Enrollment Form for
MFA Mortgage Investments, Inc.
Discount Waiver, Direct Stock Purchase
[MFA MORTGAGE INVESTMENTS, INC. LOGO] and Dividend Reinvestment Plan
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This form when completed and signed, should be mailed in the courtesy envelope
provided to: Mellon Investor Services,
P.O. Box 3339, South Hackensack, NJ 07606-1939
Is this account for an existing stockholder? YES ( ) NO ( )
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Account Registration Complete only one section. Print clearly in CAPITAL LETTERS.
1. ( ) INDIVIDUAL OR JOINT ACCOUNT
Owner's Name
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Owner's Social Security Number Owner's Date of Birth
(used for tax reporting) Month Day Year
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Joint Owner's Name
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Joint Owner's Social Security Number
(used for tax reporting) The account will be registered "Joint Tenants with Rights
---- ---- ---- ---- ---- ---- ---- ---- ---- of Survivorship" unless you check a box below:
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---- ---- ---- ---- ---- ---- ---- ---- ---- ( ) Tenants in common ( ) Tenants by entirety ( ) Community property
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( ) GIFT TRANSFER TO A MINOR (UGMA/UTMA)
Custodian's Name
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Minor's Name
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Minor's Social Security Number Minor's Date of Birth
(required) Month Day Year
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( ) TRUST Please check only one of the trustee types: ( ) Person as Trustee ( ) Organization as Trustee
Trustee: Individual or Organization Name
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and Co-Trustee's Name, if applicable
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Name of Trust
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For the Benefit of
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Date of Trust
Trust Taxpayer Identification Number Month Day Year
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( ) ORGANIZATION OR BUSINESS ENTITY Check one: ( ) Corporation ( ) Partnership ( ) Other
Name of Entity
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Taxpayer Identification Number
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Address
2. Mailing Address (including apartment or box number)
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City State Zip Code
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Home Phone Work Phone
( ---- ---- ---- ) ---- ---- ---- ---- ---- ---- ---- ( ---- ---- ---- ) ---- ---- ---- ---- ---- ---- ----
( | | | | | | ) | | | | | | - | | | | | | | | ( | | | | | | ) | | | | | | - | | | | | | | |
( ---- ---- ---- ) ---- ---- ---- ---- ---- ---- ---- ( ---- ---- ---- ) ---- ---- ---- ---- ---- ---- ----
For mailing address outside the U.S.:
Country of Residence Province Routing or Postal Code
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Cash Purchase (Make checks payable to Mellon Bank/MFA)
3. ( ) As a CURRENT registered stockholder I wish to ( ) As a NEW investor I wish to enroll in the Plan
make an additional investment. Enclosed is my by making an initial investment. Enclosed is my
check or money order for $ ______________. Minimum check or money order for $_______________. Initial
$50 with the maximum not to exceed $10,000 investment must be for at least $1,000 with a
monthly. maximum not to exceed $10,000. AS A NEW INVESTOR,
YOU MUST ALSO COMPLETE SECTIONS 1, 2, & 8.
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Bank Authorization Agreement
4. ( ) AUTOMATIC ADDITIONAL INVESTMENTS
I hereby choose to make additional investments in MFA Mortgage Investments, Inc. common stock ("MFA Stock") by authorizing
automatic monthly debits from my bank account.
Please complete the following and Section 5:
I hereby authorize the Plan Administrator and the Financial Institution indicated below to deduct from my bank account
$__________ per month (minimum of $50) and apply amounts so deducted to the purchase of MFA Stock under the account
designated. Note: deductions will occur on or about the 25th of each month.
( ) AUTOMATIC INITIAL INVESTMENT
I hereby choose to initiate my investment in MFA Stock by authorizing a one-time deduction from my bank account (minimum of
$1,000).
Upon receipt of this form, properly completed, the Plan Administrator will contact your bank to deduct the amount indicated
from your bank account on or about the 25th of each month. The Plan Administrator will invest in MFA Stock beginning on the
next Investment Date. For monthly investments, deductions and investments will continue until you notify the Plan
Administrator to change or discontinue them. Should your bank account contain insufficient funds to cover the authorized
deduction, no deduction or investment will occur. In such event, you may be charged a fee by your bank for insufficient
funds.
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5. Bank Account Information (complete only if a feature in Section 4 is selected)
This information will be used for ( ) Automatic Investment (Sec. 4)
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| | Checking account Banking or credit union's ABA transit routing number
---- (available from the bank or credit union) Bank or credit union account number
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| | Savings account | | | | | | | | | | | | | | | | | | | | | | | | | | | |
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Tape your voided check here
Bank and credit union routing information.
For deposits to or withdrawals from your checking account, please tape a voided blank
check so the Plan Administrator may obtain bank or credit union account information.
For deposits to or withdrawals from a savings account, please tape a preprinted deposit
slip.
(Please Do Not Staple)
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6. Dividend Reinvestment
You may choose to reinvest all or a portion of the dividends paid on your MFA Stock. If no box is selected, the Plan
Administrator will automatically reinvest all of the dividends on your MFA Stock.
( ) Reinvest the dividends on ALL shares of my MFA Stock.
( ) I would like a portion of my dividends reinvested. Please remit to me the dividends on __________ shares of my MFA
Stock. I understand that the dividends on my remaining shares of MFA Stock, as well as all future shares that I
acquire, will be reinvested.
( ) All cash (no dividend reinvestment).
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7. Safekeeping
MFA Stock certificates deposited for safekeeping in your account must be in the same registration as your Plan account.
( ) Please accept the enclosed certificate(s) for deposit to my account. Enclosed are ______________ MFA Stock certificates.
insert number
Certificate Number Number of Shares
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8. Account Authorization Signature (required)
( ) REQUEST FOR TAXPAYER IDENTIFICATION - The beneficial owner is not a U.S. person;
NUMBER (Substitute Form W-9)
- The income to which this form relates is not
I am a U.S. citizen or a resident alien. I certify, effectively connected with the conduct of a trade or
under penalties of perjury, that (1) the taxpayer business in the United States or is effectively
identification number in Section 1 is correct (or I am connected but is not subject to tax under an income tax
waiting for a number to be issued to me) and (cross out treaty; and
the following if not true) (2) I am not subject to
backup withholding because: (a) I am exempt from backup - For broker transactions or barter exchanges, the
withholding, (b) I have not been notified by the beneficial owner is an exempt foreign person as defined
Internal Revenue Service that I am subject to backup in the instructions.
withholding as a result of failure to report all
interest of dividends, or (c) the IRS has notified me Furthermore, I authorize this form to be provided to
that I am no longer subject to backup withholding. any withholding agent that has control, receipt or
custody of the income of which I am the beneficial
( ) CERTIFICATE OF FOREIGN STATUS OF BENEFICIAL owner or any withholding agent that can disburse or
OWNER (Substitute Form W-8BEN) make payments of the income of which I am the
beneficial owner.
Under penalties of perjury, I declare that I have
examined the information on this form and to the best ( ) CLAIM OF TAX TREATY BENEFITS I CERTIFY THAT:
of my knowledge and belief it is true, correct and
complete. I further certify under penalties of perjury The beneficial owner is a resident of ______________
that: within the meaning of the income tax treaty between the
United States and that country.
- I am the beneficial owner (or am authorized to sign
for the beneficial owner) of all the income to which ( ) FOR ORGANIZATIONS AND BUSINESS ENTITIES
this form relates; EXEMPT FROM BACKUP WITHHOLDING
I qualify for exemption and my account will not be
subject to tax reporting and backup withholding.
MY/OUR SIGNATURE(S) BELOW INDICATES I/WE HAVE READ THE PLAN PROSPECTUS
AND AGREE TO THE TERMS THEREIN AND HEREIN.
Signature of Owner Date (month, day, year)
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Signature of Joint Owner Date (month, day, year)
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