Non Qualified Transfer Of Assets Form Page 2
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31. ACCOUNT REGISTRATION
Please provide your primary legal address, in addition to any mailing address (if different).
Owner’s Name (First, Middle, Last)
Social Security Number
Street Address
Date of Birth
City, State, Zip
Daytime Telephone
Email Address
Evening Telephone
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This is a new account. I have completed and enclosed an Application with this transfer form.
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This is an existing account. Please apply transfer proceeds to my account number: __________
2. INFORMATION ABOUT YOUR EXISTING ACCOUNT
Name of Firm Currently Holding Your Account
Account Name
Street Address
Account Number
City, State, Zip
Firm Telephone Number
Please attach a copy of the most recent statement for this account.
3. TRANSFER INFORMATION
Please transfer assets from the above account to Issachar Fund. Transfers should be in cash or in kind according to the
following instructions:
This transfer is a: (check one)
The type of account I am transferring from is a: (check one)
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Complete Transfer. Please liquidate all assets in my account.
Individual
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Joint Tenant
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Partial Transfer. Liquidate $
from my account.
Transfer on Death
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Trust
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Transfer in kind:
Other
Please transfer
shares of
(Fund Name)
The type of account I am transferring to is a: (check one)
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Individual
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Joint Tenant
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Transfer on Death
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Trust
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Other
Issachar Fund: Transfer Form Page 2 of 3
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