Securities Transfer Form - Friends of the Earth Canada

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Donation of Publicly Traded Securities – Transfer Form Charitable Registration Number: 11893 3001 RR0001 We are delighted that you have chosen to make a donation of securities to Friends of the Earth! To initiate the transfer of securities to Friends of the Earth (FOE), please complete this form and send a copy to your broker. It is important that you send a copy to us as well so we can track your donation and issue a receipt for income tax purposes. Please send a copy of this form to FOE, either by email: [email protected], Fax (613) 566-3449 Attention: Friends of the Earth or by mail to the address below. PLEASE NOTE: If you plan to donate securities that are thinly traded, highly volatile, or not easily liquidated, please call Beatrice Olivastri, CEO at 1-888-385-4444 BEFORE initiating a transfer. A. Donor Information First name

Last name

Address City

Prov.

Telephone

Fax

Postal Code

Email

B. Information about your Broker and Securities C. Broker’s Name

Financial Institution

Broker’s Telephone Securities description CUSIP #

Broker’s Email Market Symbol # of Shares to Transfer Donor’s Account #

Account Name

I, hereby give authority to deliver free the following securities to RBC Direct Investing Inc (FINS T002, DTC 5002, CUID – DOMA; for mutual funds: Dealer # 9190) and to credit the Friends of the Earth Account # 689-79823-1-7. I understand that Friends of the Earth’s policy is to sell the publicly traded securities the same day they are received in the Friends of the Earth’s account. I will receive a charitable receipt for the fair market value of the securities on the date they are received into the Friends of the Earth account. Donor’s signature (Required)

Day/Month/Year

Friends of the Earth | 200-251 Bank Street, Ottawa, ON K2P 1X3 Tel: (613) 241-0085 | Toll Free: 1-888-385-4444 | Fax: (613) 566-3449 [email protected] | www.foecanada.org

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Securities Transfer Form - Friends of the Earth Canada

Donation of Publicly Traded Securities – Transfer Form Charitable Registration Number: 11893 3001 RR0001 We are delighted that you have chosen to make...

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