Computershare Transfer Request PDF Details

The Computershare Transfer Request form serves as a critical document for shareholders looking to transfer their stock holdings, whether due to sale, gifting, inheritance, or changing the type of registration such as from individual to joint tenancy. This form meticulously captures important information, starting from the current account holder details to the specific intent behind the transfer, underlining its significance in managing the movement of stock ownership. For Current Account Type, the form distinguishes between Non-Custodial and Custodial Registrations, requiring detailed input about the account holder or custodian, respectively. A noteworthy aspect of the form is its section on the Cost Basis/Reason for Transfer which stresses the need for clarity in the purpose of transfer, as this has implications for how the transfer is treated tax-wise. Shareholders must indicate whether the transfer is a private sale, gift, inheritance, or other, with further details such as sale price or value per share required for specific types. The process necessitates the authorization of current registered holders or their legal representatives, underscored by the mandatory Medallion Signature Guarantee to validate the signatures. Additionally, the form guides the transferor through specifying the new account type and holder information, ensuring a seamless transition of share ownership. This level of detail highlights the form’s comprehensive approach in facilitating stock transfers, securing both the transferor’s and transferee’s interests while complying with regulatory requirements.

QuestionAnswer
Form NameComputershare Transfer Request
Form Length9 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min 15 sec
Other namestransfer my stock form, request computershare, computershare forms, computershare request

Form Preview Example

.Reset Form

Name of Current Account Holder

Joint Tenant

Address

City, State, Zip

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Computershare

PO Box 505013

Louisville, KY 40233-5013

www.computershare.com/investor

Current Holder Account Number

Company Name

Transfer Request

PLEASE PRINT CLEARLY

1. CURRENT ACCOUNT TYPE (account you are transferring shares out of)

Non-Custodial Registrations - complete section 2 below

OR

Custodial Registrations - Custodian to complete section 3 (reverse page)

2. NON-CUSTODIAL REGISTRATIONS

Current Holder Information (as it appears on your account statement)

Current Tax ID / SSN on Account (do not use hyphens)Telephone Number (do not use hyphens)

Name(s) / Registration on Current Account (include ALL names/entities listed on account)

Current Street Address

City

Apt. / Unit Number

State

Zip Code

E 4 0 8 U T R

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02SY3A_WEB

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3.CUSTODIAL REGISTRATIONS Current Custodian Information

The Custodian registered to the current account (that you are transferring shares out of) must provide and/or verify the following information:

Name of Custodian

Name(s) / Registration on Current Account (include ALL names/entities listed on account)

Current Street Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Apt. / Unit Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

Custodian Account Number/Investor ID at Custodian

 

Custodian Taxpayer ID Number (do not use hyphens)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State

Zip Code

Custodian Telephone Number (do not use hyphens)

 

 

 

Ext.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. COST BASIS/REASON FOR TRANSFER

Please check off the applicable purpose of the transfer for shares acquired after 12/31/10. If this section is not fully completed, all transfers will be treated as Gifts, unless we receive documentation that this is a decedent transfer (i.e. Affidavit of Domicile) in which case the transfer will be treated as an inheritance. We recommend that you consult with your tax advisor regarding the tax implications for each type of transfer. Please check ONLY ONE box. If you check more than one box your transfer will be treated as if you had not made any selection.

Private Sale

 

Date of Sale:

(If Private Sale)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cost Per Share:

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

US Dollars

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gift

 

Date of Gift:

Inheritance

Date of Death:

(If blank we will default to the effective date of the transfer.)

No Change of Ownership (please specify)

(If Inheritance) Value Per Share:

.

US Dollars

E 4 0 9 U T R

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02SY3A_WEB

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5. SHARE TRANSFER

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A. Transfer All Securities

OR

B. Transfer Shares As Instructed Below

If box B is checked, complete the Security Description/Share Type details below.

Security Description / Share Type (ex: Common, Preferred, etc)

Transfer All

Enter number of whole and / or fractional shares to transfer, if applicable

or

or

or

or

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6. AUTHORIZED SIGNATURES

The undersigned does (do) hereby irrevocably constitute and appoint Computershare as attorney to transfer the said stock, as the case may be, on the books of said Company, with full power of substitution in the premises.

The signature(s) below on this Transfer Request form must correspond exactly with the name(s) as shown upon the face of the stock certificate or a Computershare-issued statement for book-entry shares, without alteration or enlargement or any change whatever. The below must be signed by all current registered holders, or a legally authorized representative with indication of his or her capacity next to the signature.

NOTE: Signature(s) must be stamped with a Medallion Signature Guarantee by a qualified financial institution, such as a commercial bank, savings bank, savings and loan, US stockbroker and security dealer, or credit union, that is participating in an approved Medallion Signature Guarantee Program (A NOTARY SEAL IS NOT ACCEPTABLE).

Required ►Medallion Guarantee Stamp

All Current Holder(s) or Legal Rep(s) (Notary Seal Is Not Acceptable)

Date (mm / dd / yyyy)

Signature of all Current Holders or Legal Representative(s)

Required ►Medallion Guarantee Stamp

Current Custodian (Notary Seal Is Not Acceptable)

Required ►Medallion Guarantee Stamp

All Current Holder(s) or Legal Rep(s) - Continued (Notary Seal Is Not Acceptable)

Date (mm / dd / yyyy)

Signature of Current Custodian

Date (mm / dd / yyyy)

Signature of Additional Current Holder(s) or Legal Representative(s)

E 4 1 0 U T R

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02T1GA_WEB

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7. NEW ACCOUNT TYPE (account you are transferring shares to)

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Non-Custodial Registrations - complete section 8 OR

 

Custodial Registrations - Custodian to complete section 9 (reverse page)

 

 

 

 

 

 

 

 

8.New Account Type (account you are transferring shares to): Non-Custodial Registration A. New Non-Custodial Registration Type

Individual

Joint Tenants with Right of Survivorship

Community Property

Tenants in Common

Corporation

Custodial for Minors Act – State of:

B. New Holder Information

New Holder’s Existing Account Number (if applicable)

Name of Individual / Entity / Trustee / Executor / Other

Estate – Include Executor Name, Provide Estate EIN on Form W-9

Qualified Pension Plan (Non-custodial)

Trust – Include Trustee Names, Trust Name, and Trust

Agreement Date below.

Transfer on Death (“TOD”) – Note: Only 1 TOD beneficiary may be registered per account. List the TOD beneficiary name below.

Other (Specify)

Name of Joint Holder / Minor / Co-Trustee / TOD Beneficiary / Other (if applicable)

Trust / Estate Name (if applicable)

Trust / Estate Name - continued

Current Street Address

City

E-mail Address

Trust Agreement Date (mm / dd / yyyy) (if applicable)

Apt. / Unit Number

State

Zip Code

E 4 1 1 U T R

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02T1GA_WEB

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9.New Account Type (account you are transferring shares to): Custodial Registrations A. New Custodial Registration Type

Traditional IRA

Roth IRA

KEOGH Plan

B. New Custodial Information

Simplified Employee Pension/Trust (SEP)

Pension/Profit Sharing Plan

Other (Specify)

Name of Custodian

Beneficial Holder for New Account (include ALL names/entities listed on account)

Current Street Address

 

Apt. / Unit Number

City

State

Zip Code

Custodian E-mail Address

 

 

Custodian Account Number / Investor ID at Custodian

 

 

Custodian Telephone Number (do not use hyphens)

 

 

 

Ext.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of New Custodian

NOTE: Signature(s) must be stamped with a Medallion Signature Guarantee by a qualified financial institution, such as a commercial bank, savings bank, savings and loan, US stockbroker and security dealer, or credit union, that is participating in an approved Medallion Signature Guarantee Program (A NOTARY SEAL IS NOT ACCEPTABLE).

Required ►Medallion Guarantee Stamp

New Custodian (Notary Seal Is Not Acceptable)

Date (mm / dd / yyyy)

E 4 1 2 U T R

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02T1GA_WEB

How to Edit Computershare Transfer Request Online for Free

Our PDF editor was built to be as straightforward as it can be. While you comply with these actions, the process of preparing the transfer my stock form document is going to be straightforward.

Step 1: At first, choose the orange "Get form now" button.

Step 2: When you enter the transfer my stock form editing page, you'll see lots of the options you can take with regards to your file within the top menu.

In order to complete the document, provide the data the program will require you to for each of the following segments:

computershare request blanks to consider

Indicate the information in CURRENT ACCOUNT TYPE account you, NonCustodial Registrations, Custodial Registrations Custodian, NONCUSTODIAL REGISTRATIONS, Current Holder Information as it, Telephone Number do not use hyphens, Names Registration on Current, Current Street Address, and Apt Unit Number.

Finishing computershare request part 2

You should be asked for some valuable details so you can complete the City, State, Zip Code, E U T R, and SYAWEB part.

Filling out computershare request part 3

The The Custodian registered to the, Names Registration on Current, Current Street Address, City, Apt Unit Number, State, Zip Code, Custodian Account NumberInvestor, Custodian Taxpayer ID Number do, Custodian Telephone Number do not, and Ext field has to be applied to write down the rights or responsibilities of both parties.

Filling out computershare request step 4

Finalize by checking all of these sections and filling out the pertinent information: COST BASISREASON FOR TRANSFER, Please check off the applicable, Private Sale, Date of Sale, Gift, Date of Gift, Inheritance, Date of Death, If blank we will default to the, If Private Sale Cost Per Share US, and If Inheritance Value Per Share US.

Completing computershare request step 5

Step 3: As you press the Done button, your ready document can be easily transferred to each of your devices or to email indicated by you.

Step 4: Generate duplicates of the document - it may help you keep clear of possible issues. And don't be concerned - we are not meant to display or watch your data.

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