Letter Of Direction To Gift Securities Form printable pdf download

Letter Of Direction To Gift Securities Form

Letter of Direction to Gift Securities

Name of Your Broker

Broker’s Title

Broker Company Name

Broker Address

City, Province, Postal Code

Broker’s Phone / Broker’s Fax

Broker’s Email

Date

Dear Broker:

This letter will authorize you to transfer securities as a donation to the Queensway Carleton Hospital

Foundation (Charitable Business #13725 3571 RR0001). To my knowledge, these shares are not subject to

restrictions on their sale or disposition and I am not aware of any material undisclosed information concerning

the shares.

Please transfer the shares…

From my account #

To RBC Dominion Securities account # 508-01043-1-7 (CUID # DOMA / FINS # T002 / DTC # 5002)

On this date

Securities to be donated

Company name or description

Stock symbol or CUSIP #

Number of shares

or shares to value approximately $

My current address and contact information is…

Name

Address

City

Prov

Postal Code

Home Phone

Work Phone

Cell Phone

Fax

_____________________________________

Signature of Donor

Prior to making the transfer, please FAX a completed copy of this form to:

David Houghton, Client Transfer Services, RBC Dominion Securities, FAX 613-721-4680

303 Moodie Drive, 5

Floor, Ottawa / Phone 613-721-8237 / Email

and to

Judith Scott, Queensway Carleton Hospital Foundation, FAX 613-721-4755

Letter Of Direction To Gift Securities Form