CASH &/OR SECURITY
JOURNAL REQUEST FORM
Instructions must be dated within 30 days from the date of receipt by Apex.
DATE
ACCOUNT INFORMATION
Delivering Account No.
Delivering Account Name/Title
Receiving Account No.
Receiving Account Name/Title
If the Receiving Account Title does not match the Delivering Account Title, the request will be considered a Third Party Transfer.
Third Party Transfers must adhere to Apex’s Third Party Policy.
TRANSFER INFORMATION
Full Transfer of Cash & Securities?
(Accrued Interest will also be transferred)
Reason for Transfer
For Partial Transfers, complete the following:
Cash $
Symbol/CUSIP Shares Symbol/CUSIP Shares
1 7
2 8
3 9
4 10
5 11
6 12
CUSTOMER AUTHORIZATION
Customer Signature J oi nt Acc oun t Holder
I/We agree to hold all parties acting on this request, including the introducing broker and Ape x Cl earin g Corporation, a nd thei r re spe ct ive a ge nt s a n d e mployees
(hereinafter, collectively, “the parties”) harmless from any and all claims, demands, proceedings, suits and actions and all liabilities, losses and expenses including
without limitation those asserted by me, associated with actions taken by the parties due to instructions received from me in this request.
NOTARY
FOR INTERNAL USE ONLY
Registered Principal Approval:
Print Name Title Signature Date
Compliance Officer Approval/Registered Principal Approval
Print Name Title Signature Date
PF10088-CSJR 08/17/2018
