Name Change Request Form - Pioneer Investments

Pioneer Investments
Name Change Request Form
Use this form to notify Pioneer that your name has changed. We will update all directly held accounts registered under the Social Security or individual
Taxpayer Identification Number you provide. Mail to Pioneer Investment Management Shareholder Services Inc. (PIMSS), P.O. Box 55014, Boston, MA
02205-5014. Overnight Address: 30 Dan Road, Canton, MA 02021-2809.
If you have questions, call Pioneer at 1-800-225-6292.
Please print in blue or black ink.
1 Registration Information for Existing Account(s)
Note: All registered owners/trustees must sign in Section 3. Print the following information exactly as it currently appears on your account.
Name (First, Middle Initial, Last)
Name (First, Middle Initial, Last)
Fund/Account Number(s)
Last Four Digits of Social Security/Taxpayer Identification Number
Address
City State Zip Telephone Number
If you want to change your name on accounts registered under a different Social Security or individual Taxpayer ID Number (e.g., joint, custodial, or trust
accounts), list the fund and account numbers below.
Fund/Account Number(s)
2 Name Change
Provide both your former name and new name in this section. A Signature Validation Program Stamp is required for this change. See Section 4.
I hereby certify that ________________________________________________ was changed to _____________________________________________
Print Former Name
Print New Name
and is one and the same person. Please change the registration on all accounts registered under my Social Security/Tax Identification Number to reflect my new name.
Note: If an account registered in your former name is invested in Pioneer Cash Reserves Fund and has the check-writing option, all authorized check signers must
complete a Pioneer Checkwriting Form.
3 Signatures
Please sign this form exactly as your new name appears in Section 2. All registered owners must sign. All authorized signers must sign in capacity. Minors are not
authorized to sign.
X
Owner’s Signature
X
Joint Owner’s Signature
Date (mo/day/yr)
Date (mo/day/yr)
4 Signature Validation
A Signature Validation Program Stamp is required on this form. Note: All registered owners/authorized signers must sign, however, for most
accounts, only the signature of the individual requesting a name change requires a Signature Validation Program Stamp. In the case of
accounts for minors (UGMA/UTMA, IRA/Roth IRA for minor) the custodian’s signature requires a Signature Validation Stamp.
Provide Signature Validation Program Stamp here.
Continues on next page

Name Change Request Form (continued)
PIMSS, Inc. accepts Signature Validation Program Stamps executed by eligible issuers participating in the Securities Transfer Agents Medallion
Program 2000 (STAMP 2000). Signature Validation Program Stamps are used by guarantors to verify signatures presented on non-financial account
requests. Eligible issuers include U.S. domestic banks, credit unions, savings associations (including savings and loan associations), trust
companies, national securities exchanges, registered securities associations, and clearing agencies. Also acceptable are participating broker/dealers,
municipal and government securities dealers whose net capital exceeds $100,000. If you are unable to obtain a Signature Validation Program
Stamp, we will accept a signature guarantee on your non-financial account request. Please keep in mind that if any part of your request results in
a financial transaction, we will require a Medallion Signature Guarantee. A notarized signature may not be used in lieu of a Signature Validation
Program Stamp or signature guarantee.
Pioneer Investments
60 State Street, Boston, MA 02109
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