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Affidavit of One and the Same Name

J.P. Morgan Securities LLC
Member FINRA and SIPC

Page 1 of 1

For your protection, a representative may call you at the number on file for your account to confirm this transaction before it is processed.
ACCOUNT HOLDER NAME (PLEASE PRINT IN ALL CAPITAL LETTERS)

JPMS Account Number

Use this Affidavit to document any differences or conflicts between a legal name and a variation of a legal name (e.g.,
nickname or use of initials) on your J.P. Morgan Securities LLC ("JPMS") account and another account or physical
securities certificate. Do not use this form to request a legal name change (e.g., due to a marriage or divorce).

1.

Request Type - select one & Affidavit

Select one of the following options:
Account Maintenance
Physical Security Deposits - name on certificate differs from the name listed on the account
Estate/Beneficiary Related Transactions
The undersigned, being duly sworn, does hereby depose and state as follows:
I hereby certify that