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Forms

Prudential Investments offers many services to help you manage your accounts.

These forms are only to be used if the Prudential Investments account is held at Prudential Mutual Fund Services LLC (PMFS) or PFPC SIMPLE IRA. They are not for use if the Prudential Investments fund is held in a broker controlled account. You must have Adobe Acrobat Reader installed on your computer to view the forms. Download a free copy now.

Mutual Funds Forms (General Investing)
Form Name Number Description
Account Registration Change Form MF 1002 Re-register (change ownership) on an existing account.
Additional Statement Request Form MF 470 Request additional account statements be sent to a different address.
Affidavit of Domicile MF 515 This form is used to certify the decedent's place of residence at the time of death and it is required for all redemptions and transfers due to death.
Automatic Investment Plan MF1006 Automatically invest by transferring money directly from your bank account into your mutual fund(s).
Checkwriting Form
(money market funds only)		 MF 010 Sign up for the checkwriting privilege from your money market fund.
Corporate Resolution MF 1015 Authorize an entity's officers and others to conduct transactions on the entity's Prudential Mutual Fund Services LLC account.
Cost Basis Election Form MF 1007 Use this form to add or change the cost basis calculation method on your non-retirement mutual fund account for shares acquired on or after January 1, 2012.
Dividend & Capital Gains Instructions Form MF 313 Update dividend and capital gains option to either reinvest or cash. Cash dividends may be received by check, deposited into your bank account.
Electronic Funds Transfer Purchase Form MF 1006 Buy shares, online or by phone. The purchase amount will be electronically (via ACH) debited from your bank account.
Exchange Authorization MF 224A Use this form to authorize fund exchanges.
Expedited Redemption Form MF 008 Sell shares, at any time, online or by phone. The redemption amount will be electronically credited (via ACH or fed fund wire) to the shareholder's bank account.
Letter of Intent Form
(Class A Shares only)		 MF 230 If the intent is to purchase a set dollar amount over a 13-month period, you may be eligible to receive a reduced sales charge.
Limited Power of Attorney Form PMFS 286 Authorize others to conduct certain transactions on your behalf for your mutual fund account(s). Read form carefully for account restrictions.
Name Change Form MF 1003 Use this form to request a name change.
Redemption Form MF 004 Use this from to redeem fund shares from non-retirement account types.
Systematic Exchange Plan Form MF 312 Establish a periodic exchange between funds.
Systematic Withdrawal Plan Form MF 310 Use this form to request periodic distributions from a non-retirement account.
Transfer Form (non-IRA) MF 1019 Move non-IRA assets from another financial institution to an existing Prudential Investments mutual fund account.
Transfer on Death Form PMFS 296 Establish or update a beneficiary on your non-IRA account.

Traditional IRA, Roth IRA, SEP IRA, Coverdell ESA, and 403(b) Forms
Form Name Number Description
Affidavit of Domicile MF 515 This form is used to certify the decedent's place of residence at the time of death and it is required for all redemptions and transfers due to death.
Automatic Investment Plan MF 1006 Automatically contribute to your IRA by transferring money directly from a bank account into your IRA mutual fund account.
Beneficiary Change Form MF 1001 Designate or change your IRA beneficiaries.
Beneficiary Distribution Form (IRA)   Use beneficiary forms to request a distribution from an IRA due to the death of an IRA owner.
• Spouse & Non-spouse MF 1024A
• Entity MF 1024C
Distribution Form (IRA) PMFS 183 Use this form to request a distribution from an IRA account.
Electronic Funds Transfer Purchase Form MF 1006 Contribute to your IRA, online or by phone.
Exchange Authorization MF 224A Use this form to authorize fund exchanges.
Name Change Form MF 1003 Use this form to request a name change.
Recharacterization Form (IRA) PMFS 1003 Use this form to recharacterize Roth IRA contributions back to a Traditional IRA and vice versa.
Required Minimum Distribution Form PRU 1168 Facilitate Required Minimum Distributions from a Traditional IRA.
Roth IRA Conversion Form
(Traditional IRA held at Prudential Mutual Fund Services LLC)		 MF 1028 Convert a Traditional IRA to a Roth IRA.
Systematic Withdrawal Plan PMFS 183 Request an IRA distribution. Request may be received as a check or deposited directly into a bank account.
Transfer (Coverdell ESA) MF 1088 Move assets from another financial institution to an existing Prudential Investments Coverdell Education Savings Account (ESA).
Transfer / Direct Rollover / Conversion Form (IRA) MF 1012 Move assets or convert a Traditional, Roth, or SEP IRA from another financial institution to an existing Prudential Investments account.
403(b) Distribution MF 1005 Take a distribution from a 403(b) account.

SIMPLE IRA Forms (Qualified Plans)
Form Name Number Description
SIMPLE IRA Change Request SM 113968 For SIMPLE IRA Accounts Only - Use this form to request a name change, address change, broker/dealer change, beneficiary change, contribution investment allocation change or an investment exchange.
SIMPLE IRA Transfer of Assets SM 113969 For SIMPLE IRA Accounts Only - Move SIMPLE IRA assets from another financial institution to an existing Prudential Investments SIMPLE IRA account.
SIMPLE IRA Withdrawal Authorization SM 113970 For SIMPLE IRA Accounts Only - Use this form to request a distribution from your SIMPLE IRA. If you need to satisfy your 70 1/2 Required Minimum Distribution (RMD) amount, please use the SIMPLE IRA 70 1/2 Required Minimum Distribution Election Form.
SIMPLE IRA 70 1/2 Required Minimum Distribution Election Form SM 113972 For SIMPLE IRA Accounts Only - Use this form to request a Required Minimum Distribution (RMD) from your SIMPLE IRA.
SIMPLE IRA Contribution Worksheet SM 113971 For SIMPLE IRA Accounts Only - Plan Sponsors use this form to submit SIMPLE IRA contributions on behalf of plan participants. Mail the contribution check with the completed contribution worksheet. Any contribution instructions received for individuals not enrolled in the plan will be rejected.