit balance in my securities account. I understand that to the extent any assets or instruments in my securities account are not readily transferable, with or without penalties, such assets or instruments may not be transferred within the time frames required by Rule 11870 of the Association's Uniform Practice Code.

I understand that you will contact me with respect to the disposition of any assets in my securities account that are nontransferable. If certificates or other instruments in my securities account are in your physical possession, I instruct you to transfer them in good deliverable form, including affixing any necessary tax waivers, to enable such receiving firm to transfer them in its name for the purpose of sale, when and as directed by me. I further instruct you to cancel all open orders for my securities account on your books.

I affirm that I have destroyed or returned to you any credit/debit cards and/or unused checks issued to me in connection with my securities account.
 
................................................ ................................................
(Customer's Signature) (Date)
 
................................................ ................................................
(Customer's Signature if Joint Account) (Date)
 
[It is suggested that a copy of the customer's most recent account statement be attached.]
 
Receiving Firm Contact:
Name ...................................... Phone Number ...............................................
 
For Broker Use Only:
Mutual Fund Registration Instructions:
Registration Name ......................................................................................................................
Address .....................................................................................................................................
Tax ID # .....................................................................................................................................
Dividend and Capital Gains Options:
Reinvest ( ) Dividend Cash/Capital Gains Reinvest ( )
All Cash ( ) Deposit to New Plan ( )
Issue Certificate ( ) Deposit to Existing Plan ...... ( )
Broker Instructions (if broker agreement exists):
Name ..........................................................................................................................................
Address ......................................................................................................................................
RR Name/Number/Branch .............................................................................................................


(b) Customer Retirement Account Transfer

CUSTOMER RETIREMENT PLAN SECURITIES ACCOUNT
TRANSFER INSTRUCTION
 
RECEIVING FIRM ...................................... CARRYING FIRM ..............................................
 
RECEIVING FIRM
ACCOUNT NUMBER .................................
CARRYING FIRM
ACCOUNT NUMBER ........................................
 
ACCOUNT TITLE .........................................................................................................................
....................................................................................................................................................
 
ACCOUNT TYPE ........................ (I = IRA, Q = QUALIFIED)
 
TAX ID OR SS NUMBER ............................................................................................................
 
TO .............................................................................................................................................
(Prior Custodian/Trustee Name, Address and Tax ID Number)
 
You are the custodian/trustee for my retirement plan securities account with
 
................................................................................................................................................
(Carrying Firm Name and Address)
 
as my broker. Please be advised that I have amended my retirement plan and have adopted a new retirement plan with the below indicated as successor custodian/trustee and
 
....................................................................................................................................as broker
(Receiving Firm Name and Address)
 
Pursuant to said amendment, please transfer all assets in my securities account to such successor custodian/trustee. 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 Rule 11870 of the Association's Uniform Practice Code.

I understand that the above indicated carrying firm will contact me with respect to the disposition of any assets in my account that are nontransferable. 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 any outstanding fees due you. 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/trustee to transfer them in its name for the purpose of sale, when and as directed by me. Upon receiving a copy of this transfer instruction, the carrying firm will cancel all open orders for my account on its books.
 
................................................ ................................................
(Customer's Signature) (Date)
 
Please be advised that .................................................................................................................
(Successor Custodian/Trustee Name, Address and Tax ID Number)
 
will accept the above captioned account as successor custodian/trustee.
Please send all checks to
 
.....................................................................................................and non-DTC eligible items to
 
....................................................................................................................................................
 
................................................................ ................................................
(Successor Custodian/Trustee Authorized Signature) (Date)
 
................................................................ ................................................
(Tax ID Number) (Date of Trust)
 
[It is suggested that a copy of the customer's most recent account statement be attached.]
 
Receiving Firm Contact:
Name ...................................... Phone Number ...............................................
 
For Broker Use Only:
Mutual Fund Registration Instructions:
Registration Name ......................................................................................................................
Address .....................................................................................................................................
Tax ID # .....................................................................................................................................
Dividend and Capital Gains Options:
Reinvest ( ) Dividend Cash/Capital Gains Reinvest ( )
All Cash ( ) Deposit to New Plan ( )
Issue Certificate ( ) Deposit to Existing Plan ...... ( )
Broker Instructions (if broker agreement exists):
Name ..........................................................................................................................................
Address ......................................................................................................................................
RR Name/Number/Branch ............................................................................................................


(c) Mutual Fund Re-Registration

MUTUAL FUND RE-REGISTRATION INSTRUCTIONS
USED FOR BROKER-TO-BROKER TRANSFERS
 
(1) TO: ...................................................................... Date: ........................
  Transfer Agent: ...........................................................................
  Address: ....................................................................................
 
(2) Present
Account
Information
Name of Fund: .......................................................

Fund A/C #: ..........................................................

Certificate # (if in physical form)

[Certificate attached must be in negotiable form.]

Account Registration: .............................................
 
(3)(A) Broker
Identification
Old Firm Name and
In-house A/C# ..................................................
 
(3)(B)   New Firm Name and
In-house A/C# ...................................................
 
(4) Registration
Instructions
Please transfer .............. shares from the above-referenced account and register as follows:
 
  Name .............................................................................................
  Address .....................................................................................
  Tax ID # .........................................................................................
 
Dividend and Capital Gains Option:
Reinvest ( ) Dividend Cash/Capital Gains Reinvest ( )
All Cash ( ) Deposit to New Plan ( )
Issue Certificate ( ) Deposit to Existing Plan ........ ( )
 
(5) Broker/Dealer Instructions If a Broker/Dealer Agreement exists:

Name ....................................................

Address .................................................

RR Name/Number/Branch ........................
 
(6) Release In consideration for your complying with the above request, we hereby agree to indemnify the:

.................................................... (fund)

and

................................................... (agent)

against any and all losses incurred hereof.

Thank you in advance for your cooperation in this matter.

Sincerely,
 
  (Signature Guarantee Stamp) ..................................
  Authorized Signature
 
If there are any questions call:
 
................................................. .........................................................
(Signature of Delivering Broker) (Phone Number)
 
....................................................... .........................................................
(Signature of Receiving Broker) (Phone Number)
 
Items 1, 2, 3a are completed by the delivering broker.
 
Items 3b, 4 and 5 are completed by the receiving broker.