Name Change Form - OppenheimerFunds

Name Change Form
Additional requirements
Please complete the form in its entirety, sign, and return it to
us at:
In addition to this form, we will require ONE of the following
to complete your name change request:
OppenheimerFunds Distributor, Inc.
A copy of the marriage certificate, divorce decree, or other
legal document authorizing the change.
Regular Mail:
P.O. Box 5270
Denver, CO 80217-5270
Overnight Courier:
12100 E. Iliff Avenue
Suite 300
Aurora, CO 80014
Your guaranteed signature in Section 4C.
Questions? If you need additional assistance completing this
form, or have questions, call 800 CALL OPP (225 5677) to
speak with a Customer Service Associate.
Fax: 303 768 1500*
*Signature guaranteed documents may not be faxed.
1| Current account holder information
First name
Middle initial
Last name
Middle initial
Last name
Social Security number
Phone number
2| Account holder name change information
Please indicate your new full, legal name here.
First name
Reason for Name Change:
j Marriage j Divorce j Other (please specify): 3| Accounts to apply name change
Additional account numbers should be provided on a separate sheet.
Account number
Account number
Account number
Account number
RPL0005.177.1015 Page 1 of 2
Please review the following and sign below.
I certify that I am of legal age and capacity and am authorized to purchase shares. I have received and read the current prospectus for each fund
I am investing in and I agree to be bound by the terms and conditions of each such prospectus. I acknowledge that it is my responsibility to read the
prospectus of any fund into which I exchange.
Householding: In the event that family members in my household have multiple accounts in a single fund, I agree that OppenheimerFunds
may send a single copy of that fund’s updated prospectus, annual or semiannual report that is required to be delivered. I agree to notify
OppenheimerFunds by phone, in writing or by email if I wish to stop householding, and receive multiple copies of these materials. My signature
below constitutes my agreement and acceptance of all terms, conditions, and features selected in any and all parts of this form and prospectus and
Statement of Additional Information for the fund.
Form W-9
I certify under penalties of perjury that:
1. The number shown on this form is my correct Taxpayer Identification number, and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified
by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or
dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
3. I am a U.S. citizen or other U.S. person, and
4. The FATCA code(s) entered on this form (if any, see below) indicating that I am exempt from FATCA reporting is correct.
If Required:
Certification 2 above: Backup withholding
You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return.
Certification 4 above: Exemption from FATCA reporting code (if any)
Exemption Codes
FATCA codes apply to persons submitting this form for accounts maintained outside of the
(If Any):
United States by certain foreign financial institutions. Therefore, if you are only submitting this
form for an account you hold in the United States, you may leave this field blank. Please visit for a list of exemption codes for all others. You may
also visit for more information on FATCA.
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications
above to avoid backup withholding.
A. Signature of OppenheimerFunds Account Owner
Please sign in both your former and new names.
Former signature
Current signature
B. Signature of Custodian, Guardian, or Agent
Please print and sign your name and provide your official title where provided. Additional paperwork may be required if you are signing
on behalf of the account owner as attorney-in-fact, guardian, conservator, or other legally defined agent. Please contact us for more
information regarding these requirements.
Printed name and title
C. Signature Guarantee1
If your request requires a Signature Guarantee, your signature must be guaranteed by a U.S. bank or trust company, credit union or savings
association, or by a foreign bank that has a U.S. correspondent bank, by a U.S. registered dealer or broker in securities, municipal or government
securities, or by a U.S. national securities exchange, a registered securities association or a clearing agency. A notarized, witnessed, verified, or
certified signature is not an acceptable substitute for a guaranteed signature.
Signature Guaranteed (Guarantor must use stamp or seal)
Printed name of Guarantor
Signature Guarantee Stamp
1. Required if a copy of the legal document authorizing the change is not included with the completed form.
RPL0005.177.1015 October 1, 2015
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