Account Forms

General Account Management Forms - Descriptions & Instructions

Add/Change or Removal of Dealer Authorization Form

Shareholders that wish to change their broker/dealer of record can complete the Add/Change or Removal of Dealer Authorization Form. The form must be signed by all registered owners. A Medallion Signature Guarantee is not required when removing a Dealer/Service Agent and not designating a new one.

 

Affidavit of Domicile

Shows the residence of decedent at time of death. Affidavit of Domicile is required when transferring the ownership of a security from a deceased person's name.

 

Auto-Exchange Form

Set up a systematic plan to exchange funds between Dreyfus fund accounts.

The Dreyfus Auto-Exchange Privilege allows regular, automatic exchanges from one Dreyfus mutual fund account into another, or several other, existing Dreyfus mutual fund accounts. This free service may be used to reallocate assets or to diversify a portfolio over time.1

Whatever the goal, this service is flexible, permitting exchanges annually, quarterly, monthly or semimonthly, on the first or 15th of the month. A shareholder may choose to exchange a fixed dollar amount of $100 or more, or a set number of shares with a minimum current value of $100.

The authorization form is all that is needed to set up the Dreyfus Auto-Exchange Privilege between two existing eligible Dreyfus accounts. Simply:

  • Tell us the amount the shareholder wishes to exchange (minimum current value $100);
  • Indicate the account out of which they wish us to exchange;
  • Indicate the account(s) into which they wish us to exchange;
  • Tell us the schedule they would prefer;
  • The shareholder must sign the Authorization Form.2

We'll do the rest at no cost. We'll also send a transaction confirmation for each exchange.

 

Automatic Withdrawal Form

Set up a systematic withdrawal from a Dreyfus account and have proceeds sent via check to an address or directly to a bank account.

 

Broker NAV Purchase Authorization Form

Allows an employee of a FINRA member firm or bank to purchase Dreyfus funds at Net Asset Value.

 

CD Transfer Form

Here's how to transfer a maturing CD into Dreyfus mutual funds.

 

Change of Registration Authorization Form

Change the account registration or transfer the title of one or more accounts into the name of a new owner. An account application also needs to be completed with this form.

 

Change of Address Authorization Form

Change the address of record on an account(s).

 

Dividend Options Form

Transfer fund distributions into another Dreyfus account or electronically into a bank account.

Dreyfus Dividend Sweep allows automatic transfers of any dividends and/or capital gains a shareholder earns in one of their Dreyfus mutual fund accounts into another one of their existing Dreyfus mutual fund accounts. For example, they may use this free service to sweep distributions from a growth-oriented fund into a money market fund.1 Or they may invest the dividends from a money market or short-term income fund into a longer term growth fund.

No matter how they choose to employ their Dreyfus Dividend Sweep, their earnings will work nonstop because they are automatically transferred on the day they are paid.

Dreyfus Dividend ACH allows automatic electronic transfers of any dividends and/or capital gains from the Dreyfus mutual fund account to another designated bank account. With Dreyfus Dividend ACH, there is no charge by Dreyfus and no chance of mail delays.1 We do suggest that the shareholder checks with their bank to see if it will charge a fee for using this service.

The Dreyfus Dividend Options Form is all that is needed to set up either Dreyfus Dividend Sweep or Dreyfus Dividend ACH on the eligible Dreyfus account. To get started, simply:

  • Select either the Dividend Sweep or Dividend ACH option;
  • Tell us whether to transfer the dividends only, or dividends and any capital gains;
  • Indicate the Dreyfus account from which they wish us to transfer;
  • Indicate, for Dreyfus Dividend Sweep, the Dreyfus account into which they wish us to transfer;
  • Indicate, for Dreyfus Dividend ACH, the bank account into which they wish to transfer and attach a voided check from their bank account (to participate, your bank must be a member of the Automated Clearing House); and
  • Shareholder must sign the form.2

We will do the rest at no cost1, and we will send them a transaction confirmation for each dividend transfer.

 

Dreyfus Automatic Asset Builder® Authorization Form

Set up a systematic investment plan to transfer funds directly from a bank account to a Dreyfus account(s).

 

Letter of Intent/Right of Accumulation

Shareholders that would like to qualify for a reduced sales charge when purchasing Class A shares of a Dreyfus Fund can complete a Letter of Intent Form.

 

Multi-Purpose Certification Form

Permits specific individuals to transact on accounts registered to a corporation, trust, partnership, estate or other entity.

 

Name Change Form

Change the registration on an existing individual and/or IRA account because of a legal name change.

 

Payroll Savings Form

Have a paycheck or a portion of it deposited into a Dreyfus account(s).

Thank you for your interest in the Dreyfus Payroll Savings Plan. We are confident our shareholders will find this a very convenient and efficient way to help them toward achieving their financial goals.1

The Dreyfus Payroll Savings Plan enables the shareholder to have a portion or all of a paycheck deposited directly into a Dreyfus mutual fund account, if their employer offers direct deposit of paychecks. With this plan, there are no checks to write, no stamps to affix, no trips to the post office. Furthermore, because the transfer is made electronically from their employer's payroll account to Dreyfus, their money goes to work as soon as we receive it.

The authorization form is all that is needed to add the Dreyfus Payroll Savings Plan to their existing eligible Dreyfus account. Simply:

  • Indicate the account into which the shareholder wishes the investments to go;
  • Tell us the amount they want to invest each pay period (they may choose any amount between $100 and their total net pay);
  • Provide us with some information about their employer;
  • Attach a voided check or transaction confirmation from their Dreyfus account;
  • Shareholder must sign the Authorization Form and give it to their payroll department.

Their employer will be responsible for arranging all transactions and may be able to arrange a different investment schedule (such as deductions from every other paycheck). Their pay stubs will report their investment and they will receive a transaction confirmation from Dreyfus for each investment.

They work hard for their paycheck. Why not make it work for them? Start today with the Dreyfus Payroll Savings Plan.

Power of Attorney Appointment and Indemnification Agreement

Give an individual the ability to make transactions on your account on your behalf.


In order to appoint an individual to act on your behalf, please complete the Power of Attorney Appointment and Indemnification Agreement. Please note the following important instructions:

  • Provide your name and address as well as the name, address and daytime telephone number of the Attorney-in-Fact.
  • List the fund name(s) and account number(s).
    • Note: Multiple accounts with the same registration may be listed, but only one Attorney-In-Fact may be selected per form.
  • The Attorney-In-Fact must sign the form in the "Attorney-In-Fact" section and have his/her signature notarized.
  • Sign your name in the "Principal" section and have your signature notarized.

Once established on your account, the Attorney-In-Fact must sign his/her name followed by "Attorney-In-Fact" on all written transactions, including redemption checks.


Upon receipt of the completed form in proper order, we will process the request.

 

Redemption Authorization Form

Request a redemption from your Dreyfus non retirement account.

 

Shareholder Services Form

Add or change services such as distribution options, checkwriting privilege, Dreyfus Automatic Asset Builder®, and teleservice privileges on one or more accounts.


In order to add or change any of the privileges on your account; please complete the Shareholder Services Form. Please note the following important instructions: For business and trust accounts where there are no authorized signer(s)/trustee(s) named in the registration, to add/change authorized signer(s), or if authorized signers/trustees currently on file wish to act independently of one another. Please be certain to complete Sections 1, 2, 3 and 8 with the signature(s) of all authorized signer(s).

For updates to:

  • Dividend and capital gain distribution options - please complete Section 4.
  • Checkwriting options - please complete Section 5.
  • Dreyfus-Automatic Asset Builder® - please complete Section 6.
  • Teleservice privileges - please complete Section 7.

A Medallion Signature Guarantee* will be required in Section 9 if you are requesting any of the following:

  • Sending dividends or dividends and capital gains by ACH to your bank.
  • Adding or updating bank information for Teletransfer/Wire Redemption/Telephone Redemption.
  • Adding or updating Checkwriting for joint accounts and only one signature will be required on checks.

The Multi-Purpose Certification Form must also be completed. Please note the following important instructions:

  • Complete Sections 1 and 2 for all registration types;
  • Complete Section 3 for corporate accounts or incorporated associations and obtain a Medallion Signature Guarantee1 or a Corporate Seal.
  • Complete Section 4 for trust accounts, partnerships, estates and other entities and obtain a Medallion Signature Guarantee.1

Upon receipt of the completed form in proper order, we will process the request.


Stock Power Form

This form should be used to redeem, exchange or transfer title of shares in an account.

 

Transfer on Death Registration Form

Establish a Transfer on Death (TOD) registration for a new or existing account or change TOD beneficiaries.

MAILING INSTRUCTIONS

Please mail the completed form to:

Dreyfus Institutional Department

P.O. Box 9882

Providence, RI 02940-8082

 

For registered/certified mail please mail to:

Dreyfus Institutional Department

4400 Computer Drive

Westborough, MA 01581

Retirement Account Forms - Descriptions & Instructions

Distribution Request Form

Make distributions from an IRA account(s).

 

Dreyfus IRA Transfer Request Form

Transfer or directly roll over all or a portion of a current IRA, qualified plan or 403(b) Plan to a Dreyfus IRA. 

 

Inherited IRA Beneficiary Distribution Form

Complete this form if you are an IRA beneficiary to take a distribution or to establish an Inherited IRA. A Dreyfus Application must also be completed to establish an Inherited IRA

Inherited IRA Distribution Form

Complete this form to request a distribution or set up a distribution schedule from your Inherited IRA.

IRA Checkwriting Privilege Addition Form

Use this form to add the Checkwriting Privilege to a Dreyfus IRA only.

In order to add the Checkwriting privilege on a Traditional IRA; the shareholder must simply complete the IRA Checkwriting Privilege Addition Form. Please note the following important instructions.

  • Complete Sections 1 through 3 with the current account information;
  • Complete Section 4 by checking the box and reviewing the information; and
  • Complete Section 5 with the signature of the registered IRA owner.

Note: Please be advised that an IRA check redemption is considered a qualified distribution and such distribution will be reported on Form 1099R to the IRS. Redemption checks are not subject to TEFRA (withholding) regardless of the withholding code on the account.

As soon as we receive the completed form in proper order, we will update the account and a checkbook will be forwarded to the address of record.

 

IRA Shareholder Services Form

Use this form to add or change the Automatic Asset Builder, Checkwriting or TeleTranfer purchase privilege to your retirement account.

Required Minimum Distribution Request Form 

Request your required minimum distribution from an IRA account.

Early in 2001, the Internal Revenue Service proposed a sweeping overhaul of the rules that regulate required minimum distributions (RMDs) from IRAs, 401(k)s and other retirement vehicles.

The newly proposed regulations could mean smaller mandatory withdrawals from an account, which could mean additional time to enjoy tax-deferred growth potential. Of course, don't forget that even simplified tax laws can still be complicated. The Retirement Center provides an understanding of IRA distribution options.

To begin taking an RMD or modify an existing distribution schedule, a shareholder will need to fill out the RMD request form. The form is simple and self-explanatory.

For more information on the proposed regulations — including how they apply to each particular situation and any recent changes — a shareholder should contact their financial advisor, retirement plan administrator and/or tax professional.

 

Individual Retirement Account Beneficiary Designation Form 

Establish or change the primary and secondary beneficiary(ies) on a Dreyfus IRA account.

In order to add or change beneficiary information on an Individual Retirement Account (IRA), please complete the Individual Beneficiary Designation Form. This form may be used to add or change beneficiaries on multiple IRA accounts provided the account ownership and the changes to beneficiary information are identical for all accounts. The information on this form will supersede all other beneficiary information on file.

In completing the form, please be sure to include the following information for the new primary and secondary (if any) beneficiary(ies): Full name and address, Social Security number, relationship to IRA holder, and date of birth. If you choose to select multiple primary or secondary beneficiaries, you must provide the percentage allotted to each, totaling 100%.

Upon receipt of the required documentation in proper order, we will process the request. Written confirmation of the new beneficiary(ies) will be sent upon request.

Mailing Instructions

Please mail the completed form to:

Dreyfus Institutional Department

P.O. Box 9882

Providence, RI 02940-8082

For registered/certified mail please mail to:

Dreyfus Institutional Department

4400 Computer Drive

Westborough, MA 01581

1. Sales loads or other charges may apply.

2. Please note that your signature(s) must be guaranteed if the account registrations on the accounts you are exchanging out of and into are different.

3. Note that you must have your signature(s) guaranteed if you are selecting Dreyfus Dividend Sweep and the registrations on the "FROM" and "TO" accounts differ or if you are opting for Dreyfus Dividend ACH.

4. Regular investing does not guarantee a profit or protect against loss in declining markets. You should consider your ability to continue making investments in down markets before engaging in a regular investment plan.

5. The Transfer Agent has adopted standards and procedures pursuant to which Signature Guarantees in proper form generally will be accepted from domestic banks, brokers, dealers, credit unions, national securities exchanges, registered securities associations, clearing agencies and savings associations. Signature Guarantees will also generally be accepted from financial institutions participating in the New York Stock Exchange Medallion Signature Program (MSP), the Securities Transfer Agents Medallion Program (STAMP) and the Stock Exchanges Medallion Program (SEMP) provided the transaction amount does not exceed the guarantor's surety bond coverage.

The Alpha Prefix obtained for the Medallion Guarantee must cover the entire transaction request. Notarization by a Notary Public is not an acceptable guarantee.

6. The Transfer Agent has adopted standards and procedures pursuant to which Medallion Signature Guarantees in proper form generally will be accepted from domestic banks, brokers, dealers, credit unions, national securities exchanges, registered securities associations, clearing agencies and savings associations participating in the New York Stock Exchange Medallion Signature Program (MSP), the Securities Transfer Agents Medallion Program (STAMP) and the Stock Exchanges Medallion Program (SEMP). Notarization by a notary public is not an acceptable guarantee.

MARK-30438-2018-06-15