Withdrawal - Retirement Accounts _IRA_ Roth IRA_ SEP IRA etc

					Pershing: One Time/Systematic Withdrawal Kit                                                       (IRA Accounts)
Custodian: Pershing
Applicable To Account Types: IRA, Roth IRA, IRA Rollover, SEP IRA, Simple IRA, and Education Savings Account.


Process Overview

Use the “IRA Distribution Request” to request a withdrawal from an IRA account. Genworth Financial Wealth
Management will execute trades to make cash available and process the distribution. The frequency of delivery can
be either a one time request or a systematic (i.e. monthly) request. The client may also choose the delivery method
of a check, wire or ACH (Automated Clearing House).


Processing Timeframes

All trading requests, received in good order, will be executed within 24 to 48 hours if received by 4pm Pacific Time.
Distribution of funds will be scheduled following the settlement of the necessary trades as indicated below:


    Investment Solution                 General Trading Times                    Settlement                 Distribution Times


          Mutual Fund                      Next Business Day                        T+1               1-2 Business Days after Settlement


              ETF                          Next Business Day                        T+3               1-2 Business Days after Settlement


        IMA’s and CMA’s              2-3 Business Days (depending on                T+3               1-2 Business Days after Settlement
                                                Manager)




Paperwork Requirements

In order to process the “One Time/Systematic Withdrawal” request, please complete the appropriate Pershing
custodial form completely and accurately.


                                                                Form Routing


        Request Type                        Selling Model                 Signature Requirements            Fax or Original




IRA Distribution Request Form              Referral / Advisor                     Client                           Fax
                                                                                                             866-209-5866


        ACH - Establish                                                                                            Fax
 (Automated Clearing House)                Referral / Advisor                     Client                     866-209-5866
 Authorization Agreement for
Retirement Plans (if applicable)




                                Please contact Advisor Services with any questions at 800-664-5345
Additional Considerations

      • Please utilize the Tracking Center to track the progress of this request
      • Check will be mailed to the address and name of record, unless otherwise indicated. Signature
      guarantee required for alternate payee.
      • Please note that in order to further protect client assets, Pershing may ask for the Reason or Purpose
      and Relationship of any 3rd Party Withdrawal. As a result, the distribution request may be delayed.
      • For ACH setup, complete the ACH Authorization Agreement and attach an original voided check with
      the agreement.
      • For an update to the banking information on an existing Systematic Withdrawal that is setup to go
      ACH, please submit an IRA Distribution Form and an IRA ACH Form with a copy of a voided check.
      • Please ensure that the distribution start date is indicated on the ACH Authorization Agreement. If the
      distribution date selected falls on a non business day, your distribution will be paid on the first business
      day thereafter.
      • For ACH instructions already on file for a given client registration, the client may submit a copy of the
      existing instructions to setup an additional ACH on a new account
      • Additional fees may apply for certain delivery methods such as a wire fee of $15 or an overnight fee
      of $12.
      • Please note ACH instructions will remain in effect once approved. Instructions will be removed if not
      used within 15 months or of Pershing Advisor Solutions LLC is notified to revoke.




                     Please contact Advisor Services with any questions at 800-664-5345
                                   IRA DISTRIBUTION REQUEST
                  Use this form to request a distribution of assets from Traditional IRAs,
                 SEP IRAs, SIMPLE IRAs, Roth IRAs, and Education Savings Accounts


                  PLEASE BE AWARE OF THE FOLLOWING WHEN COMPLETING THIS FORM:


■   Use of this form will result in a distribution that is reportable to the Internal Revenue Service (IRS) and,
    if applicable, the tax authorities in your state

■   Read the attached instructions prior to completing the form

■   Do not use this form to request a transfer of assets from this account (including transfer due to death of
    participant or for a divorce decree), a Roth conversion, or to purchase securities for this retirement account

■   You are responsible for ensuring that the funds you request are available; this may require asking your
    investment professional to sell securities in order to make the cash you are requesting available

■   Some delivery methods result in fees being applied (as noted in the instructions)—for a schedule of fees, please
    contact your investment professional

■   Please separate the instructions from the distribution request prior to returning the form

■   The completed form should be returned to your investment professional or financial organization
                                                                   IRA DISTRIBUTION REQUEST
                                                                         INSTRUCTIONS
 I. PARTICIPANT INFORMATION                                                                         C. TOTAL DISTRIBUTION—This election will close your account.
    Please print your name (First, Middle Initial, Last) and fill in the boxes for account             1. Total distribution of entire account in cash—Select this if you wish to
    number, Social Security Number, date of birth, and state of residence. Provide the                    have all assets distributed in cash. Please arrange with your investment
    two-letter state abbreviation for state of residence. If payment is being made to                     professional or financial organization to sell securities.
    an alternate payee and/or address, provide the appropriate information in section IV.              2. Total distribution in-kind—Your account will be closed. Your securities will be
                                                                                                          mailed to you, if possible, along with any remaining cash balance, unless you
                                                                                                          request them to be moved to the Pershing account indicated in section IV.
II. TYPE OF DISTRIBUTION (Please see your tax advisor regarding possible taxes and penalties.)
                                                                                                       3. Account termination fees may be due for total distributions. You may either pay
    A. NORMAL—For clients who are the age of 59 1/2 and older. This includes Required                     by check or have the fees deducted from this account or another Pershing
       Minimum Distributions (RMDs) from Traditional IRAs, SEPs, and SIMPLE                               account over which you have trading authority. Contact your investment
       IRAs for clients who are the age of 70 1/2 and older. If you are over 70 1/2, the IRS              professional or financial organization to obtain a fee schedule.
       requires that minimum distributions be taken according to a specific, elected
       formula. Please verify the method and amount of your RMD calculation with                    D. TAX WITHHOLDING ELECTION—Rates are subject to change without notice.
       your tax professional.                                                                          (NOTE: Education Savings Accounts are exempt from tax withholding.)
    B. EARLY—For clients who are under the age of 591/2 and do not qualify for any of                  We are required to withhold federal income tax (and state income tax depending
       the exceptions to tax penalties as defined in IRC Section 72(t); death, disability,             on your residency) from distributions. You may elect not to have federal income
       or substantially equal series. The distribution may be subject to the early                     tax withheld by completing this section. In some cases, you may elect not to have
       distribution penalty.                                                                           state income tax withheld. If no election is made, 10% federal income tax and
                                                                                                       applicable state income tax will be withheld unless you indicate otherwise. If you
    C. SUBSTANTIALLY EQUAL SERIES —As defined in IRC Section 72(t). Complete                           select scheduled payments as the distribution method, federal and state income
       if you are under the age of 59 1/2 and are taking distributions as part of                      tax withholding must be stated as a percentage. Dollar amount selections are
       substantially equal periodic payments. Premature distribution penalty does                      not available for scheduled payments. For requests to have federal income tax
       not apply. Please consult with your tax professional for more information.                      withholding in a dollar amount, ensure that the amount is equal to or greater
    D. RETURN OF EXCESS CONTRIBUTION—State the amount and date of the excess                           than 10% of the gross distribution amount. Penalties may be incurred under
       contribution(s). Excess contribution(s) plus their earnings must be withdrawn                   the estimated tax rules if your withholding and/or tax payments are not sufficient
       by your tax-filing deadline for the year the deposit was made, plus extensions.                 for the tax year. Taxes withheld from your distribution in accordance with your
       Provide the date of contribution and the excess amount. State the earnings                      instructions will not be reversed. You may revoke your election at any time before
       separately. Indicate if the request is being submitted prior to your tax return                 the distribution is processed. Your election remains effective until revoked. For
       filing date, plus extensions. Excess contributions removed after tax-filing date                additional information regarding federal and state tax withholding, contact your
       (including extensions) will be reported as normal or early, depending on the age                tax professional.
       of the participant and will not include earnings.
    E. DISTRIBUTION DUE TO DEATH—For distributions that are taken as a result of                 IV. DELIVERY INSTRUCTIONS
       the death of the IRA owner. The distribution is taken from the inherited/                     (Leave blank for delivery of a check or security certificate(s) in the account owner’s
       beneficiary IRA.                                                                              name. These items are mailed to the address of record.)
    F. PERMANENT DISABILITY—Within the meaning of IRC Section 72(m)(7). Consult                     A. ALTERNATE PAYEE—Provide information if a check or securities should be delivered
       your tax professional or employer to determine eligibility.                                     to an alternate payee. For your protection, your investment professional or
    G. DIRECT ROLLOVER TO A QUALIFIED RETIREMENT (QRP) PLAN—For distributions                          financial organization will need to provide a signature guarantee in section V
       from an IRA that are being rolled back to a qualified plan (QRP, a 403(b) plan,                 for all distributions paid to an alternate payee.
       or a 457 plan). An acceptance letter is required from the successor custodian or             B. ALTERNATE ADDRESS—Provide information if a check or securities should be
       trustee of the QRP.                                                                             delivered to an alternate address.
    H. ROTH—For any distributions from a Roth or Roth Conversion Account.                           C. ACH—For scheduled distributions only. An original ACH agreement and
    I. SIMPLE IRA EARLY—Distribution taken within two years of participation in an                     preprinted (encoded) voided check must accompany the distribution request.
       employer’s SIMPLE IRA plan that does not qualify for tax penalty exceptions.                    This election will transmit funds directly to your account. No fee will apply.
    J. EDUCATION SAVINGS ACCOUNT — For any distributions from an Education Savings                  D. TO THE FOLLOWING PERSHING ACCOUNT—To transfer your distribution to another
       Account. DO NOT elect tax withholding. Education Savings Accounts are                           Pershing account. Please provide the receiving account number.
       exempt from tax withholding.                                                                 E. OVERNIGHT DELIVERY—You may elect to receive the distribution overnight.
                                                                                                       A fee is assessed for this service. This service is not available for delivery
III. DISTRIBUTION METHOD AND TAX WITHHOLDING                                                           to a P.O. Box address.

    A. ONE-TIME DISTRIBUTION:                                                                       F. FEDERAL FUND WIRE—A fee is assessed for this service. This service is not available
                                                                                                       for scheduled distributions.
       1. Indicate the dollar amount of the partial distribution.
                                                                                                       ■ ABA NUMBER—The bank’s code for wiring funds
       2. Indicate the description and quantity of securities that you wish to receive.
                                                                                                       ■ BANK NAME—The bank to which the funds are being sent
          Please use the security descriptions as they appear on your brokerage
          account statement.                                                                           ■ CITY, STATE—City and state location of the bank
                                                                                                       ■ ACCOUNT NUMBER—Bank account number to be credited with funds
    B. SCHEDULED DISTRIBUTION—For recurring distributions on a specified date.
                                                                                                       ■ FOR THE BENEFIT OF—Name of recipient
       1. Indicate whether this is a new request or a change of an existing instruction.
                                                                                                       ■ FURTHER CREDIT TO, ACCOUNT NUMBER—If required, ask your bank for
       2. Provide a dollar amount to receive distributions of a specified amount. Only
          available funds will be sent on the date you select. You must make arrangements                specific instructions
          with your investment professional or financial organization to ensure cash is
          available on scheduled distribution dates.                                             V. SIGNATURE (This form cannot be processed without your signature.)
       3. Income includes: dividends, interest, and mutual fund capital gains.                       By signing this form, I acknowledge that I have read and understood the Tax
       4. Select distribution frequency and provide beginning date. If no beginning date             Withholding Instructions and the Custodian is not responsible for determining
          is selected, the first day of the month following the month that Pershing receives         the appropriateness of the distribution and withholding election. Also, my federal
          a complete form, will be selected. If the day selected falls on a nonbusiness              and state income tax withholding election is applicable to any subsequent scheduled
          day, your payment will be made on the first business day thereafter.                       distributions, until I revoke the election under the procedure established by the
                                                                                                     Custodian. (A signature guarantee is required for a distribution payable to an alternate
                                                                                                     payee. Please contact your investment professional or financial organization.)
                                                                                  IRA DISTRIBUTION REQUEST                                                           Fax to (925) 521-1050
                                                                                               PLEASE READ THE ATTACHED INSTRUCTIONS.


       I. PARTICIPANT INFORMATION (Complete all sections.)                                                               D. TAX WITHHOLDING ELECTION (Rates are subject to change without notice.)
                                                                                                                            1. FEDERAL INCOME TAX WITHHOLDING (Select one):
           NAME (Please print): _________________________________________________________________________                      (If an election is not made below, we will withhold 10 percent of the gross distribution amount.)

           ACCOUNT NUMBER:                          -                                                                           ❏ Do NOT withhold federal income tax from the gross distribution amount.
                                                                                                                                ❏ Withhold federal income tax from the gross distribution amount at the rate of 10%.
           SOCIAL SECURITY NUMBER:                          -                 -                                                 ❏ Withhold _______ % based on the gross distribution amount (must be at least 10%).

           DATE OF BIRTH:                 -                -                                                                    ❏ Withhold $________________ of federal income tax from the gross distribution
                                                                                                                                  amount. (NOT available for scheduled distributions.)
           STATE OF RESIDENCE:                  (For state tax purposes.)                                                       State income tax withholding may be required when you elect federal income tax withholding.
                                                                                                                            2. STATE INCOME TAX WITHHOLDING (Select one): (If an election is not made, we will
      II. TYPE OF DISTRIBUTION (Select one type.)                                                                              withhold from your distribution according to your state of residence requirement.)
           A. ❏ NORMAL (Age 59 1/2 and older)                                                                                   ❏ Do NOT withhold state income tax from the distribution. (Not applicable to all states.)
           B. ❏ EARLY (Under age 59 1/2—no known exceptions)                                                                    ❏ Withhold state income tax from the distribution.
           C. ❏ SUBSTANTIALLY EQUAL SERIES                                                                                      ❏ Withhold ________ % based on the distribution amount.
           D. ❏ RETURN OF EXCESS CONTRIBUTION FOR TAX YEAR ______________                                                       ❏ Withhold $________________ of state income tax from the distribution amount.
              1. Specify excess amount, month, day, and year contribution was made:                                               (NOT available for scheduled distributions.)

                  $________________________                  _______ / _______ / _______                             IV. DELIVERY INSTRUCTIONS
              2. Earnings accrued on excess contribution $________________________                                       Leave blank for delivery of a check or security certificate(s) in the account
                                                                                                                         owner’s name. These items are mailed to the address of record.
              3. Is excess being removed prior to the tax return due date, including extensions?
                 ❏ YES       ❏ NO                                                                                        A. ❏ ALTERNATE PAYEE: ____________________________________________________
                                                                                                                              (Signature guarantee required.)
           E. ❏ DUE TO DEATH FROM INHERITED/BENEFICIARY IRA
                                                                                                                         B. ❏ ALTERNATE ADDRESS: __________________________________________________
           F. ❏ PERMANENT DISABILITY
                                                                                                                                ___________________________________________________________________________
           G. ❏ DIRECT ROLLOVER TO A QUALIFIED RETIREMENT PLAN
                                                                                                                         C. ❏ ACH (For scheduled distributions only. See instructions for paperwork requirements.)
           H. ❏ ROTH IRA
           I. ❏ SIMPLE IRA EARLY                                                                                         D. ❏ TO THE FOLLOWING PERSHING ACCOUNT:

           J. ❏ EDUCATION SAVINGS ACCOUNT (No tax withholding—see instructions.)                                                                    -
                                                                                                                         E. ❏ OVERNIGHT DELIVERY (Fees will be assessed.)
     III. DISTRIBUTION METHOD AND TAX WITHHOLDING
                                                                                                                         F. ❏ FEDERAL FUND WIRE (Not available for scheduled distributions. Fees will be assessed.)
           Select one distribution method, make a tax withholding election, and then
           select the delivery method in section IV.                                                                            ABA NUMBER: _______________________________________________________________

           A. ❏ ONE-TIME DISTRIBUTION                                                                                           BANK NAME: ___________________________________________________________________________________

                  1. Payment in the amount of $______________________________                                                   CITY, STATE: _____________________________________________________________________________________
                                                                                                                                ACCOUNT NUMBER: _____________________________________________________________________________
                  2. In-kind distribution of securities (Indicate description and quantity.)
                     DESCRIPTION                                                QUANTITY                                        FOR THE BENEFIT OF: ___________________________________________________________________________
                                                                                                                                ACCOUNT NUMBER: _____________________________________________________________________________
                     __________________________________________________ _____________________
                                                                                                                                FURTHER CREDIT TO: _________________________________________________________________________
                     __________________________________________________ _____________________
                                                                                                                                ACCOUNT NUMBER: _________________________________________________________________
           B. ❏ SCHEDULED DISTRIBUTION (Complete applicable items below.)
                                                                                                                      V. SIGNATURE (This request cannot be processed without your signature.)
                  1. SELECT ONE: ❏ New request              ❏ Change of instruction
                                                                                                                          Refer to section V of the IRA Distribution Request Instructions.
                  2. ❏ Principal payment in the amount of $______________________________
                  3. ❏ Income (dividends and capital gains) and interest
                                                                                                                         SIGNATURE: _____________________________________________ DATE: _________________
                  4. SELECT ONE: ❏ Monthly          ❏ Quarterly     ❏ Semi-Annually       ❏ Annually

                                    Beginning: _______ / _______ / _______

           C. ❏ TOTAL DISTRIBUTION (Select one—account will be closed.)                                                                                     SIGNATURE GUARANTEE BOX
                  1. ❏ Total distribution of entire account in cash
                       (Please arrange to have your investment professional liquidate all assets.)
                  2. ❏ Register and mail securities, and distribute cash
                  3. ❏ Fees enclosed or charge to the following Pershing account:
  w 8-03

FRM IRA DIST 7-03
                                           -
Exhibit 1


                                           TRADITIONAL IRA, SEP, SIMPLE, AND ROTH IRA
                                    FEDERAL AND STATE INCOME TAX WITHHOLDING INSTRUCTIONS
 In most cases, federal and state income tax law requires that we withhold tax from your distribution. You can submit your
 elections by completing Section III D of your IRA Distribution Request Form and following the chart below. If you do not
 make an election, we will automatically withhold as follows:


 FEDERAL: 10 percent of your gross distribution.
 STATE: Based on your residency as outlined below.


    IF YOUR STATE OF RESIDENCE IS:                   STATE INCOME TAX WITHHOLDING REQUIREMENTS AND ELECTIONS

    AK, FL, HI, NH, NV, SD, TN, TX, WA, WY           STATE INCOME TAX WITHHOLDING IS NOT REQUIRED
                                                     State income tax withholding is not required for residents of these states. We will not withhold
                                                     state income tax from your distribution if you reside in these states.


    AL, AZ, CO, CT, DC, GA, ID, IL, IN, KY, LA,      VOLUNTARY STATE INCOME TAX WITHHOLDING
    MD, MI, MN, MO, MS, MT, ND, NJ, NM, NY,          We will withhold state income tax only if you instruct us to do so. If you want state income taxes
    OH, PA, RI, SC, UT, VA, WI, WV                   to be withheld, you must indicate the amount or percentage.
                                                     NOTE: We require tax withholding amounts to be requested in whole dollars for the following states:
                                                     Colorado, Connecticut, Missouri, and New Jersey.


    DE, IA, KS, MA, ME, NE, OK                       MANDATORY STATE INCOME TAX WITHHOLDING WHEN FEDERAL INCOME TAX IS WITHHELD
                                                     We will withhold state income tax according to the rates below when federal income tax is withheld
                                                     from your distribution:

                                                     DELAWARE, IOWA, KANSAS, MAINE, NEBRASKA, AND OKLAHOMA ...............................................5.00% OF GROSS DISTRIBUTION
                                                     MASSACHUSETTS ........................................................................................................................5.30% OF GROSS DISTRIBUTION

                                                     If you have elected not to withhold federal income tax, but request state income tax withholding, the
                                                     following rules apply:

                                                     DELAWARE, KANSAS, MAINE, MASSACHUSETTS, AND NEBRASKA ........................... SPECIFY A DOLLAR AMOUNT OR A PERCENTAGE
                                                     IOWA AND OKLAHOMA .............................................................................................. 5.00% OR MORE OF GROSS DISTRIBUTION




    AR, CA, NC, OR, VT                               MANDATORY STATE INCOME TAX WITHHOLDING WHEN FEDERAL INCOME TAX IS WITHHELD
                                                     We will withhold state income tax according to the rates below whenever federal income
                                                     tax is withheld from your distribution, unless you indicate otherwise:

                                                     ARKANSAS .................................................................................................................................3.00% OF GROSS DISTRIBUTION
                                                     CALIFORNIA ............................................................................................................10.00% OF FEDERAL INCOME TAX WITHHELD
                                                     NORTH CAROLINA ......................................................................................................................4.00% OF GROSS DISTRIBUTION
                                                     OREGON ....................................................................................................................................9.00% OF GROSS DISTRIBUTION
                                                     VERMONT ..............................................................................................................27.00% OF FEDERAL INCOME TAX WITHHELD

                                                     If you want state income tax withholding at a di erent rate (or no state income tax withholding), check
                                                     the box “Do not withhold state income tax” in Section III D 2 of your IRA Distribution Request Form
                                                     or specify a dollar amount or a percentage to indicate your state income tax withholding election.


                                         Rates are subject to change without notice. Keep this page for your records.




                                                                                                                                                                                                                          767A-10_TAXGRID IRA 07-10
    Reset Form                    Print Form                                                       ACH AUTHORIZATION AGREEMENT
Please complete the following fields to begin the electronic transfer of funds between your Pershing brokerage account and the account with your financial
institution. You may begin depositing funds into your brokerage account from your financial institution or send payments to your financial institution
account from your brokerage account up on approval. All transactions are processed through the Automated Clearing House (ACH) system.

       I.       ACCOUNT INFORMATION (Required)

                                             —                                   
ACCOUNT NUMBER:                                                                       ACCOUNT TITLE: _______________________________________________________________

      II.       INSTRUCTIONS (Select Only One Option)
           Set up new instructions. (Complete Sections III & IV, also complete Section V for Retirement Contributions. Original voided check is required.)

           Replace existing instructions. (Complete all applicable sections. Original voided check is required if changing bank information.)

     III.       TYPE OF REQUEST (Select All that Apply)
    A. STANDING INSTRUCTIONS – AD-HOC (This option allows for present or future transfers into and out of your brokerage account.)

           Transfers INTO and/or OUT of my account                      (Proceed to Section VII, complete and sign.)
    B. PERIODIC CONTRIBUTIONS/DISTRIBUTIONS (SELECT ONE OPTION BELOW THEN PROCEED TO SECTION IV & VII, COMPLETE AND SIGN.)

           Periodic contributions INTO my brokerage account (Deposit) (For retirement accounts, also indicate a contribution type in Section VI.)

           Periodic distributions OUT of my brokerage account (Pay Principal)

           Periodic Income distributions OUT of my brokerage account (Pay Income)

           Periodic purchase of mutual funds (SRS) (ACH is contingent upon the execution of periodic mutual fund purchases.)
            NOTE: An IRA or QRP Distribution form is required for distributions out of retirement accounts.

     IV.        AMOUNT AND START DATE (Required. Select a dollar amount and start date.)

    Amount: $ ________________________________________                                               Start date (MM/DD/YY) _________________________

     V.         FREQUENCY (Select One Option Only.)
           Monthly – Occurs every month                                                                                                    Quarterly – Occurs every 3 months
           Semi-monthly – Occurs twice a month                                                                                             Semi-annually – Occurs twice a year
           Bi-monthly – Occurs every other month                                                                                           Annually – Occurs once a year
            NOTE: When selecting Semi-monthly, the beginning date must be between the 1st and the 16th of the month.

     VI.        CONTRIBUTION TYPE (For Applicable Pershing Retirement Accounts Only)
    Contribution type (Select only one)
           Participant current year                                      Employer current year                                       Employer prior year
           Employee deferral current year                                Employee deferral prior year                                Employer matching current year
           Employer matching prior year                                  Qualified matching                                          Qualified non-elective
           Voluntary after tax
    VII.        BANK AND OTHER FINANCIAL INSTITUTION ACH INFORMATION (Required)


BANK/FINANCIAL INSTITUTION NAME                                                              CITY                                                 STATE               ZIP CODE


ACCOUNT NUMBER                                                                              ABA NUMBER

ACCOUNT TYPE:                           Checking                                    Savings



                                                                                                                                                                    PCPRACH

Pershing Advisor Solutions LLC, member FINRA, SIPC, a subsidiary of The Bank of New York Mellon Corporation.                                                                 FRM-PAS-ACH-03-11
Clearing, custody, or other brokerage services may be provided by Pershing LLC, member FINRA, NYSE, SIPC.                                                                          PAGE 1 OF 2
Pershing Advisor Solutions relies on its affiliate Pershing to provide execution services. Trademark(s) belong to their respective owners.
 
I (we) hereby authorize Pershing LLC to initiate credit/debit entries to the financial institution indicated in Section IV and further authorize my (our) financial
institution to debit the same to such account.

This authority is to remain in full force and effect until Pershing Advisor Solutions LLC has received written notification from me (or either of us) of its
termination in such time and in such manner as to afford Pershing Advisor Solutions LLC and my (our) financial institution a reasonable opportunity to act
on it. It is understood that if the period purchase of mutual funds is selected as a contribution type, this agreement authorizes payment for purchasing
securities through my investment professional or financial organization via the systematic reinvestment system (SRS).

Be sure to attach an original voided check (no photocopies). All registered owners on your brokerage account and U.S. bank, credit union or
other financial institution account must sign below as per the attached voided check.




    VIII.       SIGNATURE (Required)


PRINT:                                                                                SIGN:                                                  DATE:


PRINT:                                                                                SIGN:                                                  DATE:


PRINT:                                                                                SIGN:                                                  DATE:


PRINT:                                                                                SIGN:                                                  DATE:


PRINT:                                                                                SIGN:                                                  DATE:


PRINT:                                                                                SIGN:                                                  DATE:




NOTES:        For business accounts, supporting documentation confirming the signature authority on the account is required.

              If the name on your attached voided check does not match the name on your Pershing brokerage account, please complete the ACH Authorization One and the
              Same Letter on the next page and have your signature notarized. Examples would include – a last name change due to marriage or divorce or use of your
              initials instead of your full name.




Pershing Advisor Solutions LLC, a subsidiary of The Bank of New York Mellon Corporation, member FINRA, SIPC.                                             FRM-PAS-ACH-03-11
Clearing, custody, or other brokerage services may be provided by Pershing LLC, member FINRA, NYSE, SIPC.                                                      PAGE 2 OF 2
Pershing Advisor Solutions relies on its affiliate Pershing to provide execution services. Trademark(s) belong to their respective owners.
 
        ACH AUTHORIZATION AGREEMENT – ONE AND THE SAME LETTER
Please complete the below fields if the name on your brokerage account does not match the name on your bank account and voided check.
    NAME DIFFERENCES (Only required if the nane on your brokerage account does not match the name on your bank account)

Please only complete the information below if the name on your check does not match the name on your brokerage account but each account belongs to
you. Examples of acceptable name differences would include a last name change due to marriage or divorce, your bank account uses your initials instead
of your full name or your bank account uses the suffix JR or SR and your brokerage account does not.

I certify that the name on the voided check is different than the name on my Pershing LLC brokerage account; and I hereby certify that I am indeed one
and the same person by signing below.

I certify that _____________________________ and ______________________________ are one and the same person.
                     Name on check                  Name on brokerage account



PRINT:                                                                                SIGN:                                                  DATE:




    Notarization

    STATE OF_____________)
                         ss: ______________
    COUNTY OF_________________)

    On the _________ day of ______________ in the year 20____ before me, the undersigned personally appeared ______________________,
    personally known to me or provide to me on the basis of satisfactory evidence to be the individual whose name is subscribed to be within the
    instrument and acknowledged to me that he/she executed the same in his/her capacity, and that by his/her signature on the instrument the
    individual, or the person upon behalf of whom the individual acted, executed the instrument.

    _____________________________________
    Notary Public




Pershing Advisor Solutions LLC, a subsidiary of The Bank of New York Mellon Corporation, member FINRA, SIPC.                                         FRM-PAS-ACH-OSL-03-11
Clearing, custody, or other brokerage services may be provided by Pershing LLC, member FINRA, NYSE, SIPC.                                                      PAGE 1 OF 1
Pershing Advisor Solutions relies on its affiliate Pershing to provide execution services. Trademark(s) belong to their respective owners.
 

				
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