Instructions For Gifting Shares Page 3

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D o d g e
D o d g e
C o x F u n d s
C o x F u n d s
&
&
®
®
Print
(Do not use for an IRA)
Clear Form
PART 3
CURRENT ACCOUNT
OWNER’S SIGNATURE
/
/
AUTHENTICATION
Signature
Date
Print Name
/
/
Signature
Date
Print Name
Medallion Signature Guarantee
NOTE: A medallion signature guarantee may be obtained from a domestic bank or trust company, broker, dealer, clearing agency, savings association,
or other financial institution which participates in a Medallion program recognized by the Securities Transfer Association. Signature guarantees from
financial institutions which do not participate in a Medallion program will not be accepted. A notary public cannot provide signature guarantees.
PART 4
I acknowledge that if (i) my Dodge & Cox Funds account uses the Average Cost basis method and (ii) the
RECIPIENT’S
shares were transferred while in a loss position, Dodge & Cox Funds will use the fair market value on the
CERTIFICATION
date the gift transfer is processed as the basis for the transferred shares. For shares transferred while in a gain
AND SIGNATURE
position, Dodge & Cox Funds will use the donor’s cost basis for the transferred shares, if known.
/
/
Signature of Recipient
Date
2 of 2
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