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403(b)(7) - DWS Investments

403(b)(7) - DWS Investments

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<strong>403</strong>(b)(7) transfer formThis form allows the Employer to transfer <strong>403</strong>(b) assets to Deutsche Investment Management Americas Inc. If a new <strong>403</strong>(b)(7)account is being opened, a completed <strong>403</strong>(b)(7) Individual Application must also be submitted.STEP 1 participant information (*Indicates required field)* Name of participant* Social Security number * Date of birth – MM/DD/YYYY* US residential address (P.O. Box not acceptable)* City * State * ZIPMailing address (if different)Name of employerCity State ZIP( )Name of contact person Daytime phone number ExtensionAddress of employerCity State ZIPSTEP 2 information about present custodian/insurerName of present custodian/insurerName of contact personStreet addressContract/account numberCity State ZIP( )Daytime phone numberExtensionBy this Agreement, I direct the Custodian/Insurer to transfer to the named Participant’s Custodial Investment Account establishedpursuant to the <strong>DWS</strong> <strong>Investments</strong> <strong>403</strong>(b)(7) Custodial Agreement, and to take whatever further action is necessary to effect such transfer.Transfer should be in cash according to the following instructions:Transfer the entire cash surrender value/asset value of the named participant’s <strong>403</strong>(b)(7) custodial account.Transferof the cash surrender value/asset value of the named participant’s <strong>403</strong>(b)(7) custodial account, andretain the balance.Transfer% of the cash surrender value/asset value of the named participant’s <strong>403</strong>(b)(7) custodial account, andretain the balance.This transfer is for:Contract exchangeDirect rolloverNo bank guarantee | Not FDIC insured | May lose value


STEP 3 instructions to dws trust companyUpon receipt of the proceeds, please invest them as designated below. Note: If there are additional funds you would like to list, pleaseattach a separate sheet of paper to this one with the name of the fund(s) and the dollar or percentage amount(s).Please select a share class: A C S* Percentages must equal 100%$ %Fund name, number, or NASDAQ symbolDollar amount OR Percentage$ %Fund name, number, or NASDAQ symbolDollar amount OR Percentage$ %Fund name, number, or NASDAQ symbolDollar amount OR Percentage$ %Fund name, number, or NASDAQ symbolDollar amount OR Percentage* Refer to your fund’s prospectus for complete details regarding Class S share eligibility.I certify that I am (select one):An existing Class S shareholder.Household member at the same address as an existing Class S shareholder.Plan participant in a <strong>DWS</strong> retirement plan.Plan participant that owns Class S shares of a <strong>DWS</strong> Fund.Former employee, and this transaction is in connection with a distribution from a Deutsche Bank employee benefit plan.STEP 4 participant SignatureName of participant (please print)Signature of participantDate – MM/DD/YYYYSTEP 5 employer authorization and SignatureAs an authorized representative of the Employer, I authorize the transfer of the named Participant’s <strong>403</strong>(b) account to <strong>DWS</strong> Trust Companyand certify that the asset transfer satisfies all applicable <strong>403</strong>(b) regulations and other legal requirements.Name of authorized representative (please print)TitleSignature of authorized representativeDate – MM/DD/YYYYSTEP 6 acceptace BY new custodian (completed by <strong>DWS</strong> <strong>Investments</strong> Trust Company)We agree to accept custodianship and the transfer described above for the <strong>DWS</strong> <strong>Investments</strong> <strong>403</strong>(b)(7) plan established on behalfof the above-named individual. <strong>DWS</strong> Trust Company accepts its appointment as successor custodian of the above <strong>403</strong>(b)(7) accountwith respect to the amount it receives as a result of the liquidation and transfer of assets indicated above.By: <strong>DWS</strong> Trust Company, <strong>DWS</strong> <strong>Investments</strong> Service Company authorized representativeSignatureDate – MM/DD/YYYYThis form is valid only if signed above by an authorized representative of <strong>DWS</strong> Trust Company.


Please return the original form to <strong>DWS</strong> <strong>Investments</strong> Service Companyand retain a copy for your records. Please mail completed form to:<strong>DWS</strong> <strong>Investments</strong> Service CompanyP.O. Box 219356Kansas City, MO 64121-9356Overnight Address:<strong>DWS</strong> <strong>Investments</strong> Service Company210 W. 10th StreetKansas City, MO 64105-1614<strong>DWS</strong> <strong>Investments</strong> Distributors, Inc.222 South Riverside PlazaChicago, IL 60606-5808www.dws-investments.com© 2011 <strong>DWS</strong> <strong>Investments</strong> Distributors, Inc. All rights reserved. (11/11) B-4489-5 <strong>403</strong>B7-FM73

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