Pledgee Agreement Form
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2Pledgee Agreement Form
To: Federal Reserve Bank of Boston
Tel: 800-327-0147, Option #4
600 Atlantic Avenue
Fax: 877-973-8972
Boston, MA 02210
Attn: Wholesale Operations/Joint Custody
Date:_______________
We, the __________________________________ agree to the terms of Appendix C of your Operating Circular 7,
dated August 19, 2005, as it may be amended from time to time with respect to the account on your books designated
__________________. (4 digit alpha-numeric account number)
We further agree that you may accept par for par substitutions: securities from the Pledgor as a replacement of, or in
substitution for, those securities presently held (please check one):
NO (Instructions required for
YES (Standing approval)
each withdrawal)
Provided that the replacement or substitution does not reduce the aggregate par amount of securities held in custody for us.
(See Operating Circular 7, Appendix C, Section 4.3.)
We authorize you to use the following call-back procedure for securities transactions pertaining to this account (please
check one):
Three-party call-back
Four-party call-back
We certify that the individuals listed below may take authoritative action on our behalf with respect to the account,
including a direction to release collateral from the account. You may rely on the authority of these individuals with respect to
the account until we otherwise notify you.
Telephone: ___________________________
Print Name:________________________________Title:___________
Fax:
__________________________
Signature: ________________________________Date: ____________
Telephone: ___________________________
Print Name: _______________________________Title:_________________
Fax:
___________________________
Signature: _________________________________Date: ______________
Telephone: ____________________________
Print Name: ______________________________Title:______________
Fax:
____________________________
Signature: _______________________________Date:______________
REV 01/2006
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