DREYFUS TRANSFER REQUEST FORM

TO Be COMPLeTeD BY THe BANk OF NeW YORk MeLLONThe Bank of New York Mellon has established an IRA (Prototype IRA under Internal Revenue Code 408 or 408A)for the individual named on this form under the terms and conditions set forth in the Dreyfus Individual RetirementCustodial Account Agreement and will deposit the transferred assets into such IRA upon receipt.Instructions to Current Plan Administrator/Trustee/CustodianPlease forward a check as directed in Section 3 made payable to:The Bank of New York Mellon, Custodian FBO____________________________________________________________.Please include the following Dreyfus Reference Number on the check: __________________________________________The Bank of New York Mellon, CustodianP.O. Box 55552Boston, MA 02205-5552The Bank of New York Mellon Signature/ /DateFund shares are distributed by The Dreyfus Family of Funds.5

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