Prudential Mutual Fund Services LLC (PMFS),
a Prudential Financial company
IRA, Roth IRA & SEP IRA Mutual Fund
Employee Application
For assistance: Pruco Financial Professional: (800) 542-7117
Financial Professionals: (888) 778-5471
Clients: (800) 225-1852
Use this application if you are an active employee of Prudential, an eligible family member of an active Prudential employee,
or a person eligible for class Z shares as indicated in the fund’s prospectus. Eligible family members generally include an
employee’s spouse, children and parents. To confirm class Z share eligibility, please contact the Prudential Mutual Fund Service
Center.
For all eligible accounts, purchases will be made in Class Z funds or selected money market funds. Class Z funds have no sales
charges and lower expenses than most other share classes. For more information on our funds, please visit our website at www.
prudentialfunds.com.
Please print clearly, preferably in capital letters and black ink. Return your completed application to Prudential Mutual Fund Services
LLC. See page 13 for complete mailing instructions.
With certain limited exceptions, the funds are only available to be sold in the United States, US Virgin Islands, Puerto Rico, and Guam.
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 • 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.
Instructions
Employee Relationship
1
If the new account is being set up for an employee or for an eligible family member of an active Prudential employee, then the
Prudential employee’s information must be completed.
Account Owner’s relationship to the employee: Self Spouse Child Parent Other:
First name
MI
Last name
Daytime phone number
Extension
Cell phone number
Department / Division Name
Employee’s Work Location Address
Account Ownership/Associated Person Information
(Required for the USA Patriot Act.)
2
All information is required. Important: If a minor IRA account is being setup, then please provide the information of the custodian/
guardian, in the same format, on a separate sheet.
First name
MI
Last name
Social Security number
Date of birth
Account mailing address
City
State
ZIP code
4-digit ext.
Residential/Permanent address
(We
cannot
accept a PO Box.)
City
State
ZIP code
4-digit ext.
Daytime phone number
Extension
Cell phone number
E-mail address (optional)
Citizenship
U.S. Citizen
Nonresident alien*
Resident 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 www.irs.gov.
Marital Status
Married Single Widowed Divorced Number of Dependents
Employment Status
Employed Unemployed Retired Prudential employee
Occupation
Employer
Employer address
City
State
ZIP code
4-digit ext. (optional)
Employer telephone number
Extension
Highest education level achieved
Choose your Beneficiaries
3
Tell us who should receive your account balance after your death. For each beneficiary you list by name, check a beneficiary type
(primary or secondary) and provide all information.
If the
Per Stirpes
designation is checked and the named beneficiary does not survive the account owner, but leaves surviving
descendants, then any share otherwise payable to such beneficiary shall instead be paid to such beneficiary’s surviving
descendants, by right of representation.
Please note, the primary and secondary beneficiary totals must each equal 100%.
Spousal Consent
—If you are a married person and have not designated your spouse as your sole primary beneficiary, your
spouse must sign section 14.
A. Primary Beneficiaries (check all that apply)
¨
Primary
¨
Secondary (Please check one)
Name:
¨
Per Stirpes Percentage:
%
Social Security Number:
Date of Birth:
Relationship:
Address:
Daytime phone number:
City:
State:
Zip Code:
4-digit ext
E-mail address
¨
Primary
¨
Secondary (Please check one)
Name:
¨
Per Stirpes Percentage:
%
Social Security Number:
Date of Birth:
Relationship:
Address:
Daytime phone number:
City:
State:
Zip Code:
4-digit ext
Beneficiaries
(continued)
3
¨
Primary
¨
Secondary (Please check one)
Name:
¨
Per Stirpes Percentage:
%
Social Security Number:
Date of Birth:
Relationship:
Address:
Daytime phone number:
City:
State:
Zip Code:
4-digit ext
E-mail address
¨
Primary
¨
Secondary (Please check one)
Name:
¨
Per Stirpes Percentage:
%
Social Security Number:
Date of Birth:
Relationship:
Address:
Daytime phone number:
City:
State:
Zip Code:
4-digit ext
E-mail address
Account Type & Contribution Information
4
2 0
2 0
2 0
2 0
A. Account Type
(Choose only one.)
Traditional IRA Roth IRA*(Establishment date)
Rollover IRA SEP IRA** (Employer name)
*
The establishment date is the earliest date you either opened a Roth IRA or originally converted from a traditional IRA to a Roth IRA.
If you do not provide this information we will use the date the account is established as the establishment date. This information is
requested by the IRS and is needed to determine compliance with the taxable five-year holding period requirement.
** For SEP IRAs, the tax year for employer contributions is for your informational purposes only; all employer contributions are
reported in the year received by Prudential Mutual Fund Services LLC (PMFS).
B. Inherited IRA
Decedent’s First name
MI
Last name
Decedent’s Date of death
Note:
Please complete and attach the Request for IRA Beneficiary Distribution (Spouse and Non-Spouse) form (MF1024B) or the
Request for IRA Beneficiary Distribution (Entity) form (MF1024C) to establish required minimum distributions (RMD) from your new
inherited IRA.
C. Contribution/Purchase Instructions
Contributions
(For SEP IRAs, input employee contributions as a Contribution.)
Contribution for tax year
Regular $
Catch-up $
Contribution for tax year
Regular $
Catch-up $
Employer contribution for tax year
Amount $
(SEP IRA only)
Employer contribution for tax year
Amount $
(SEP IRA only)
Rollover Purchase
. Within 60 days of your receipt either from another like IRA (e.g. Roth IRA to Roth IRA or Traditional IRA to
Traditional IRA) or an eligible rollover distribution from a retirement plan to a Traditional IRA, Rollover IRA or Roth IRA.
Rollover check amount $
Direct Rollover from an employer-sponsored retirement plan.
Complete the Transfer/Direct Rollover/Conversion Authorization form (MF1012). Estimated amount $
Direct Rollover from a Roth 401(k) plan or Roth 403(b) plan.
Complete the Transfer/Direct Rollover/Conversion Authorization form (MF1012). Estimated amount $
Transfer of an existing IRA, Roth IRA, SEP IRA, or SARSEP account from
another custodian.
Complete the Transfer/Direct Rollover/Conversion Authorization form (MF1012). Estimated amount $
Conversion from an existing Traditional IRA, SEP IRA, or SARSEP IRA account
from another custodian into a Roth IRA.
Complete the Transfer/Direct Rollover/Conversion Authorization form (MF1012). Estimated amount $
Please make check payable to Prudential Mutual Fund Services.
Mutual Fund Selection & Allocation
5
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
Fund Name Class Z Other % $
ASSET ALLOCA TION FUNDS
Asset
Allocation Prudential Balanced Fund 160 _____ % ____ $ ______
Prudential Conservative Allocation Fund 1512 _____ % ____ $ ______
Prudential Growth Allocation Fund 1504 _____ % ____ $ ______
Prudential Moderate Allocation Fund 1508 _____ % ____ $ ______
Prudential QMA Global Tactical Allocation Fund 1135 _____ % ____ $ ______
EQUITY
FUNDS Equity Prudential Jennison 20/20 Focus Fund 451 _____ % ____ $ ______
Prudential Jennison Blend Fund 403 _____ % ____ $ ______
Prudential Jennison Conservative Growth Fund* ---- 560 % ____ $ ______
Prudential Jennison Equity Income Fund 427 _____ % ____ $ ______
Prudential Jennison Equity Opportunity Fund 425 _____ % ____ $ ______
Prudential Jennison Growth Fund 413 _____ % ____ $ ______
Prudential Jennison Rising Dividend Fund 1103 _____ % ____ $ ______
Prudential Jennison Select Growth Fund 465 _____ % ____ $ ______
Prudential Jennison Small Company Fund 407 _____ % ____ $ ______
Prudential Jennison Value Fund 404 _____ % ____ $ ______
Prudential QMA Large-Cap Core Equity Fund 459 _____ % ____ $ ______
Prudential QMA Mid-Cap Value Fund 499 _____ % ____ $ ______
Prudential QMA Small-Cap Value Fund 171 _____ % ____ $ ______
Prudential QMA Stock Index Fund 165 _____ % ____ $ ______
Prudential QMA Strategic Value Fund 468 _____ % ____ $ ______
Prudential QMA Defensive Equity Fund 456 _____ % ____ $ ______
Specialty Prudential Financial Services Fund 461
_____ % ____ $ ______
Prudential Jennison Global Infrastructure Fund 1092 _____ % ____ $ ______
Prudential Global Real Estate Fund 450 _____ % ____ $ ______
Prudential Income Builder Fund 455 _____ % ____ $ ______
Prudential International Real Estate Fund 1043 _____ % ____ $ ______
Prudential Jennison MLP Fund 1095 _____ % ____ $ ______
Prudential Jennison Natural Resources Fund 416 _____ % ____ $ ______
Mutual Fund Selection & Allocation (continued)
5
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.
Total: (100% or $) % $ Note: The total must equal 100% or the total dollar amount provided in section 4.
Fund Share Class Initial Investment
Fund Name Class Z Other % $
EQUITY
FUNDS Global/Internat ional Equity
Prudential QMA International Equity Fund 464 _____ % ____ $ ______
Prudential Jennison Emerging Markets Equity Fund 1117 _____ % ____ $ ______
Prudential Jennison Global Opportunities Fund 1039 _____ % ____ $ ______
Prudential Jennison Intl Opportunities Fund 1085 _____ % ____ $ ______
FIXED INCOME FUNDS
Taxable Fixed Income
Prudential Absolute Return Bond Fund 1047 _____ % ____ $ ______
Prudential Core Bond Fund 161 _____ % ____ $ ______
Prudential Corporate Bond Fund 159 _____ % ____ $ ______
Prudential Emerging Mkts Debt Local Currency Fund 1057 _____ % ____ $ ______
Prudential Floating Rate Income Fund 1036 _____ % ____ $ ______
Prudential Global Absolute Return Bond Fund 1149 _____ % ____ $ ______
Prudential Global Total Return Fund 442 _____ % ____ $ ______
Prudential Government Income Fund 406 _____ % ____ $ ______
Prudential High Yield Fund 408 _____ % ____ $ ______
Prudential Short Duration High Yield Income Fund 1088 _____ % ____ $ ______ Prudential Short Duration Multi-Sector Bond Fund 1098 _____ % ____ $ ______
Prudential Short-Term Corporate Bond Fund 434 _____ % ____ $ ______
Prudential Total Return Bond Fund 422 _____ % ____ $ ______
Prudential Unconstrained Bond Fund 1145 _____ % ____ $ ______
Tax-
Exempt Prudential California Muni Income Fund 417 _____ % ____ $ ______
Prudential Muni High Income Fund 418 _____ % ____ $ ______
Prudential National Muni Fund 458 _____ % ____ $ ______
Prudential Short Duration Muni High Income Fund 1109 _____ % ____ $ ______
Money
Distribution Options
6
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 9.
Capital Gains:
Reinvest in shares Pay in cash* Send by ACH to the bank specified in section 9.
* If the dividends and capital gains are to be distributed in cash or sent by ACH, please complete, sign and return
IRS Form W-4P
with this application.
Purchase Options
(Check all that apply.)
8
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
Z
$
into the
Fund
Z
$
into the
Fund
Z
$
into the
Fund
Z
$
into the
Fund
Z
$
into the
Fund
Z
$
Total amount
(to be debited from bank/credit union account as specified in section 9)
Telephone/Online Exchange and Redemption Option
7
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.
Bank of Record* (Complete only if section 8 is completed.)
9
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)
Ý
123456789
ABA number (9 digits)
555555
55555
1234
Name on bank account Check no. 1234
Street address City, State ZIP
DATE
PAY
TO THE
ORDER OF $
DOLLARS
FOR _________________________________
Ü
Attach voided
check here.
Ü
VOID
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 www.prudential.com/prualertstandc
.
Text Message alert for financial transactions on your account
11
e-Delivery and Mailing Preferences
10
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 email 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 an 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.
E-mail 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 www.prudentialfunds.com/myaccess to enroll your account online. PMFS will
only use your email 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.
Account Owner(s) Investment Profile (
Incomplete
Information may result in delayed processing)
12
If a Prudential Advisor (financial professional )is listed in section 13 then this section must be completed. Otherwise skip to
section 14. The information in this section is used to help determine whether the investments you have selected are appropriate,
given your financial objectives.
•
Annual Income – Owner’s income from all sources, before taxes.
•
Household Income – Income from all sources, before taxes, from all members of the household contributing income.
•
Net Worth – The value of your assets minus liabilities. For an individual it would be the total value of existing assets, such as
stocks, bonds, bank accounts, mutual funds, life insurance cash value, annuities, real estate, and other investments minus all
outstanding liabilities, such as mortgages, loans, taxes and credit card balances.
•
Liquid Net Worth – That part of a person’s net worth held in cash or easily convertible to cash, such as money market fund
shares, bank deposits, mutual funds or other marketable securities.
Ranges
Annual Household Net
Liquid
Income
Income
Worth
Net Worth
Up to $24,999 . . . . . . . . . .
$25,000 – $49,999 . . . . . . . . . .
$50,000 – $74,999 . . . . . . . . . .
$75,000 – $99,999 . . . . . . . . . .
$100,000 – $149,999 . . . . . . . . . .
$150,000 – $249,999 . . . . . . . . . .
$250,000 – $499,999 . . . . . . . . . .
$500,000 – $749,999 . . . . . . . . . .
$750,000 – $999,999 . . . . . . . . . .
$1,000,000 – $2,499,999 . . . . . . . . . .
$2,500,000 – $4,999,999 . . . . . . . . . .
$5,000,000 – $9,999,999 . . . . . . . . . .
$10,000,000 – $24,999,999 . . . . . . . . . .
$25,000,000 or greater. . . . . . . . . .
Federal Tax Bracket:
15% or less
25%
28%
33%
35%
Investment Time Horizon
(Indicate the number of years you intend to hold your mutual fund account.)
0–3 Years
4–7 Years
More Than 7 Years
What are your monthly expenses
(e.g., food, medical expenses, rent/mortgage, revolving debt, property taxes, transportation, utilities,
entertainment and other recurring living expenses): $
Years of Investment Experience
(Indicate number of years of experience in any of the following that apply.)
Equities Bonds Options Other
Futures Mutual Funds Variable Annuity/Life None
Were the mutual fund selections based on an investment allocation pursuant to a company-approved
asset allocation model?
Yes
No
Risk Tolerance
Your risk tolerance is your comfort level to withstand risk with respect to investments (e.g., the potential to absorb losses in your
investments). For example, an investor whose risk tolerance is conservative seeks securities that are most likely to preserve principal
with low risk, while an investor with an aggressive risk tolerance is willing to accept a high degree of risk regarding potential loss
of principal.
•
Conservative – Prefer little risk and low volatility in return for accepting potentially lower returns. Minimizing exposure of
principal to loss or fluctuation is very important.
Account Owner(s) Investment Profile
(continued)
(
Incomplete
Information may result in delayed processing)
12
•
Moderately Conservative – Willing to take some risk to seek enhanced returns. Reduced exposure of principal to loss or
fluctuation is important.
•
Moderate – Willing to assume an average amount of market risk and volatility or loss of principal to achieve potentially higher returns.
•
Moderately Aggressive – Willing to assume an above-average amount of risk and volatility or loss of principal to take advantage
of potentially higher return opportunities.
•
Aggressive – Willing to sustain substantial volatility or loss of principal and assume a high level of risk in pursuing potentially
higher returns.
Risk Tolerance (Check one.)
Conservative
Moderately conservative
Moderate
Moderately aggressive
Aggressive
Investment Objectives
Your investment objective is how you seek to have your investments achieve your financial goals. For example, a person who
chooses growth as a primary investment objective is seeking growth of principal rather than generation of income.
• Preservation of Capital – Seeks to preserve the value of your investments through all market conditions with a preference for
holding cash and/or cash equivalents (e.g., money market funds, CDs, Treasury securities with maturities of one year or less).
• Income – Seeks to earn income through holdings of bonds and/or income-yielding securities.
• Tax-Free Income – Predominantly seeks to earn income free from income taxes.
• Growth – Seeks to achieve growth of capital through investment in securities.
• Short-Term Gain – Emphasis on short-term trading practices to capitalize on market fluctuations. This objective is associated
with higher-than-normal market risk.
• Speculation – Emphasis on aggressive investments that assume above-average market risk with hope of achieving
commensurate gains.
• Diversified – Investment options selected conform with recommendations of company-approved Asset Allocation Model.
Investment Objectives
Select up to two (2) objectives. Indicate first choice as 1 and second choice, if any, as 2.
Preservation of capital
Income
Tax-free income
Growth
Short-term gain
Speculation
Diversified
Investment Funding
I will pay for my initial investment through my:
CDs/Liquid assets/Savings
Mutual funds
Annuities
Life insurance (If selected, please specify death proceeds, dividends, cash value, etc.)
Rollover (from)
o
Other
Tentatively, I plan on making additional investments.
During the
first year, my
total additional
investments planned are $
I will pay for these additional first year investments through my:
CDs/Liquid assets/Savings
Mutual funds
Annuities
Life insurance (If selected, please specify death proceeds, dividends, cash value, etc.)
Rollover (from)
o
Other
1. Financial professional
(first name, MI, last name) (Please print.)
Financial professional’s signature
X
Broker/dealer name (Please print.)
Broker/dealer number
Financial prof. # /Contract #
Branch office #/Agency code
Percent Office phone number Alternate phone number
%
Ext. Ext.
2. Financial professional
(first name, MI, last name) (Please print.)
Financial professional’s signature
X
Broker/dealer name (Please print.)
Broker/dealer number
Financial prof.#/Contract #
Branch office #/Agency code
Percent Office phone number Alternate phone number
%
Ext.
Ext.
Spousal Consent Authorization
14
Special laws apply to the designation of a beneficiary by a married person residing in a “community property” state. Community
property is recognized in AZ, CA, ID, LA, NV, NM, TX, WA, WI and Puerto Rico. If you are married and reside in a community property
state and have not designated your spouse as your sole primary beneficiary, your spouse must sign this section. Your spouse’s
signature represents consent to the beneficiary designation.
For Federal tax purposes, the term “spouse” includes any married individuals (same sex or otherwise), if the individuals are lawfully
married under state law. Federal law does not recognize domestic partnerships or civil unions that are not designed as “married”
under state law.
There are numerous situations that may affect your beneficiary designation. We suggest you consult an advisor who understands
both tax-law and related estate-planning implications of this form.
Neither Prudential Mutual Fund Services, LLC nor Prudential Investments, or its affiliates will be liable for any consequences resulting
from failure to provide proper spousal consent.
First name
MI
Last name
Signature of spouse
X
Date
(of IRA owner)
Sign here
Financial Professional(s) Identification and Signature(s)
(if applicable)
13
1. Financial professional
(first name, MI, last name) (Please print.)
Financial professional’s signature
X
Broker/dealer name (Please print.)
Broker/dealer number
Financial prof. # /Contract #
Branch office #/Agency code
Percent Office phone number Alternate phone number
%
Ext. Ext.
2. Financial professional
(first name, MI, last name) (Please print.)
Financial professional’s signature
X
Broker/dealer name (Please print.)
Broker/dealer number
Financial prof.#/Contract #
Branch office #/Agency code
Percent Office phone number Alternate phone number
Signature and Tax Certification
15
The undersigned warrants that I have full authority and I am of legal age to purchase shares pursuant to this application. Further, I
acknowledge receipt of the prospectus(es) for the mutual fund(s) which I have selected, and agree to its/their terms. I acknowledge
receipt of the applicable Individual Retirement Custodial Account Agreement and Disclosure Statement and I understand that there
may be fees associated with this account. I understand this Agreement contains a pre-dispute arbitration clause. By signing below
I agree to be bound by these provisions.
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.
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.
The Internal Revenue Service does not require your consent to any provision of this document
other than the certification required to avoid backup withholding.
Sign here
Owner’s signature
X
Date
State of domicile* State where application is signed
*Domicile is defined as a person’s fixed, permanent, and principal home for legal purposes.
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).
Mailing Instructions for Mutual Fund Account Application
Standard
Prudential Mutual Fund Services LLC
mail to
:
PO Box 9658
Providence, RI 02940
Overnight
Prudential Mutual Fund Services LLC
mail to
:
4400 Computer Drive
Premature Distribution Penalties
With some exceptions, monies distributed from your IRA prior to age 59 ½ will be taxed as
ordinary income and be subject to a 10 percent early withdrawal penalty. For more details,
see the applicable “Distributions” section(s) of the Custodial Account Agreement and
Disclosure Statement.
IRA Fees
The Prudential Trust Company, the custodian for your IRA, reserves the right to change it fee
schedule from time to time without prior notification.
Annual Maintenance Fee
The annual maintenance fee is $15 per fund, with a $25 maximum for two or more funds.
NO FEE will be charged if the value of your IRAs and/or SEP IRAs totals $50,000 or more.
Account values are determined on the day of the systematic deduction of the fee, which
usually occurs in December of each year.
Prudential Mutual Fund Services LLC (PMFS),
a Prudential Financial company
Transfer/Direct Rollover/
Conversion Authorization
For assistance:
Clients: (800) 225-1852 Pruco representatives: (800) 542-7117 Financial professionals: (888) 778-5471
Submit a separate transfer form for each Resigning Custodian and each unique account type.
Instructions
Account Owner Information
1
First name
MI
Last name
Social Security number
PMFS account number
(Required for existing accounts only.)
Account(s) to be Transferred to PMFS
(Please attach copies of your most recent account statements.)
2
Complete all sections for your request to be processed.
Note: Prudential Mutual Fund Services LLC cannot accept stock certificates
.
A. Account types being transferred to PMFS
Traditional IRA
Roth IRA
SEP-IRA
403(b) Plan
Governmental 457 Plan
Roth 401(k) Plan
Roth 403(b) Plan
SIMPLE IRA
Employer-Sponsored 401(a) Retirement Plan (i.e., 401(k), pension or profit sharing plan, or defined benefit plan)
B. Account number(s) to be transferred
C. Resigning Custodian information
Name of institution/employer-sponsored retirement plan from which the accounts in section B above will be transferred
Attention
Mailing address
City
State
ZIP code
4-digit ext.
Contact telephone number Extension
Name of contact person or department
Transfer Instructions
3
All liquidations are done immediately unless special instructions are provided below. Check with your sending institution about
financial penalties, suspensions, signature guarantees, or other restrictions that could affect the transfer of your account to PMFS.
A. Liquidate
All $
(estimated value)
Partial %
or
$
B. Special instructions for CDs and certain annuity contracts
Transfer immediately. I am aware of and acknowledge
Transfer at maturity
(month, day, year)
:
any penalty I may incur from an early withdrawal.
(Please submit 4 weeks prior to maturity date.)
Page 2 of 3
MF1012 Ed. 03/2015
PMFS Account Type
5
The transferred proceeds will be invested into the following account type.
Traditional IRA, Rollover IRA, or SEP IRA
Roth IRA or Roth Conversion IRA Establishment date*
403(b) Plan – You must have an existing account at PMFS. New accounts will not be accepted.
*
The date you originally contributed to a Roth IRA or converted from a traditional IRA to a Roth IRA. This information is required by
the IRS for compliance with the 5 tax-year holding period requirement.
Mailing Instructions for Resigning Custodian
8
Withholding Election and Roth Conversion Disclosure
7
Federal tax law requires that income tax be withheld at a rate of 10% from the total amount of your IRA distribution/conversion
unless you elect not to have tax withheld. Depending on your state of residence, state tax withholding may also apply.
If you do not want taxes withheld, proceed to the next section.
If you would like to have taxes withheld, please check the box below:
¨
I would like federal and applicable state income taxes withheld from my IRA distribution being converted to a Roth IRA. I
understand that, as a result, the portion of my IRA distribution that is withheld as income taxes will not be converted to my
Roth IRA and may result in adverse tax consequences. (
Please consult with your tax adviser
.) If you would like more than
10% withheld, please indicate below:
Federal taxes
State taxes*
(Percentage or Dollars)
Percentage: % (minimum 10% distribution),
or
Percentage: %,
or
Dollar amount $ (Amount cannot be less than 10% of distribution.) Dollar amount $
*
Percentage/dollar amount cannot be less than the minimum required for your state.
Standard
Prudential Mutual Fund Services LLC
mail to
:
PO Box 9658
Providence, RI 02940
If you have any questions, please call PMFS at
(800) 225-1852
, Monday through Friday between 8 a.m. to 6 p.m. Eastern time.
Checks should be made payable to “
PMFS
for the benefit of (account owner).” Checks should be sent to:
Overnight
Prudential Mutual Fund Services LLC
mail to
:
4400 Computer Drive
Westborough, MA 01581
Mutual Fund Selection and Allocation
6
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.
Please provide investment fund selections and indicate allocations. Refer to the fund’s prospectus for the fund minimum and
eligibility requirements.
Note: All allocations by percentage must total 100%.
Share class
Fund name
Fund number
Percent
Amount
A C Other
% or $
% or $
% or $
% or $
% or $
% or $
Total 1 0 0
% or $
Fund Holding Years. Indicate the number of years you intend to hold your mutual fund
Authorization
9
For Traditional IRAs, Roth IRAs, SEP-IRAs, and 403(b) accounts
. It is my intention to effect a transfer, without inclusion of the
amount to be transferred in my gross income. You are directed to transfer all or a portion of the redemption value of the account
as identified in section 2 to an account established for me with Prudential Trust Company (PTC) as custodian. Accordingly, you
are hereby directed to request on my behalf the transfer of my interest in the account referenced in section 2 for subsequent
investment in Prudential Mutual Funds for investment in the custodial account(s) maintained for me. I hereby agree to the terms
and conditions set forth in this Transfer/Direct Rollover/Conversion Authorization.
For direct rollover
. This authorizes the employer-sponsored retirement plan designated in section 2 to distribute my eligible
rollover distribution directly from my retirement plan to PTC in accordance with the instructions in section 3.
I have received and considered a copy of “The Should You Rollover Your Retirement Plan? Challange” for applicable IRA
rollovers.
I understand that the conversion of a traditional IRA to a Roth IRA will result in a taxable event which will be reported to the IRS.
If the account owner has attained the age of 70½ or older in the year of this transfer request, the required minimum distribution
must be removed prior to the transfer being made.
I understand that the Resigning Custodian may charge a closeout fee for IRA accounts
. The default election is for the Resigning
Custodian to redeem shares to cover charges.
I authorize the Resigning Custodian to redeem
shares to cover those charges.
Owner’s signature
X
Date
Signature Guarantee
(If applicable, may be required by Resigning Custodian.)
I will arrange to cover those charges by other means.
Important
: If elected, any fees must be paid to the resigning custodian,
prior to submitting this form, or they may deny the request.
Prudential Trust Company’s Acceptance
(To be completed by PMFS.)
10
Prudential Mutual Fund Services LLC, as agent for the Prudential Trust Company (PTC) which is custodian of the traditional IRA,
Roth IRA, SEP IRA or 403(b) plan, hereby confirms its acceptance of the above mentioned transfer or rollover.
Authorized signature of Prudential Mutual Fund Services LLC
(as agent for PTC)
X
Financial Professional Identification and Signature
(if applicable)
11
Financial professional’s name
(first name, MI, last name) (Please print.)
Financial professional’s signature
X
Broker/Dealer’s name
(Please print.)
0270749-00001-00 Ed. 12/2014
The Should You Rollover
Your Retirement Plan? Challenge
PRUDENTIAL INVESTMENTS
If you are retiring or have changed jobs, it may be challenging to decide what to do with the assets in your
company’s pension and 401(k) plans.
Here are the options available to you:
`
1. Roll over the assets into a Traditional IRA or roll over the assets into a Roth IRA
1;
`
2. Roll over the assets into your new employer’s retirement plan;
`
3. Leave the assets in your old employer’s retirement plan, if greater than plan minimum; or
`
4. Take a lump-sum distribution.
DETERMINING WHICH OPTION IS RIGHT FOR YOU depends on your specific situation and financial needs.
Benefits of rolling over your plan funds directly to an IRA (Traditional or Roth) may include:
`
IRAs generally offer a wider range of investment choices than employer-sponsored retirement plans.
`
Consolidating your retirement assets from multiple sources allows for easier account management and
control of asset allocation.
`
IRAs allow a higher degree of control of investment fees associated with your assets.
`
Assets are typically more easily accessible in an IRA than an employer-sponsored plan. (Keep in mind that
distributions from a Traditional IRA are subject to current taxes, and a 10% early withdrawal penalty may
apply if you are under age 59½.)
Benefits of an employer-sponsored retirement plan may include:
`
Employer-sponsored plans typically allow loans which are not an option with IRAs.
`
Company or Employer stock gets special tax treatment when it’s distributed directly. Taxes are paid on
original purchase price; earnings are taxed when liquidated at long-term capital gain rates. If rolled over to
an IRA it would be taxed upon distribution at current income tax levels.
`
Depending on your state of residence, different creditor protection laws apply to employer plan assets than
IRAs.
`
If you separate from service after you turn 55, you can make penalty-free withdrawals before the age of
59½.
`
Required Minimum Distributions (RMD) may not be required if you are still working for that employer over
the age of 70½.
In order to determine what is right for you, you should review all fees and expenses associated with the different
options available. An IRA rollover may have certain tax consequences. You may want to speak with a tax advisor
about any specific tax-related questions. There are portability rules that allow you to consolidate various
retirement plan balances. They are:
`
Your 401(k) (and other qualified plans), 403(b), and 457(b) state or local government plan balances can
be rolled into an IRA or they can be rolled into each other (as long as the plan permits such rollovers and is
able to separately account for the plan assets).
2`
After-tax employee contributions can be included in rollovers into an IRA, but once rolled over into an IRA
they may not be rolled over again into an employer-sponsored plan.
THE SHOULD YOU ROLLOVER YOUR RETIREMENT PLAN? CHALLENGE
There are two ways to roll over your retirement plan assets into an IRA: a direct rollover or an indirect rollover.
The following is an overview of each:
DIRECT ROLLOVERS
The easiest way to roll over your retirement plan assets into a Traditional IRA is a direct rollover, which allows
you to transfer eligible assets from your company’s retirement plan directly into a Traditional IRA. In doing so,
you are not subject to current taxes and potential penalties, and your savings can continue to grow tax-deferred.
In addition, you will not be subject to the mandatory 20% federal income tax withholding on retirement plan
distributions.
You can choose from several methods to transfer your retirement plan assets into your Rollover Traditional IRA.
For example, your employer can send a check for your eligible retirement plan distribution directly to the financial
institution where you maintain your Traditional IRA. Or your employer can make out the check to the custodian of
the Traditional IRA and send it to you for immediate deposit with the custodian. You may also be able to directly
transfer mutual fund shares or other securities into your Traditional IRA.
3INDIRECT ROLLOVERS
Another option is to use an indirect rollover. In this case, you receive a distribution in your name and roll all or
part of it into a Traditional IRA at a later date. To avoid being subject to tax, and possibly the 10% early withdrawal
penalty, you must complete the rollover within 60 days of receiving the distribution. You should also note that 20%
of the distribution will be withheld for federal income tax if you receive a distribution check or securities made out
in your name. In order to have no current tax liability, you would then need to make up the 20% from other sources
to complete the rollover within the 60-day period.
*Note: There are often times when an employee must complete paperwork with a previous employer to initiate a
rollover.
1
Rollovers into the Roth IRA are subject to ordinary income tax, but the rollover is not subject to early distribution
penalties. You may find it beneficial to roll over to a Roth IRA, since after paying the initial tax on the rollover,
distributions from the Roth IRA are free of federal income and penalty taxes if taken after you have reached age
59½ and at least five tax years after opening a Roth account.
2
After-tax contributions may be rolled over from one qualified plan to another, but never from an IRA to a qualified plan.
In addition, after-tax contributions to a 457(b) state or local government plan may never be rolled over.
3
Because the portability rules may be applied differently by each plan, you should review the options a plan provides
before making your rollover decision.
Neither Prudential Financial, its affiliates, nor its financial professionals, render tax or legal advice. Clients and prospects
should consult with an attorney, accountant, and/or tax advisor for advice concerning their particular circumstances.
NOTE: Mutual fund investing involves risk. Some mutual funds have more risk than others. The investment return and principal
value will fluctuate and shares when sold may be worth more or less than the original cost and it is possible to lose money.
There is no guarantee a Fund’s objectives will be achieved. The risks associated with each fund are explained more fully
in each fund’s respective prospectus.
Consider a fund’s investment objectives, risks, charges, and expenses carefully before investing. The prospectus and summary
prospectus contain this and other information about the fund. Contact your financial professional for a prospectus and summary
Page 1 of 2
MF1028 Ed.10/2015
Prudential Mutual Fund Services LLC (PMFS),
a Prudential Financial company
Authorization to Convert from
a Traditional IRA to a Roth IRA
For assistance:
Clients: (800) 225-1852
Pruco representatives: (800) 542-7117
Financial professionals: (888) 778-5471
