Gifts Of Publicly Listed Securities Share Transfer Form

Gifts of Publicly Listed

Securities Share Transfer Form

Donor

Name:

_____________________________________________________________________________________________

Address

: ___________________________________________________________________________________________

City, Province

Postal Code

: _____________________________________________________

: ____________________

Daytime Phone Number

E-mail

: __________________________

: ___________________________________________

Donor’s Account

Financial Institution

Account Number

: _____________________________________________

: ___________________

Name of Financial Advisor

Contact Phone Number

: _______________________________

: _____________________

Donation

Name of Security

Quantity

: __________________________________

: _________ CUSIP/ISN: __________________

Name of Security

Quantity

: __________________________________

: _________ CUSIP/ISN: __________________

Allocation of Donation (optional

): _____________________________________________________________________

I understand that I will receive a gift-in-kind tax receipt for these securities from TLC – The Land Conservancy for the

closing price on the date these securities are received in the charity’s account. These securities have been donated to

TLC – The Land Conservancy without restriction and can be sold by the charity at their discretion.

Signature of Donor

Date

TLC – The Land Conservancy

Receiving Firm:

Raymond James Ltd.

Dealer/Rep #: 9485/P340

FINS: T089

DTC #: 5076

CUID: MSLW

EURO CLEAR #: 91770

Account Number:

2K7-540A-0

Name of Account:

TLC – The Land Conservancy

Charitable Registration Number:

88902 8338 RR0001

A checklist for your reference:



Please call TLC – The Land Conservancy prior to initiating the transfer of securities, to ensure that your

gift is handled smoothly and efficiently. (250) 479-8053



Notify your financial advisor of your intention to make a gift of securities.



Give your financial advisor authorization to initiate the transfer on your behalf. This form, completed and

signed, should be sufficient for authorization.



Fax a copy of this signed form to Frank Arnold at Raymond James Ltd. Fax # (250) 405-2499

If you have any questions please call Frank’s assistant, Christine Edwards at (250) 405-2420.

Thank you for your generous support of TLC – The Land Conservancy!

TLC – The Land Conservancy

Phone: (250) 479-8053

Fax: (205) 744-2251

PO Box 50054 RPO Fairfield Plaza, Victoria, BC V8S 5L8

Email:

mhawkins@conservancy.bc.ca

*Form revised December 2014

Gifts Of Publicly Listed Securities Share Transfer Form -

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