2. Complete name and address of the new registration. Please use formal names and do not provide honorary or professional titles.
Please indicate if this is a:
a. Joint account (will be ”joint tenants with right of survivorship” unless otherwise indicated)
b. Trust - include name of trustee(s), title and date of trust
c. Custodian Account- 1. name of the minor and custodian
i. social security number of minor
ii. address of minor
iii. state under which the uniform transfer/gift to minors act was created
3. Total certificate shares which are being transferred. If you do not have any certificate shares write “none”.
4. Reinvestment Plan shares which are being transferred. If you are transferring all Reinvestment Plan shares write “all”. If you do not have any Reinvestment Plan shares write “none”.
5. Please fill in the name of the corporation that appears on your certificate or Reinvestment Plan Statement.
6. Current Registration of shares as it appears on the face of the certificate or Reinvestment Plan Statement.
7. List the certificate number(s) printed on the upper left hand side of the certificate(s) being surrendered. If all shares are held in your Reinvestment Plan write “none”.
8. Signature of current owner(s) signed exactly as name(s) appear(s) on the face of the certificate(s) or Reinvestment Plan Statement. Please note that the signature(s) must be guaranteed by an Eligible Guarantor Institution such as a Commercial Bank, Trust Company, Securities Broker /Dealer, Credit Union or Savings Association participating in a Medallion Program approved by the Securities Transfer Association, Inc. We cannot accept a notarized signature in lieu of this guarantee.