KYC Information Form – LLC - Bolton Global



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

|DBTCA Account (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 one Select 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 |♦ |Liquidate Certificates of Deposit at Maturity |

| |transfer assets in kind as per delivery instructions on page 2) | |(Maturity Date: ____/____/______) |

|♦ |Liquidate all assets and 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 |Ass|CUSIP®/Symbol |Fund Account Number |

| |et | | |

| |des| | |

| |cri| | |

| |pti| | |

| |on*| | |

| |* | | |

|Joint Account Holder’s Signature | |Date | |

| | | | |

| | | | |

| | | | |

|X | | | |

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 |USD sent from outside U.S. Bank |ONSHORE / US TAXABLE CLIENT |

|FED Wire |SWIFT Payment |State Street Bank and Trust Co. |

|State Street Bank |State Street Bank & Trust Co. |Participant #: 93793 |

|ABA # 011-0000-28 |BIC: SBOSUS3N |Account: State Street Bank and Trust Company |

|DDA # 00041178 |Account #CH334291 |FFC NJD1 - DB Onshore Custody |

|I/N/O Deutsche Bank Trust Co Americas |Nostro # 40414401 |Global Plus Account Number and Name |

|F/B/O Account #: Global Plus Account Number and |Global Plus Account Number (must be in field |Note: Use transaction code 03C or 07C and Code 93793 |

|Name |21A) |(State Street Bank and Trust Company) |

| |FFC: BJ60 (must be in field 42) | |

|USD DELIVERY INSTRUCTIONS - SECURITY RELATED ACTIVITY | |

|FED Wire |SWIFT Payment |OFFSHORE / US TAXABLE CLIENT |

|State Street Bank |State Street Bank |State Street Bank and Trust Co. |

|ABA # 011-0000-28 |BIC: SBOSUS3NXXX |Participant #: 93793 |

|DDA # 00041194 |Account Name: BIC SBOSUS3FXXX |Account: State Street Bank and Trust Company |

|I/N/O Deutsche Bank Trust Co Americas |Cash Account: 40414401 |FFC NJD2 - DB Offshore Custody |

| |FFC: DDA # 00041194 |Global Plus Account Number and Name |

| |I/N/O Deutsche Bank Trust Co Americas |Note: Use transaction code 03C or 07C and Code 93793 |

| | |(State Street Bank and Trust Company ) |

|DTC - DVP/RVP - ID |DTC Non-ID or FREE DELIVERY |ACATS INSTRUCTIONS |

|State Street Bank and Trust Co. |State Street Bank and Trust Co. |STATE STREET BANK & TRUST COMPANY |

|DTC# 987 |DTC# 987 |DTC #987 |

|Internal A/C#: Global Plus Account Number |FFC: BJ 60 for A/C#: Global Plus Account Number|Internal A/ C # G+ |

|AGENT #: 59136 |and Name |FFC: BJ60 |

|Institutional ID #: (59136 or Various per | | |

|External Investment Advisor) | | |

|PHYSICAL |FED BOOK ENTRY SECURITIES | |

|DTCC/New York Window |STATE STREET BOSTON /SPEC / BJ60 | |

|55 Water Street |ABA # 011-00-0028 | |

|New York, NY10041 |I/F/O: Global Plus Account Number and Name | |

|Attn: Robert Mendez | | |

|ACCOUNT: State Street | | |

|FFC: BJ60 | | |

|I/F/O: Global Plus Account Number and Name | | |

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