Mutual Fund Account Application

Transcription

1 Prudential Mutual Fund Services LLC (PMFS), a Prudential Financial company Instructions Mutual Fund Account Application Non-IRAs only For assistance: Financial Professionals: (888) Clients: (800) Please print clearly, preferably in capital letters and black ink. Return completed application to Prudential Mutual Fund Services LLC. See page 10 for complete mailing instructions. USA Patriot Act requirements To help the government fight the funding of terrorism and money laundering activities, Prudential Financial is required to obtain, verify, and record information on each person who opens an account. Please be sure to review the Privacy Policy at the end of this application. FATCA reporting - The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specified United States persons. Important The following information is required for each person associated with the account: Name Residence address (may not be a PO Box) Date of birth Taxpayer ID number (SSN or EIN) If this information is not provided, we will be unable to open the account. If we are unable to verify your identity, Prudential Financial reserves the right to close your account or take other steps we deem reasonable. 1 Account Ownership (Complete only one account type.) A. Individual or Joint Account (If more than one owner, joint tenants with rights of survivorship is assumed unless otherwise specified.) Owner First name MI Last name Social Security number (required for tax reporting) Joint Owner First name MI Last name Additional Owners If there are more than two account owners, include the information for each account owner on a separate sheet using the same format as in section 3. Transfer on Death For individual accounts only, you may choose to designate a beneficiary under a Transfer on Death (TOD) Plan. To setup as part of your new account, complete the Transfer on Death (TOD) Consent form (PMFS296). B. Uniform Gifts/Transfers to Minors Act (UGMA/UTMA) Account Minor First name MI Last name Minor s Social Security number (required for tax reporting) Date of birth Custodian First name MI Last name State State under whose laws the gift or transfer is being made. SEE NEXT PAGE FOR TRUST, INSTITUTIONAL, CORPORATION, OR OTHER ENTITY. Page 1 of 11

2 1 Account Ownership (continued) C. Trust We require that you include a copy of the pages in your trust agreement that show the name of the trust, the trust date, and a listing of all trustees and their signatures. Provide trustee name(s) in section 3. Trust name (as it appears on the trust document) Date of trust Employer identification number OR Social Security number* Is it tax exempt? Yes No For the benefit of* *If you provide a Social Security number, you must also provide the name of the beneficial owner. D. Institutional Investor, Corporation, or Other Entity*** Type of entity Partnership Sole proprietorship Bank Estate C Corporation S Corporation Limited Liability Company (if you checked this box, please indicate the U.S. federal income tax classification of the LLC below.) C Corporation S Corporation Partnership Other: Name of entity Employer identification number OR Social Security number** Is it tax exempt? Yes No Please complete the Institutional Suitability Certificate (on last page) if there is no broker/ dealer associated with this account. **A Social Security number would only be used if sole proprietorship is selected. E. Employer Sponsored Retirement Plan*** PMFS no longer accepts new plans; however, a new participant is permitted to establish an account in an employer s plan that already exists at PMFS. PMFS does not provide services for these plans that are invested in Prudential mutual funds via this application. Type of plan Profit sharing Money purchase Keogh Defined benefit Defined compensation 401(k) Name of plan Employer identification number of plan First name of participant MI Last name First name of employer contact MI Last name Employer contact telephone number *** Important Message About Institutional Investor, Corporation, Employer Sponsored Retirement Plan, and Other Entity Accounts. You are required to submit certified copies of organization documents, as applicable, in order to establish your account. Such documentation is required by PMFS to verify the identity of the entity. Page 2 of 11

3 2 Mailing Address This mailing address will be considered the account s address of record and will be used for all account mailings. It is important that each associated person s residential address be provided in section 3. Street address (You may use a PO Box as a mailing address.) City State ZIP code 4-digit ext. 3 Account Owner/Associated Person Information (Required for the USA Patriot Act.) Every associated person with the account must provide all the information requested. Important: If there are more than two owners/associated persons, provide the information, in the same format, on a separate sheet. A. Name of Owner Minor Trustee Administrator/Executor Other First name MI Last name Social Security number Date of birth Marital Status Married Single Widowed Divorced Number of Dependents Citizenship U.S. Citizen Resident alien Nonresident alien* Country of residence * Nonresident aliens must attach the applicable Internal Revenue Service (IRS) Form W-8 (BEN, ECI, EXP, IMY), which can be obtained at Residential/Permanent address (We cannot accept a PO Box or rural route number) City State ZIP code 4-digit ext. Daytime phone number Extension Cell phone number address (optional) B. Name of Joint owner Custodian Trustee Administrator/Executor Other First name MI Last name Social Security number Date of birth Citizenship U.S. Citizen Resident alien Nonresident alien* Country of residence * Nonresident aliens must attach the applicable Internal Revenue Service (IRS) Form W-8(BEN, ECI, EXP, IMY), which can be obtained at Residential/Permanent address (We cannot accept a PO Box or rural route number.) City State ZIP code 4-digit ext. Daytime phone number Extension Cell phone number Page 3 of 11

4 4 Mutual Fund Selection & Allocation Please provide your investment selections by checking the box next to the fund number and indicate allocations as either a percentage (%) or dollar amount ($). If a fund offers a share class not listed, then write the fund number or share class in the Other column next to the fund name. Refer to the fund s prospectus for fund minimum and eligibility requirements. Fund Share Class Initial Investment ASSET ALLOCA TION FUNDS EQUITY FUNDS Fund Name Class A Other % $ Asset Allocation Prudential Balanced Fund 296 Prudential Conservative Allocation Fund 1509 Prudential Growth Allocation Fund 1501 Prudential Moderate Allocation Fund 1505 Prudential QMA Global Tactical Allocation Fund 1132 Equity Prudential Jennison 20/20 Focus Fund 515 Prudential Jennison Blend Fund 21 Prudential Jennison Diversified Growth Fund 560 Prudential Jennison Equity Income Fund 1760 Prudential Jennison Equity Opportunity Fund 285 Prudential Jennison Focused Growth Fund 576 Prudential Jennison Growth Fund 267 Prudential Jennison Mid Cap Growth Fund 298 Prudential Jennison Rising Dividend Fund 1101 Prudential Jennison Small Company Fund 25 Prudential Jennison Value Fund 26 Prudential QMA Large-Cap Core Equity Fund 533 Prudential QMA Mid-Cap Value Fund 1756 Prudential QMA Small-Cap Value Fund 1100 Prudential QMA Stock Index Fund 573 Prudential QMA Strategic Value Fund 586 Prudential QMA Defensive Equity Fund 527 Specialty Prudential Global Real Estate Fund 511 Prudential Income Builder Fund 525 Prudential Jennison Financial Services Fund 546 Prudential Jennison Global Infrastructure Fund 1090 Prudential Jennison MLP Fund 1093 Prudential Jennison Natural Resources Fund 32 Prudential Jennison Utility Fund 9 Prudential QMA Large-Cap Core Equity PLUS Fund 1191 Prudential QMA Long-Short Equity Fund 1104 Prudential Real Assets Fund 1050 Prudential Real Estate Income Fund 1140 Prudential Select Real Estate Fund 1110 Prudential US Real Estate Fund 1030 Page 4 of 11 (continued)

5 4 Mutual Fund Selection & Allocation (continued EQUITY FUNDS FIXED INCOME FUNDS Target Date FUNDS Global/ International Equity Taxable Fixed Income Tax Exempt Money Market Day One Funds Page 5 of 11 Fund Share Class Initial Investment Fund Name Class A Other % $ Prudential QMA International Equity Fund 574 Prudential Jennison Emerging Markets Equity Fund 1114 Prudential Jennison Global Opportunities Fund 1037 Prudential Jennison Intl Opportunities Fund 1083 Prudential Absolute Return Bond Fund 1044 Prudential Core Bond Fund 1128 Prudential Corporate Bond Fund 1136 Prudential Emerging Mkts Debt Hard Currency Fund 2100 Prudential Emerging Mkts Debt Local Currency Fund 1054 Prudential Floating Rate Income Fund 1034 Prudential Global Absolute Return Bond Fund 1146 Prudential Global Total Return Fund 272 Prudential Global Total Return USD Hedged Fund 2104 Prudential Government Income Fund 84 Prudential High Yield Fund 87 Prudential International Bond Fund 1167 Prudential Short Duration High Yield Income Fund 1086 Prudential Short Duration Multi-Sector Bond Fund 1096 Prudential Short-Term Corporate Bond Fund 78 Prudential Total Return Bond Fund 264 Prudential Unconstrained Bond Fund 1143 Prudential California Muni Income Fund 6 Prudential Muni High Income Fund 28 Prudential National Muni Fund 22 % $ Prudential Short Duration Muni High Income Fund 1107 Prudential Government Money Market Fund Day One Funds Class R2 Prudential Day One Income Fund 4001 Prudential Day One 2010 Fund 4007 Prudential Day One 2015 Fund 4013 Prudential Day One 2020 Fund 4019 Prudential Day One 2025 Fund 4025 Prudential Day One 2030 Fund 4031 Prudential Day One 2035 Fund 4037 Prudential Day One 2040 Fund 4043 Prudential Day One 2045 Fund 4049 Prudential Day One 2050 Fund 4055 Prudential Day One 2055 Fund 4061 Prudential Day One 2060 Fund 4067 Total: (100% or $) Note: The total must equal 100% or the total dollar amount provided in section 5.

6 5 Purchase Information Check, made payable to Prudential Mutual Fund Services. Check amount $ Transfer account from another institution. Complete the Mutual Fund Account Transfer form (MF1019). Estimated amount $,.,. 6 Letter of Intent & Rights of Accumulation Letter of Intent (LOI): Check here if establishing, complete the Letter of Intent form (MF230 PMFS), and include with this application. Financial professionals can request a copy by calling (888) Rights of Accumulation: Check here and list account numbers below if you qualify for sales discounts on Class A shares. Please refer to the fund s prospectus and Statement of Additional Information to learn more about accounts that may be eligible. Indicate eligible accounts below. Account Number Account Owner Name (first name, MI, last name) Relationship to You 7 Distribution Options Distributions (of dividends or capital gains) of less than $10.00 will not be paid out in cash, but will be automatically reinvested into your account to purchase additional shares at Net Asset Value (NAV), without any sales charge. All dividends and capital gains will be reinvested if you do not make an election. Dividends Reinvest in shares Pay in cash Send by ACH to the bank specified in section 10 Capital Gains Reinvest in shares Pay in cash Send by ACH to the bank specified in section 10 8 Telephone/Online Exchange and Redemption Option Your account will automatically be coded with the Telephone/Online Redemption and the Telephone/Online Exchange Privileges, unless you check the No box below. I do not want telephone exchange and redemption privileges. Unless otherwise indicated above, you authorize the Fund s distributor, Prudential Investment Management Services LLC (PIMS), to accept telephone exchange and redemption instructions from any person identifying himself/herself as the owner of the account or as the owner s dealer representative conveying instructions of the owner. PIMS and/or the Fund s transfer agent, Prudential Mutual Fund Services LLC (PMFS), will employ reasonable procedures to confirm that such telephone instructions are genuine. Neither the Funds, PIMS nor PMFS shall be liable for any losses due to unauthorized or fraudulent instructions provided that such procedures are followed. Telephone exchanges and redemptions are subject to the procedures and conditions set forth in each Fund s prospectus. Page 6 of 11

7 9 Purchase Options (Check all that apply.) A. ACH Purchase Option: Check if you want the capability to make wire purchases, online or by telephone, upon demand, by having the purchase amount debited from your bank account. B. Automatic Investment Plan (AIP): Set up recurring purchases into a fund and have the purchase amount debited from your bank account. Note: All contributions will be processed as current year contributions and the total contributions may not exceed the maximum allowed per tax year. Frequency (The minimum investment amount is $50 per fund.) Weekly on (enter day of week e.g. Monday) Monthly on the (enter a day of the month e.g. 15th) Start date* *If a specific day of the month is not listed above, debits will be made on or about the 15th of the month. Share class $ into the Fund A C $ into the Fund A C $ into the Fund A C $ into the Fund A C $ into the Fund A C $ into the Fund A C $ Total amount (to be debited from bank/credit union account as specified in section 9) Other 10 Bank of Record* (Complete only if section 9 is completed.) Bank/Credit union name Bank telephone number Bank routing number Bank account number *To ensure accuracy, verify with your bank or credit union. Name of depositor on bank records (first, middle initial, last name) Bank type: Checking Savings Name of joint depositor on bank records (first, middle initial, last name) Attach voided check here. Ü Ý Name on bank account Check no Street address City, State ZIP DATE pay to the order of $ FOR Ü VOID ABA number (9 digits) DOLLARS ÝBank account number Page 7 of 11

8 11 E-Delivery & Mailing Preferences Consider our e-delivery service as your preferred delivery option. It is a fast, easy, and secure way to get account information at any time. It is environmentally friendly by reducing paper and ink use. If you elect e-delivery, you will receive an informing you when your account documents become available and instructions on how to view them online. Note: Certain entity and institutional accounts are not eligible for e-delivery. FEE WAIVER By selecting the three e-delivery options marked with asterisk (*) below and completing the enrollment in e-delivery, your account will qualify for a waiver of the $15 account maintenance fee that is assessed annually on each fund balance under $10,000. Document Type Delivery Preference Prospectuses, Shareholder Reports, and Proxy Mailings e-delivery* U.S. mail Quarterly Statements e-delivery* U.S. mail Year-end Statements and Privacy Notice e-delivery U.S. mail Confirmations e-delivery* U.S. mail Tax Forms After account setup, log in online to elect the tax form e-delivery option. address for e-delivery required only if e-delivery is selected above. By enrolling for e-delivery, you consent to receive electronic versions instead of paper copies of materials for your mutual fund accounts. Once your account is established, visit to enroll your account online. PMFS will only use your address to provide you with the material you requested or to send important news about your account. Note: All documents will be sent to you by U.S. Mail if you do not select a delivery preference. 12 Text Message alert for financial transactions on your account If you would like to receive a text (SMS) message when a financial transaction takes place on your account, please check the box below. We will use the cell phone number in section 1 to send you a text message to confirm your financial transactions (purchases, exchanges and redemptions). Please read our alert user agreement below. Yes, I wish to receive text messages regarding financial transactions processed on my account. You are agreeing to receive periodic service alerts from Prudential, each of which may be delivered to your phone using an automated system. Message frequency may vary. Standard Message and Data Rates may apply to any SMS or MMS you send or receive as part of this program. At any time, you may reply to a text with STOP to cancel future notifications. Terms and Privacy Policy at Page 8 of 11

9 13 Cost Basis Election Please provide your cost basis calculation method, if applicable, for shares acquired on or after January 1, You will only need to complete this section if you would like to select a different cost basis method than PMFS default method, PMFS default method is Average Cost for most Prudential mutual funds and it is First In First Out (FIFO) for the Prudential Jennison MLP Fund. If you accept PMFS default method for your taxable transactions on shares acquired on or after January 1, 2012, then you can skip this section. Under current IRS regulations, you have up to the date of the first redemption of shares acquired on or after January 1, 2012 to change your election. Note: Money market funds are excluded from cost basis reporting requirements. Check only one method from the list below. * Average Cost Under this method, we use the average basis of all shares owned at the time of redemption, regardless of how long you owned them. To determine the holding period, the shares sold are considered to be those acquired first. First In First Out (FIFO) This method keeps track of every tax lot of shares purchased. When calculating gain or loss, this method depletes tax lots in the chronological order in which available lots were acquired. Last In First Out (LIFO) The most recent shares acquired will be redeemed first. Highest Cost In, First Out (HIFO) The highest cost shares will be redeemed first. Highest Cost Long-Term In, First Out (HILT) The long-term highest cost shares will be redeemed first. Highest Cost Short-Term In, First Out (HIST) The short-term highest cost shares will be redeemed first. Lowest Cost In, First Out (LOFO) The lowest cost shares will be redeemed first. Lowest Cost Long-Term In, First Out (LILT) The long-term lowest cost shares will be redeemed first. Lowest Cost Short-Term In, First Out (LIST) The short-term lowest cost shares will be redeemed first. Note: The Specific Lot Depletion Method (SLDM) may also be used as a cost basis method. This method allows shareholders to choose which tax lots they are selling, thereby giving the shareholder more control over whether they will generate a gain or loss on the transaction. Shareholders must specify the particular lots to be sold no later than the settlement date of the redemption. The gain or loss will vary, depending on which shares they choose. This method cannot be pre-selected as a default method on your account. Also, this method cannot be selected for systematic transactions such as Systematic Withdrawal Plans (SWPs), systematic exchanges, and exchange rebalancing among multiple funds. If you would like to select a different cost basis method for each fund in your new account, please provide that information on a separate sheet with the date and your signature. * For the Prudential Jennison MLP Fund, the only allowable cost basis methods are FIFO, LIFO and SLDM. Page 9 of 11

10 14 Financial Professional(s) Identification and Signature(s) (if applicable) Broker/dealer name (Please print.) Address City State ZIP code 4-digit ext. Broker/dealer number Branch number Representative number* *If more than one rep, use your joint rep number. 1. Financial professional (first name, MI, last name) (Please print.) Financial professional s signature X Branch telephone number Ext. Financial Professional telephone number Ext. 2. Financial professional* (first name, MI, last name) (Please print.) Financial professional s signature X Branch telephone number Ext. Financial Professional telephone number Ext. Check here if you are a fee-based consultant. Page 10 of 11

11 15 Signature(s) and Tax Certification The undersigned warrants that I have full authority and, if a natural person, I am of legal age to own and purchase shares pursuant to this application. Further, I acknowledge receipt of the prospectus(es) for the mutual fund(s) referenced herein, and I agree to its/ their terms. I consent to the householded delivery of any mutual fund prospectuses, shareholder reports, or proxy statements. This means Prudential Mutual Fund Services LLC (PMFS) will deliver a single copy of these documents to shareholders who share an address, even if the accounts are registered in different names. My participation in this program will continue indefinitely unless I contact PMFS. According to Federal law and/or state regulations, your account(s) may be subject to escheatment to your state of residency. Escheatment may be based on account inactivity and/or mail being returned by the post office (RPO). Check with your state Controller s office for additional guidance. Under penalties of perjury, I certify that (cross out any item that is not true): (1) The number shown on this form is my correct Social Security/Tax ID number, (2) I am not subject to backup withholding due to failure to report interest or dividend income, (3) I am a U.S. citizen or other U.S. person (including a U.S. resident alien), and (4) I am not subject to FATCA reporting If you crossed out item 3 above, please indicate country of citizenship and attach applicable Internal Revenue Service Form W-8(BEN,BEN-E,EXP, ECI,IMY). To help the government fight the funding of terrorism and money laundering activities, Prudential Financial is required to obtain, verify, and record information on each person who opens an account. This verification process will take place as we open your account. Once verification is completed, Prudential Financial will be able to fully service and maintain the account. Account Restriction: Check here if you would like PMFS to establish a restricted account from which funds shall be disbursed only upon receipt of a valid court order or other document(s), as appropriate. A copy of the restriction (court order or otherwise), signed and dated on has been provided with this mutual fund application. The restriction shall continue until PMFS receives a valid court order or other written instruction as directed by PMFS, expressly authorizing the removal of the restriction. Sign here: All those listed in section 3 (except minors) must sign below. Attach an additional sheet if necessary. The Internal Revenue Service does not require your consent to any provision of this document other than the certification required to avoid backup withholding. Signature X Date Signature X Date Mailing Instructions for Mutual Fund Account Application Standard Prudential Mutual Fund Services LLC Overnight mail to: PO Box 9658 Providence, RI mail to: Prudential Mutual Fund Services LLC 4400 Computer Drive Westborough, MA Page 11 of 11

12 Prudential Mutual Fund Services LLC a Prudential Financial company Mutual Fund Account Transfer Form (Non-IRAs only) For assistance: Clients: (800) Financial Professionals: (888) Pruco Financial Professionals: (800) What to do to submit your Transfer of Asset request: 1. Decide You can use this form to request these types of transfers: Transfer of Assets If you want to liquidate and transfer the account proceeds from another institution to PMFS, complete section 3 and the other sections that apply to your request. Transfer-in-Kind If you want to transfer existing Prudential mutual funds and change the custodian to Prudential Trust Company, complete section 4 and the other sections that apply to your request. 2. Complete Read the attached instructions carefully before completing this form. Please provide all requested information in each section to ensure your request is processed in a timely manner. 3. Return Send us your completed form. Return form to: Regular mail Prudential Mutual Fund Services LLC P.O. Box 9658 Providence, RI Express mail Prudential Mutual Fund Services LLC 4400 Computer Drive Westborough, MA 01581

13 1. About You (Please attach only one account type.) If this is for a new Prudential account, you can leave the account number field below blank. PMFS account number Social Security number First name Middle initial Last name Entity name (if applicable) Street Address City State ZIP Code Home phone Mobile phone address 2. About the Account You are Transferring to PMFS A. Sending Institution Information Name of institution/employer-sponsored retirement plan Attention Street address City State ZIP Code Contact name Contact phone B. Account number(s) to be transferred Account number Account number Account number MF1019 Ed. 6/2017 page 1 of 5

14 3. Transfer of Assets All liquidations are done immediately unless special instructions are provided below. A. Liquidate All $ (estimated value) Partial % or $ B. Special instructions for CDs and certain annuity contracts Transfer immediately. I am aware of and acknowledge any penalty I may incur from an early withdrawal. Transfer at maturity (month, day, year): / / (Please submit 4 weeks prior to maturity date.) 4. Transfer-in-Kind Complete this section only if you have existing Prudential mutual funds and want to change your current Trustee/ Custodian. Transfer my funds in kind immediately. All Partial $ 5. Mutual Fund Selection and Allocation I am opening a new account and have attached a completed application. Allocation instructions are included in section 4 of my new account application. For this transfer request, invest the amount received into my existing account(s) (indicated in section 1) in the funds and allocations listed below. Note: All allocations by percentage must total 100%. Fund Name Fund Number Share Class Percent or Amount MF1019 Ed. 6/2017 page 2 of 5

15 6. Authorization I authorize the institution designated in section 2 to redeem/transfer-in-kind my account and transfer the proceeds to Prudential Mutual Fund Services LLC (PMFS). I am aware of and acknowledge that penalties may be incurred from early/ late withdrawal. All account owners who are authorized parties must sign below. Attach an additional sheet if necessary. X X Account owner s signature Date (mm/dd/yyyy) Account owner s signature (if applicable) Date (mm/dd/yyyy) Important: If you are acting on behalf of the account owner, please indicate the capacity in which you are acting by checking the appropriate box below. If the correct box is not listed, please check Other and specify your capacity. Appointee under POA Other, please specify Place medallion signature guarantee here 7. Financial Professional Identification and Signature (if applicable) Financial professional s name (first name, MI, last name) (Please print.) Financial professional s signature X Broker/Dealer s name (Please print.) Broker/Dealer number Branch/Agency number Rep./Contract number Branch telephone number Alternate telephone number MF1019 Ed. 6/2017 page 3 of 5

16 Prudential Mutual Fund Services LLC a Prudential Financial company Instructions & Disclosures For assistance: Clients: (800) Pruco Financial Professionals: (800) Financial Professionals: (888) About You Use this form to request a transfer of assets or transfer in kind from another institution to Prudential Mutual Fund Services LLC (PMFS). Complete a separate transfer form for each sending institution. Include a copy of your most recent account statement with this form. Note: Prudential Mutual Fund Services LLC cannot accept stock certificates. Once we receive your transfer request and confirm that it is in good order, we will send a letter to your current institution requesting that the assets be sent to PMFS. Please follow up with your current institution to determine the time frame for transferring your account to PMFS. Also, check with the resigning institution about any financial penalties, suspensions, medallion signature guarantee, federal and state tax withholding elections or other restrictions that could affect the account proceeds that are being transferred to PMFS. If the account you are liquidating is subject to federal and state tax withholdings, then we suggest that you attach a letter of instruction to provide your withholding election for the resigning institution. About the Account(s) You are Transferring to PMFS Indicate the type of account and account number that you currently own which you would like the resigning institution to liquidate or transfer to PMFS. Also, provide the name and address of the financial institution or employer-sponsored retirement plan from which the account will be liquidated or transferred. Transfer of Assets This section must only be completed if you own assets (other than Prudential Mutual Funds) and you want the proceeds to be liquidated and transferred to PMFS. Also, indicate any special instructions about when your account at the resigning institution should be liquidated. Transfer-in-Kind This section should only be completed if you own existing Prudential mutual funds and want to change your current Trustee/ Institution to PMFS. If you own shares of Prudential mutual funds, those shares will not be liquidated. PMFS Account Type State the type of account you want the proceeds to be invested in at PMFS. MF1019 Ed. 6/2017 page 4 of 5

17 Mutual Fund Selection and Allocation If you are opening a new account, attach a completed new account application and we will follow the allocation instructions indicated on your application. You do not need to provide separate allocation instructions in this section of this form. If the transfer proceeds will be invested into an existing account, indicate in this section the fund(s) and the amount that should be allocated to each fund. Note: All allocations by percentage must total 100%. Refer to the fund s prospectus for the fund minimum and other important information about the fund(s) you have selected. Authorization Some resigning custodians require a medallion signature guarantee in order to transfer your account proceeds to PMFS. Please have your signature medallion guaranteed in this section if your current custodian requires a medallion signature. MF1019 Ed. 6/2017 page 5 of 5

18 Privacy Notice Prudential values your business and your trust. We respect the privacy of your personal information and take our responsibility to protect it seriously. This privacy notice is provided on behalf of the Prudential companies listed at the end of this notice (Prudential), and applies to our current and former customers. This notice describes how we treat the information we receive about you, including the ways in which we will share your personal information within Prudential and your right to opt out of such sharing. Protecting Your Personal Information We maintain physical, electronic and procedural safeguards to protect your personal information. The people who are authorized to have access to your personal information need it to do their jobs, and we require them to keep that information secure and confidential. Personal Information We Collect We collect your personal information when you fill out applications and other forms, when you enter personal details on our websites, when you respond to our s, and when you provide us information over the telephone. We also collect personal information that others give us about you. This information includes, for example: name address, address, telephone number, and other contact information income and financial information Social Security number transaction history medical information for insurance applications consumer reports from consumer reporting agencies participant information from organizations that purchase products or services from us for the benefit of their members or employees Using Your Information We use your personal information for various business purposes, including: normal everyday business purposes, such as providing services to you and administrating your account or policy business research and analysis marketing products and services of Prudential and other companies in which you may be interested as required by law Sharing Your Information We may share your personal information, including information about your transactions and experiences, among Prudential companies and with other non-prudential companies who perform services for us or on our behalf, for our everyday business purposes, such as providing services to you and administering your account or policy. We may also share your personal information with another financial institution if you agree that your account or policy can be transferred to that financial company. We may share your personal information among Prudential companies so that the Prudential companies can market their products and services to you. We may also share consumer report information among Prudential companies which may include information about you from credit reports and certain information that we receive from you and from consumer reporting agencies or other third parties. You can limit this sharing by following the instructions described in this notice. For those customers who have one of our products through a plan sponsored by an employer or other organization, we will share your personal information in a manner consistent with the terms of the plan agreement or consistent with our agreement with you. We may also share your personal information as permitted or required by law, including, for example, to law enforcement officials and regulators, in response to subpoenas, and to prevent fraud. Unless you agree otherwise, we do not share your personal information with non-prudential companies for them to market their products or services to you. We may tell you about a product or service that other companies offer and, if you respond, that company will know that we selected you to receive the information.

19 Limiting Our Sharing Opt Out/Privacy Choice You may tell us not to share your personal information among Prudential companies for marketing purposes, and not to share consumer report information among Prudential companies, by opting out of such sharing. To limit our sharing for these purposes: visit us online at: call us at: If you previously told us in 2016 not to share your personal information among Prudential companies for marketing purposes, or not to share your consumer report information among Prudential companies, you do not need to tell us not to share your information again. You are not able to limit our ability to share your personal information among Prudential companies and with other non-prudential companies for servicing and administration purposes. Questions If you have any questions about how we protect, use, and share your personal information or about this privacy notice, please call us. The toll-free number is We reserve the right to modify this notice at any time. This notice is also available anytime at This notice is being provided to customers and former customers of the Prudential companies listed below. Insurance Companies and Insurance Company Separate Accounts The Prudential Insurance Company of America; Prudential Annuities Life Assurance Corporation; Pruco Life Insurance Company; Pruco Life Insurance Company of New Jersey; Prudential Retirement Insurance and Annuity Company (PRIAC); CG Variable Annuity Account I & II (Connecticut General); Pruco Insurance Company of Iowa; All insurance company separate accounts that include the following names: Prudential, Pruco, or PRIAC Insurance Agencies Prudential Insurance Agency, LLC; Mullin TBG Insurance Agency Services, LLC Broker-Dealers and Registered Investment Advisers AST Investment Services, Inc.; Prudential Annuities Distributors, Inc.; Global Portfolio Strategies, Inc.; Pruco Securities, LLC; Prudential Investment Management, Inc.; Prudential Investment Management Services LLC; Prudential Investments LLC; Prudential Private Placement Investors, L.P. Bank and Trust Companies Prudential Bank & Trust, FSB; Prudential Trust Company Investment Companies and Other Investment Vehicles Prudential Investments Mutual Funds; Prudential Capital Partners, L.P.; The Target Portfolio Trust; Advanced Series Trust; Private Placement Trust Investors, LLC; All funds that include the following names: Prudential, PCP, PGIM, or PCEP Vermont Residents: We will not share information about your creditworthiness among Prudential companies, other than as permitted by Vermont law, unless you authorize us to make those disclosures. Prudential, the Prudential logo and the Rock symbol are service marks of Prudential Financial, Inc. and its related entities, registered in many jurisdictions worldwide. Ed. 1/2017

20 INSTITUTIONAL SUITABILITY CERTIFICATE AFFIRMATIVE INDICATION OF EXERCISE OF INDEPENDENT JUDGMENT (Pursuant to FINRA Rule 2111) 1 In connection with any recommended 2 transaction or investment strategy by Prudential Investment Management Services LLC (PIMS), a registered broker dealer and Prudential Financial company, the undersigned acknowledges on behalf of the Institution named below that: 1. It is an Institutional Account as defined in FINRA Rule 4512(c) 3 ; 2. It (a) is capable of evaluating investment risks independently, with regard to all transactions involving Prudential mutual funds; and (b) will exercise independent judgment in evaluating any recommendation made by PIMS or its associated persons with respect to such funds, unless it has otherwise notified PIMS in writing. 3. It will notify PIMS if anything in this Certificate ceases to be true. 4. This Certificate and the information contained herein may be shared by PIMS with its affiliates and regulators; and 5. He or she is authorized to sign on behalf of the Institutional Account named below. By signing this Certificate, the undersigned affirms that the above statements are accurate but does not waive any rights afforded under the U.S. federal or state securities laws, including without limitation, any rights under Section 10(b) of the Securities Exchange Act of 1934, as amended, and the rules and regulations promulgated thereunder. NOTE: This Certificate shall apply with respect to all recommended transactions and investment strategies involving securities that are entered into by the Institutional Account named in this Certificate, whether for the account of such Institutional Account or for the account of any beneficial owner that has delegated decision making authority to such Institutional Account. Institutional Account Name: Name of Authorized Signatory: Title of Authorized Signatory: Signature of Authorized Signatory: Address, City, State, Zip: U.S. Tax ID/EIN (if applicable): Telephone: Address: Date: 1 Available at 2 As defined in FINRA Rules. 3 The term Institutional Account means the account of : (1) a bank, savings and loan association, insurance company or registered investment company; (2) an investment adviser registered either with the SEC under Section 203 of the Investment Advisers Act or with a state securities commission (or any agency or office performing like functions); or (3) any other person (whether a natural person, corporation, partnership, trust or otherwise) with total assets of at least $50 million as of the date of this Certificate (whether such assets are invested for such person s own account or under management for the account of others). Prudential Investment Management Services LLC, 100 Mulberry Street, Three Gateway Center, 14 th Floor, Newark, NJ 07102