Duplicate Statement/Confirm Request
J.P. Morgan Securities LLC
Member FINRA and SIPC Account Number
Use this form to
• Authorize J.P. Morgan Securities LLC (JPMS) to send duplicate account statements and/or trade confirmations for this account to an
interested party.
What you need to know
• This form can also be used to update or remove an existing interested party.
• For your protection, a representative may call you at the number on file for your account to confirm this request before it is processed.
Account Holder Name
1. Request Type - select one
Add a new Duplicate Mailing (provide Recipient Name and Mailing Address below)
Update an existing Duplicate Mailing (provide Existing Recipient Name AND updated Recipient Name and/or Mailing Address below)
Remove an existing Duplicate Mailing (provide Existing Recipient Name or write "all" below)
Provide the following information to UPDATE or REMOVE a Duplicate Mailing:
Existing Recipient Name
Provide the following information to ADD or UPDATE a Duplicate Mailing:
Recipient Name
Mailing Address
City State ZIP Code
2. Duplicate Mailing Type - select one
Statements only
Confirms only
Statements and Confirms
PLEASE NOTE: If you are required by your employer to provide duplicate statements and/or confirms due to your affiliation or association
with any of the following listed below, please ALSO include a letter from your employer stating that you are able to maintain this brokerage
account and where to send duplicate statements and/or confirms:
• Municipal Securities Dealer
• Securities Exchange
• Investment Advisor
• State or Federal Securities Regulator
• Broker-dealer other than J.P. Morgan Securities LLC
INVESTMENT AND INSURANCE PRODUCTS:
• NOT A DEPOSIT • NOT FDIC INSURED • NOT INSURED BY ANY FEDERAL GOVERNMENT AGENCY
• NO BANK GUARANTEE • MAY LOSE VALUE
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Duplicate Statement/Confirm Request
3. Account Holder Signature
X
Account Holder Signature Date (month/day/year)
Primary Account Holder Identity Verification
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate
is attached, and not the truthfulness, accuracy, or validity of that document.
Place Stamp Here
STATE OF )
) SS:
COUNTY OF )
Subscribed, sworn to and acknowledged before me by
,
Name of Document Signer (above)
this day of , .
Day Month Year
X
Signature of Notary Public My commission expires
Please keep a copy of this form for your records.
After reviewing and signing this form, please select how you'd like to submit it:
• Email - Visit [Link]/brokerageforms for instructions on how to submit this completed document and any attachments.
• Regular or Overnight Mail - Send the form and any attachments to:
J.P. Morgan Securities LLC
Attn: Account Processing
Mail Code: IL1-0291
10 S. Dearborn St.
Chicago, IL 60603
Questions? Please call us at (800) 392-5749.
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