Irrevocable Stock Or Bond Power Form
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1Internal Acct ID: _____________________
External Acct #: _____________________
IRREVOCABLE STOCK OR BOND POWER
Complete this form to make a certificate negotiable when the back of the certificate has not been
signed.
I. ASSIGNMENT
For value received, the undersigned does (do) hereby sell, assign, and transfer to Pershing LLC:
STOCKS (For stocks, complete this section)
shares of
stock of
(Number of Shares)
(Common, Preferred, or Other)
(Name of Company)
represented by
inclusive, standing in the name of the
(Certificate Number(s))
undersigned on the books of said Company.
BONDS (For bonds, complete this section)
bonds of
in the principal amount of $
(Number of Bonds)
(Name of Company)
represented by
inclusive, standing in the name of the
(Certificate Number(s))
undersigned on the books of said Company.
II. AUTHORIZATION AND SIGNATURE
The undersigned does (do) hereby irrevocably constitute and appoint Pershing LLC attorney to transfer the said stock or
bond(s), as the case may be, on the books of said Company, with full power of substitution in the premises.
Person(s) executing this power must sign here:
SIGNATURE:
DATE:
SIGNATURE:
DATE:
III. CERTIFICATION (Important—read carefully)
Signatures(s) must correspond with the name(s) as written upon the face of the certificate(s) or bond(s) in every
particular without alteration or enlargement or any change whatever. A signature guarantee must be made by an
authorized medallion signature guarantor.
SIGNATURE GUARANTEED BY:
Pershing LLC, a subsidiary of The Bank of New York Mellon Corporation
PAGE 1 OF 1
Member FINRA, NYSE, SIPC
FRM-SBPWR-11-07
INV0313
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