Fillable Brokerage Transfer Form - T. Rowe Price (Page 2 of 3) in pdf

Signatures

Sign Below

4B Unlike Ownership Transfers

Complete this section if you are transferring from an account with a

Unless otherwise indicated in the instructions, transfer my entire securities

different owner than the account being transferred into.

account to Pershing LLC, as clearing broker for T. Rowe Price Investment

Services, Inc. (receiving organization), which has been authorized by me

I (We) are transferring from delivery firm

to make payment to you of the debit balance or to receive payment of

Name of Firm:

the credit balance in my securities account. If I am transferring my IRA

assets, please be advised that I have adopted a new IRA custodial agree-

Registered as (name(s) on account):

ment with T. Rowe Price Trust Company as successor custodian and

the receiving organization as broker. I understand that, to the extent any

assets in my securities account are not readily transferable, with or with-

and hereby authorize this transfer to T. Rowe Price

out penalties, such assets may not be transferred within the time frames

required by Financial Industry Regulatory Authority (FINRA) Rule 11870

Registered as (name(s) on account):

or similar rule of FINRA or other designated examining authority.

Unless otherwise indicated in the instructions, I authorize you to

liquidate any nontransferable proprietary money market fund assets

All owners of the T. Rowe Price account must sign. A signature guarantee

that are part of my securities account and transfer the resulting credit

is required.

balance to the receiving organization. I understand that you will

Signature(s) and Date(s) Required

contact me with respect to the disposition of any other assets in my

securities account that are nontransferable.

Owner (as it appears on statement)

Date (mm/dd/yyyy)

If certificates or other instruments in my securities account are in your

- X

physical possession, I instruct you to transfer them in good deliver-

able form, including affixing any necessary tax waivers, to enable the

Joint Owner (if applicable)

Date (mm/dd/yyyy)

receiving organization to transfer them in its name for the purpose

- X

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

4C Signature Guarantee

unused checks issued to me in connection with my securities account.

I understand that if the transfer constitutes a change of ownership of the

A signature guarantee is required if:

assets, the new registered owners will have exclusive rights to the assets.

• The account being transferred is not identically registered to your

T. Rowe Price account. Additional documentation may be required.

Sign Below

4A Account Owners

• Your current firm requires it.

You can obtain the Medallion signature guarantee from most banks,

Account Statement Required to Process: Enclose a complete copy

savings institutions, or broker-dealers. We cannot accept guarantees

of your most recent statement.

from notaries public or non-Medallion guarantors. The level of coverage

All owners of the account at delivering firm must sign.

provided by the guarantor’s stamp must cover the dollar amount of the

transaction or it may be rejected.

Signature(s) and Date(s) Required

Medallion Signature Guarantee—Place Medallion Stamp Below

Owner (as it appears on statement)

Date (mm/dd/yyyy)

- X

Joint Owner (if applicable)

Date (mm/dd/yyyy)

- X

Plan Administrator (PSP, MPP, and Individual 401(k) transfers)

Date (mm/dd/yyyy)

- X

T. Rowe Price Brokerage is a division of T. Rowe Price Investment Services,

Inc., member FINRA/SIPC. Brokerage accounts are carried by Pershing LLC,

a BNY Mellon company, member NYSE/FINRA/SIPC. T. Rowe Price mutual

This Box for T. Rowe Price Use Only

funds not held as positions in your Brokerage account are serviced by T. Rowe

Price Services, Inc., and are not carried by Pershing.

T. Rowe Price maintains an account (or IRA/retirement plan account

as applicable) for this individual and will deposit the transferred

assets in the same type of account designated. T. Rowe Price’s

clearing number is 0443.

Authorized Signature, T. Rowe Price

Date (mm/dd/yyyy)

- X

Title

FBR2BTRF

Questions?

| 800-225-7720

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Brokerage Transfer Form - T. Rowe Price Page 2

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