Forms

These forms are only to be used if the PGIM Investments account is held at Prudential Mutual Fund Services LLC (PMFS) or BNY Mellon Trust Company SIMPLE IRA. They are not for use if the PGIM 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 NameNumberDescription
Account ApplicationMF 1017Open a PGIM Investments mutual fund account (not for use by Pruco Securities LLC financial professionals).
Account Registration Change FormMF 1002Re-register (change ownership) on an existing account.
Additional Statement Request FormMF 470Request additional account statements be sent to a different address.
Automatic Investment PlanMF1006Automatically invest by transferring money directly from your bank account into your mutual fund(s).
Checkwriting Form
(money market funds only)
MF 010Sign up for the checkwriting privilege from your money market fund.
Corporate ResolutionMF 1015Authorize an entity's officers and others to conduct transactions on the entity's Prudential Mutual Fund Services LLC account.
Cost Basis Election FormMF 1007Use 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 FormMF 313Update 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 FormMF 1006Buy shares, online or by phone. The purchase amount will be electronically (via ACH) debited from your bank account.
Exchange AuthorizationMF 224AUse this form to authorize fund exchanges.
Expedited Redemption FormMF 008Sell 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.
Investment Profile Questionnaire (for Pruco Securities, LLC only)MF 1010For Pruco Securities, LLC (Pruco) customers, please complete this form to help determine whether the investments you have selected are appropriate, given your financial objectives. (for use by Pruco Securities, LLC financial professionals but excludes Command or other brokerage accounts.)
Living Children AffidavitMF 1190Living Children Affidavit Form
Letter of Intent Form
(Class A Shares only)
MF 230If 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 FormPMFS 286Authorize others to conduct certain transactions on your behalf for your mutual fund account(s). Read form carefully for account restrictions.
Name Change FormMF 1003Use this form to request a name change.
Redemption FormMF 004Use this from to redeem fund shares from non-retirement account types.
Systematic Exchange Plan FormMF 312Establish a periodic exchange between funds.
Systematic Withdrawal Plan FormMF 310Use this form to request periodic distributions from a non-retirement account.
Transfer Form (non-IRA)MF 1019Move non-IRA assets from another financial institution to an existing PGIM Investments mutual fund account.
Transfer on Death FormPMFS 296Establish or update a beneficiary on your non-IRA account.

 

Traditional IRA, Roth IRA, SEP IRA, Coverdell ESA, and 403(b) Forms

Form NameNumberDescription
Account ApplicationMF 1011Open a PGIM Investments mutual fund Traditional, Roth, or SEP IRA account with Prudential Mutual Fund Services LLC (not for use by Pruco Securities LLC financial professionals).
Affidavit of DomicileMF 515This 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.
Application (Coverdell ESA)ORD 97828Open a PGIM Investments Coverdell ESA with Prudential Mutual Fund Services LLC.
Automatic Investment PlanMF 1006Automatically contribute to your IRA by transferring money directly from a bank account into your IRA mutual fund account.
Beneficiary Change FormMF 1001Designate or change your IRA beneficiaries.
Beneficiary Distribution Form
 
MF 1024Use this form to request a distribution/transfer from an IRA due to the death of an IRA owner.
Distribution Form (IRA)PMFS 183Use this form to request a distribution from an IRA account.
Electronic Funds Transfer Purchase FormMF 1006Contribute to your IRA, online or by phone.
Exchange AuthorizationMF 224AUse this form to authorize fund exchanges.
Investment Profile Questionnaire (for Pruco Securities, LLC only)MF 1010For Pruco Securities, LLC (Pruco) customers, please complete this form to help determine whether the investments you have selected are appropriate, given your financial objectives. (for use by Pruco Securities, LLC financial professionals but excludes Command or other brokerage accounts.)
Name Change FormMF 1003Use this form to request a name change.
Recharacterization Form (IRA)PMFS 1003Use this form to recharacterize Roth IRA contributions back to a Traditional IRA and vice versa.
Required Minimum Distribution FormPRU 1168Facilitate Required Minimum Distributions from a Traditional IRA.
Roth IRA Conversion Form
(Traditional IRA held at Prudential Mutual Fund Services LLC)
MF 1028Convert a Traditional IRA to a Roth IRA.
Systematic Withdrawal PlanPMFS 183Request an IRA distribution. Request may be received as a check or deposited directly into a bank account.
Transfer (Coverdell ESA)MF 1088Move assets from another financial institution to an existing PGIM Investments Coverdell Education Savings Account (ESA).
Transfer / Direct Rollover / Conversion Form (IRA)MF 1012Move assets or convert a Traditional, Roth, or SEP IRA from another financial institution to an existing PGIM Investments account.
403(b) DistributionMF 1005Take a distribution from a 403(b) account.

 

SIMPLE IRA Forms (Qualified Plans)

Form NameNumberDescription
SIMPLE IRA Account ApplicationSM113967Open a PGIM Investments mutual fund Simple IRA account.
SIMPLE IRA Change RequestSM 113968For 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 AssetsSM 113969For SIMPLE IRA Accounts Only - Move SIMPLE IRA assets from another financial institution to an existing PGIM Investments SIMPLE IRA account.
SIMPLE IRA Withdrawal AuthorizationSM 113970For 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 FormSM 113972For SIMPLE IRA Accounts Only - Use this form to request a Required Minimum Distribution (RMD) from your SIMPLE IRA.
SIMPLE IRA Contribution WorksheetSM 113971For 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.

0171355-00015-00 Ed. 10/2016