Stock Donation Instructions Page 2
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3PFIZER UNITED WAY CAMPAIGN
STOCK TRANSFER VERIFICATION FORM
SECTION I (to be completed by retiree donor)
Donor Name: _____________________________________________________
Donation of:
_____________
Pfizer Common Stock
(check one)
_____________
Other Stock (Identify)
---------------------------------------------------------------------------------------------------------
SECTION II (to be completed by stock transfer agent - Private Broker / Brokerage Firm)
Total Number of Shares Transferred:
___________________
Total Dollar Value of Transfer:
$ ___________________
Date Transfer Completed:
___________ / ____________ / ___________
Verification Signature: __________________________________________
Date:
____________ / _____________ / ______________
Please return completed form to:
Pfizer United Way Campaign Processing
Center
P.O. Box 2072
Princeton, NJ 08543
Fax: 609-799-8019
Note: Form must be returned in order to receive a match.
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