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55 views2 pages

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ACH Request J.P.

Morgan Securities LLC


Page 1 of 2 Member FINRA and SIPC
JPMS Account Number Rep Code
73433251 HI5

Use this form to establish new or update current bank account information on a brokerage account.

1. Account Holder Information


ACCOUNT HOLDER NAME (PLEASE PRINT IN ALL CAPITAL LETTERS)
ANWAR CHOWDHURY

2. Request Type - select only one A, B or C


x A. Banklink to JPMorgan Chase Bank, N.A. Bank Account
Client authorizes, directs and empowers J.P. Morgan Securities LLC (“JPMS”) to debit and credit, through a JPMS account at
JPMorgan Chase Bank, N.A. (“Chase Bank”), the Chase Bank bank account specified in Section 3 for all transactions executed
through JPMS or other indebtedness in connection with such transactions and adjustments for any erroneous entries. PLEASE
NOTE: If you currently use a money market mutual sweep or J.P. Morgan Chase Deposit sweep and select Banklink, these assets will
be liquidated (if necessary) and automatically transferred into your Banklink account at Chase Bank, N.A. I certify that I am
authorized to link the bank account specified below to my brokerage account.

B. Referenced Chase Bank Account


JPMS may, from time to time, as a convenience to the Client and only upon Client's verbal or written direction to JPMS, initiate
debits and credits between the JPMS brokerage account and the Chase Bank account specified in Section 3.
C. Referenced Non-Chase Bank Account
JPMS may, from time to time, as a convenience to the Client and only upon Client's verbal or written direction to JPMS, initiate
debits and credits between the JPMS brokerage account and the bank/financial institution account specified in Section 3. This
feature is not available to pay for trade settlement for a JPMS brokerage account with Banklink sweep. For a CHECKING account,
attach a copy of a voided check (counter or starter checks will NOT be accepted). For a SAVINGS account, attach a notarized letter
containing account holder name, account number, ABA routing number, account type (savings) and a signature of an individual on
behalf of the bank/financial institution on their letterhead (client signature will not be accepted). Clients who wish to link their
brokerage account to a non-Chase deposit account will notice a $1 charge and $1 credit to their deposit account as we validate the
account before linking it to their brokerage account.

Deposit Account/Money Market Mutual Fund Selection - must complete if B or C was selected above
Money Market Fund

3. Bank Account Information


Account Type Checking x Savings (not available for Banklink) Money Market Account (MMA)
(select one)

ABA Routing Number Bank/Financial Institution Account Number


021000021 3803575852

INVESTMENT AND INSURANCE PRODUCTS ARE:


• NOT FDIC INSURED • NOT INSURED BY ANY FEDERAL OR GOVERNMENT AGENCY
• NOT A DEPOSIT OR OTHER OBLIGATION OF, OR GUARANTEED BY, JPMORGAN CHASE BANK, N.A. OR ANY OF ITS AFFILIATES
• SUBJECT TO INVESTMENT RISKS, INCLUDING POSSIBLE LOSS OF THE PRINCIPAL AMOUNT INVESTED
33019_OLAM 11-10-2017
ACH Request J.P. Morgan Securities LLC
Page 2 of 2 Member FINRA and SIPC
JPMS Account Number Rep Code
73433251 HI5

4. Account Holder Signature


• Subject to the terms of the Brokerage Account Agreement governing the JPMS brokerage account (the "JPMS Account”), the
undersigned hereby authorizes JPMS to direct transfers of money electronically according to the instructions outlined on this
form between the JPMS Account and the Bank/Financial Institution account designated above (the “Checking/Savings Account”)
through a JPMS account at Chase Bank, if applicable, and authorizes that Bank/Financial Institution to credit and/or debit the
same to the Checking/Savings Account. JPMS will undertake to make transfers as herein directed but is not responsible for
damages of any nature resulting from delays, failures, omissions or errors relating to such transfers. The undersigned understands
that in rare instances erroneous credits or debits may be made to the Checking/Savings Account. If such is the case, the
undersigned authorizes JPMS to reverse such errors by debiting or crediting the Checking/Savings Account and crediting or
debiting the JPMS Account as is appropriate.
• The undersigned hereby agrees to indemnify and hold JPMS, its successors, affiliates, assigns, officers, directors, agents and
employees (the “Indemnified Parties”) harmless from, and to pay the Indemnified Parties promptly on demand, any and all losses,
liabilities, damages, claims, costs or expenses (including attorneys’ fees and expenses) incurred by the Indemnified Parties in
connection with their reliance on this authorization. These indemnification provisions are in addition to (and in no way limit or
restrict) any rights which any of the Indemnified Parties may have under any other agreement(s) between the undersigned and
any of the Indemnified Parties or under any federal or state statutes, laws, rules or regulations. This indemnity shall survive
termination of this authorization with respect to transactions entered into during the term of this authorization.
• The undersigned acknowledges that the origination of Automated Clearing House (ACH) transactions to or from the account must
comply with the provisions of U.S. law. This authorization is to remain in full force and effect until written notice of its revocation is
received by JPMS at J.P. Morgan Securities LLC, Attn: Account Processing, IL1-0291 4th Floor, 131 South Dearborn Street, Chicago,
IL 60603-5506 in such time and in such manner as to afford JPMS and the Bank/Financial Institution a reasonable opportunity to
act on it.
Account Holder Signature Date (mm/dd/yyyy)
X / /

5. This Section For JPMS Use Only


• Please provide a copy of this form to your clients for their records.
• Please Fax this form and any attachments to (800) 805-3909 by 2pm ET for same day processing.

33019_OLAM 11-10-2017

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