Current Registration Information Custodian Change Form - Corporate Capital Trust

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Customer Service
Corporate Capital Trust
Corporate Capital Trust
Toll-Free (844) 857-4557
PO Box 219984
430 W. 7th Street, Ste. 219984
Fax (844) 871-9770
Kansas City, MO 64121-9984
Kansas City, MO 64105-1407
Custodian Change Form
one
Resigning Custodian Current Registration Information
Assignor Name
Investor (Beneficial Owner) Name
Investor Account Number
Social Security Number/TIN
Product Name
Number of Units/Shares
Medallion Stamp
Signature Guarantee
Product Name
Number of Units/Shares
The Assignor hereby assigns to the Assignee 100% of the Assignor’s right, title and interest in the Product(s) described
herein. This hereby constitutes and appoints the said General Partner(s)/Company to transfer the above-referenced
assets/interests on the books of record with full power of substitution in the premises.
Authorized Custodian Signature
Date
two
New Custodian Registration
Note: By signing this form, you
Assignee Name
Assignee Tax I.D. Number
authorize any pending redemption
requests to remain on the account
Assignee Address
Assignee Phone Number
for future payment unless a request
to cancel/withdrawal is received.
Investor (Beneficial Owner) Name
Investor Account Number
Social Security Number/TIN
Medallion Stamp
Signature Guarantee
Investor
City
State
Zip Code
Authorized Custodian Signature
Date
if applicable
three
Change of Financial Advisor or Investor Representative (
)
New Broker-Dealer/Financial Institution
New Financial Advisor/Investor Representative Name(s) Advisor Number/Team ID
Mailing Address
Zip Code
City
State
Phone Number
Fax
Revised 12/18/201714 Page 1 of 1
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