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How to fill in this form? (JP Morgan)

Hi,

I want to transfer matured Sharesave shares out of JP Morgan Workplace solutions.

They have the following online form to fill in.

Are they asking for my name and address or the name/address of the bank/platform I want to transfer to? I contacted them a week ago via the online query form but still haven't received a response. I need to get this done within 90 days of me buying the shares and preferably before end of tax year.

Thank you.

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