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CURRENT HOLDER INFORMATION
Shares to be Transferred
See the following Frequently Asked Questions (FAQs) section for more
information about number and type of shares. All shares transferred will be
in book-entry form unless otherwise requested in writing.
Enter date of death as recorded on the death certificate.
Enter a daytime telephone number where you can be reached should we
have any questions regarding this transfer request.
Check this box only if you wish to transfer all of the shares in the decedent’s
account. These shares include Direct Registration System (DRS) and
investment plan shares held in book-entry form, as well as any certificates
submitted. If this box is checked, do not complete sections 4, 5 and 6.
Enter the number of DRS book-entry shares you wish to transfer.
Enter the number of certificated shares you wish to transfer. IMPORTANT:
In order to transfer certificated shares, you must submit the original
certificates with this form. If the number of shares to transfer is less than the
number of shares on the certificate, the balance will be put into DRS book-
entry form in the name of the current holder and a statement will be mailed.
Enter the number of investment plan book-entry shares you wish to transfer.
If you would like to transfer all of the decedent’s investment plan shares,
you must enter the exact number of shares the decedent held including any
partial share amount.
Check Replacements: Check this box with an ‘X’ to replace any checks that
may be outstanding on the account (please see FAQ for details). Reissued
checks will be made payable as originally issued. Not all accounts will have
outstanding checks but Computershare will review and replace if applicable.
Checks are sent to the address of record for the original account.
Authorized Signatures – This section must be completed
for your
transfer to be executed.
After reviewing the form to ensure that all information provided is correct,
please sign and date the form in the appropriate boxes. Please note, if you
are signing on behalf of the current registered holder you must indicate your
capacity (e.g. John Smith, Executor).
Signature(s) must be stamped with a Medallion Signature Guarantee
from a qualified financial institution, such as a commercial bank, savings
bank, savings and loan, US stockbroker and securities dealer, or credit
union that is participating in an approved Medallion Signature Guarantee
Program. The guarantor institution should verify the medallion stamp is
sufficient to cover the value of assets being transacted upon. A Notary Seal
is NOT acceptable.
NEW HOLDER/RECIPIENT INFORMATION
If you are transferring to multiple new holders, feel free to photocopy the
“New Holder/Recipient” page of the form prior to completion. This page
must be completed for each new holder. Please be sure to clearly note the
top of each page with the number of shares (not a percentage) to be
transferred to each recipient.
Account Type – Mark only one box with an “X” indicating the type of
account into which you are transferring shares. Complete additional
sections as indicated.
Definitions of Account Types:
■ An individual registration, e.g. John T. Smith, is used if there is only one
account holder. There is only one individual listed on the account.
■A joint tenant registration with right of survivorship, e.g. John T. Smith and
Jane T. Doe JT TEN, is used if there are two or more equal holders listed
on the account. Please note, the registration must read “and.” The word “or”
cannot appear in the registration. In the event of the death of one of the
listed holders, the securities in the account become the property of the
surviving joint holder.
■Atrust registration, e.g. John T. Smith and Jane T. Doe TR UA 4-3-66
Smith Family Trust, is used to allow the appointed trustees to handle the
securities. All acting trustees are listed on the account, which also names
the legal name and date of the trust agreement. To register shares under a
trust, a legal trust agreement must exist.
■A custodial with minor registration is only valid for a US citizen under the
Uniform Gifts to Minors Act (UGMA) or Uniform Transfer to Minors Act
(UTMA) of the state of the donor, the state of the custodian or the state of
the minor, e.g. John Doe Custodian for Jonathan Doe UTMA NY, is used if
the securities are held by a custodian on behalf of a minor. The named
custodian is given the legal authority to act on the account on behalf of the
minor, until the minor reaches the age of majority under the applicable
state’s law. The Social Security number associated with the account is that
of the minor. A US citizen living abroad needs to indicate the applicable state.
■ An estate registration, e.g. John Smith Executor for the Jane Doe Estate, is
used to allow a court-appointed legal representative to act on the account.
The account is registered in the decedent’s estate.
■ Other common registrations include community property, Limited Liability
Company (LLC), nominee, partnership, tenants by entireties and
unincorporated association.
If the new holder already owns stock in the company under the exact
account name being requested, transfer the shares to the existing account
by entering the new holder’s 11-digit Computershare account number, which
starts with a “C”.
Enter the new holder’s name (first, middle initial, last) if the account type is
individual, custodial, trustee, executor or other.
Enter the name (first, middle initial, last) of the second new holder on the
account if the account type is joint, minor, co-trustee or other (if applicable).
Enter the name of the trust or estate (if applicable).
If a trust is entered in section 9D, enter the date of the trust. Leave this
section blank if the new account is for an estate or another type of account.
Enter the street address or PO Box for the new holder whose name was
entered in section 9A. If applicable, enter apartment or unit number.
Enter the new holder’s city or town.
Enter the new holder’s state or province.
Enter the new holder’s postal code.
Enter the new holder’s country.
Enter Purpose for Transfer/Cost Basis Data instructions for shares
acquired after 12/31/2010. Please check off the applicable purpose of the
transfer. If this section is not fully completed, all transfers will be treated as
Gifts, unless we receive documentation that this is a decedent transfer (i.e.
Affidavit of Domicile) in which case the transfer will be treated as an
inheritance. We recommend that you consult with your tax advisor regarding
the tax implications for each type of transfer.
■ Private Sale: Include the Date of Sale and the Cost Per Share.
■ Gift: Include the Date of Gift was received or the gift date will default to
the date that the transfer is processed.
■ Inheritance: Include the Date of Death and Cost per Share or it will
default to the date that the transfer is processed.
■ No Change of Ownership: Change of name in cases of marriage or
divorce, minor coming of age, addition of spouse to registration, etc.
Existing cost basis of shares will be carried over to the new account.
How to Complete the Transfer Request Form
SEE FAQs FOR MORE INFORMATION
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