ELECTRONIC SECURITIES TRANSFER FORM This Stock Transfer Form is to be completed by the Donor or the Donor’s representative, and serves as authorization and instruction to transfer specified securities to the University of New Brunswick. This completed form should be faxed or e-mailed to both of the individuals identified below. UNB RBC DS Account Number: 284-00598-1-6 Security Name: Donor’s Name: Donor’s Account Number: CUSIP Number: Number of Shares: Name of Transfer Agent: Transfer Agent’s DTC Number: Name of Transfer Agent’s Contact Person & Telephone Number: Note: RBC Dominion Securities DTC Number: UNB’s FINS Number: Send to: RBC Dominion Securities contact person: François LeBlanc RBC Dominion Securities P.O. Box 251, Fredericton, NB E3B 4Y9 Phone: 1-506-459-6927 Fax: 1-506-459-2725 E-mail:
[email protected]
5002 T002 Also send a copy to: UNB contact person: Peter Coates University of New Brunswick P.O. Box 4400, Fredericton, NB E3B 5A3 Phone: 1-506-452-6305 E-mail:
[email protected]
Please arrange to process this transaction immediately. This is my authorization to transfer the above securities from my account into the name and account of the University of New Brunswick. UNB will issue a tax receipt on the value at the close of business on the day securities are received. Please forward a receipt in the name of: Title
First Name
Initial
Last Name
Address City
Province/State
Phone (Home)
Email
Signature (if required by broker) Charitable Registration Numbers:
Postal/Zip Code
Country
I would like to receive my tax receipt electronically at this email. Date
Canadian No. 10816 2025 RR0001
United States No. 23-710-3810