Form 542667 - Stock Or Bond Power
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Clear
Stock or Bond Power
Sub Firm #
BR Code
FA Code
Account Number
(Office Use Only)
IMPORTANT: READ CAREFULLY – The signature(s) to this power must correspond with the name(s) as written upon the face of the
certificate(s) or bond(s). If the signature does not match the registration on the face of the certificate, the signer must disclose their
capacity in which they are signing.
FOR Deposit into street name, the undersigned does (do) hereby sell, assign, and transfer:
Stock Description:
________________________________________________________________________________
If Stock,
Class:
Number of Shares:
(Common, PFD, Class A) ____________________
_______________________________
Complete
This Portion.
Certificate No(s):
_________________________________________________________________________________
Inclusive standing in the name of the undersigned on the books of said Company.
OR
Bond Description:
________________________________________________________________________________
If Bonds,
Complete
Principal Amount $
, Certificate No(s):
___________________________
________________________________
This Portion.
Inclusive standing in the name of the undersigned on the books of said Company.
CLIENT AUTHORIZATION AND CAPACITY IS REQUIRED IF NOT SIGNED BY CURRENT REGISTERED OWNER
•
The undersigned does (do) hereby irrevocably constitute and appoint our clearing agent, First Clearing, LLC attorney to transfer
the said stocks or bond(s), as the case may be, on the books of said Company, with the full power of substitution in the premises.
•
Capacity must be typed or written.
Signature of current owner and Capacity, if applicable
Print Name
Date
X
Capacity, (examples: Executor, Trustee, Survivor, Custodian, Heir)
Signature of current owner and Capacity, if applicable
Print Name
Date
X
Capacity, (examples: Executor, Trustee, Survivor, Custodian, Heir)
Return Original Completed Documents to Physical Processing at H0006-092.
Office Use Only - Client Identification/Signature Validation
Signature Guarantee
(Check one of the four Validation Options)
1.
Client Personally Known to Me
2.
Validated Government-Issued Photo ID (when client is present)
3.
Compared signature to imaged documents.
4. Verbally confirmed two of the following (when client is not present):
Social Security Number or Tax Identification Number
Date of Birth
Home Telephone Number
Recent Account Activity
I certify that I validated the client's identity and/or signature via the
method indicated above. I further certify that the client has the
authority to execute the transaction.
Name (Print)
Signature
Date
X
Investment and Insurance Products:
Not Insured by FDIC or any Federal Government Agency
May Lose Value
Not a Deposit of or Guaranteed by a Bank or any Bank Affiliate
Wells Fargo Advisors, LLC is a registered broker-dealer and separate non-bank affiliate of Wells Fargo & Company.
542667 (Rev 13 – 06/15)
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Parent category: Legal