CKUA Radio Foundation 9804 Jasper Ave Edmonton, AB T5J 0C5 Fax: 780-428-7624 Phone: 1-800-494-2582
CKUA SECURITIES TRANSFER FORM To My Broker: ____________________________________________________
Donor’s Brokerage Firm (Transferring Institution)
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Address of Transferring Institution
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Donor’s Advisor/Contact at Transferring Institution
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Name and Phone Number
My Information: ____________________________________________
Name of Donor/ Transferor
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Residential Address of Transferor
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Account No. of Donor at Transferring Institution
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Name and Phone Number
You are hereby authorized and directed to transfer in kind the following securities from the above noted account to the address and the account number noted below.
Security Description
CUSIP/ISIN/SEDOL#
# of Shares/Units
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To my knowledge these shares are freely tradable and not subject to restrictions on their sale or disposition.
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Signature of Transferor/Donor
Date
Credit Account Number: 11-WZH4A CKUA Radio Foundation Donor/Transferor Fax this completed form to: Your broker (your broker may require the original of this form.) CKUA’s broker: Jane Alm, Investment Advisor National Bank Financial (CUID #NBCS) Fax: (780) 423-4882 Tel: (780) 412-6646 AND to CKUA Finance Department, Attn: Mary Phillips-Rickey, Director Finance & Administration Fax: (780) 428-7624 Or Email:
[email protected] Your generosity can inspire others. May CKUA recognize your gift online, in print or on-air? Yes No If yes, please print your name as you would like it to appear: __________________________________
For more information, please contact: Natalie O’Toole, Director of Development Thank You for your Gift of Music!
[email protected]
780-428-2030