Account Holder Change - T. Rowe Price
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1A CCOUN T HOLDE R CH ANG E
✓ USE T HI S F O R M TO:
R ET U R N T H I S F OR M T O :
EX P R E SS M A I L O N L Y :
• Change the Account Holder or Custodian.
T. Rowe Price
T. Rowe Price
P.O. Box 17302
Mail Code 17302
✗ DO NOT U SE T HI S F OR M T O :
• Remove a Custodian or rename the Custodian as the Account
Baltimore, MD 21297-1302
4515 Painters Mill Road
Holder. Use the
Custodian
form.
Owings Mills, MD 21117-4903
This stamp indicates a signature guarantee is required.
This paper clip indicates you may need to attach documentation.
1
3
RELINQUISHING ACCOUNT
SIGNATURE
If the Account Holder is changing because the current Account Holder is
By signing this form, I understand and hereby certify that:
deceased or legally incompetent, call for required documentation.
• The information on this form is accurate, and I agree to hold harmless the
Trust, T. Rowe Price, and the University of Alaska for any claims arising as
Account Holder
Social Security Number
(SSN)
a result of misrepresentations made by me.
• I authorize this transaction from my Account(s).
• I understand that it is my responsibility to maintain accurate records as may
Beneficiary
SSN
be required by the IRS to substantiate this change.
• All signatures on this form are genuine signatures of the respective individu-
als or their legal guardians.
Custodian/Trustee (if applicable)
SSN
A signature guarantee is required if:
• The transfer amount is $50,000 or more.
SIG NA TUR E A ND D ATE RE QUI RE D
Day Phone
Evening Phone
Relinquishing Account Holder, Custodian (if Account Holder is a minor),
Date (mm/dd/yyyy)
or Trustee(s)
Provide the Account number and portfolio to be transferred.
X
1. Portfolio Name
Account Number
You can obtain the Medallion signature guarantee from most banks, savings
institutions, or broker-dealers. We cannot accept guarantees from notaries public
Full Amount
Partial Amount: $
OR
%
or non-Medallion guarantors. The level of coverage provided by the guarantor’s
stamp must cover the dollar amount of the transaction or it may be rejected.
2. Portfolio Name
Account Number
M E D A L L I O N S I g N A t u r E g u A r A N t E E—
PLAc E M E DALL ION S tAM P BE L O w
OR
Full Amount
Partial Amount: $
%
For more Accounts, check this box and attach a
separate
page.
2
RECEIVING ACCOUNT HOLDER OR CUSTODIAN
Name
Account Holder
Custodian
SSN (last 4 digits)
Check one:
New Account. The new Account Holder or Custodian (if applicable) must
complete and enclose a
New Account Agreement
form.
Existing Account. Provide the existing Account number for reference.
Portfolio(s) will remain the same as the relinquishing Account.
Account Number
F5N3NTAH
Questions?
| 866-521-1894
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