Computershare Transfer Request – Fill Out and Use This PDF

The Computershare Transfer Request form is a crucial document for individuals or entities looking to transfer ownership of their shares. It meticulously outlines the requirements for both non-custodial and custodial registrations, detailing necessary information from current account holders to new registration types. For those ready to make a transfer, click the button below to ensure your shares are transferred seamlessly.

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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.

Question	Answer
Form Name	Computershare Transfer Request
Form Length	9 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	2 min 15 sec
Other names	transfer 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

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

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

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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

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5. SHARE TRANSFER

A. Transfer All Securities

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

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)

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

	Non-Custodial Registrations - complete section 8 OR		Custodial Registrations - Custodian to complete section 9 (reverse page)
	Non-Custodial Registrations - complete section 8 OR

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

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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

Required ►Medallion Guarantee Stamp

New Custodian (Notary Seal Is Not Acceptable)

Date (mm / dd / yyyy)

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10. Distribution for new account

Bank Routing Number – this is a nine-digit number.

Bank Account Number – account numbers vary in length and must not include check numbers.

DO NOT USE YOUR CREDIT CARD NUMBER. If you are unsure of your Bank Routing Number or Bank Account Number, please check with your financial institution. Please DO NOT provide a check number in the fields above. This is commonly listed with your Account and Bank Routing Numbers on your check.

Checking Account

Savings Account

Name(s) that appear on the account at your financial institution

Name of Financial Institution

I/We hereby authorize Computershare as disbursing agent for the payer, to initiate credit entries to my (our) account; or if necessary debit entries or adjustments for any credit entries in error. This authority is to remain in effect until my (our) written authorization to terminate electronic funds transfer is received in time to afford Computershare reasonable opportunity to act on it or until this service is terminated by the payer or Computershare. All registered holders as well as all individuals listed on the financial account must sign below.

Signature 1 - Please keep signature within the box.

Signature 2 - Please keep signature within the box.

Date (mm / dd / yyyy)

Telephone Number (do not use hyphens)

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11.FINANCIAL ADVISOR / FINANCIAL INSTITUTION INFORMATION

A. Financial Advisor Information

Financial Advisor Name

Financial Advisor CRD Number

Telephone Number (do not use hyphens)

Ext.

Financial Advisor E-mail Address

Financial Advisor Street Address/PO Box

City

B. Financial Institution Information

Financial Institution Name

State

Zip Code

Financial Institution CRD Number

Telephone Number (do not use hyphens)

Ext.

Financial Institution Street Address/PO Box

City

State

Zip Code

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12.Form W-9

A.Taxpayer Identification Number (TIN)

Enter the TIN for the new Holder or new Custodian in the appropriate box. For individuals, this is your Social Security number (SSN).

For other entities, it is your Employer Identification Number (EIN). For joint tenant accounts, the TIN provided must belong to the first owner on the registration to avoid backup withholding. COMPLETE ONLY ONE BOX.

Social Security Number (do not use hyphens)

Employer Identification Number (do not use hyphens)

B. Federal Tax Classification

Check appropriate box (required); check only ONE of the following boxes:

Individual / Sole

Trust /

Proprietor or Single-

C Corporation

S Corporation

Partnership

Estate

Member LLC

Note: For a single-member LLC that is disregarded, check the appropriate box above for the tax classification of the single-member owner.

C. Exempt Payee Code (if any)

If you are exempt from backup withholding, enter in the Exemptions box, any code that may apply to you.

See Exempt payee codes on the back of this form.

Limited Liability Company

Other Classification

If you are an LLC or Other Classification, do not complete this form. You must complete an IRS Form W-9. This form can be found on the IRS website at www.irs.gov. See “Limited Liability Company or Other Classification” on the back of this form for more information.

Exemption from FATCA reporting code (if any)

Not Applicable

(Applies to accounts maintained outside the U.S.)

D. Certification

Under penalties of perjury, I certify that:

1.The number shown on this form is my correct Taxpayer Identification Number, and

2.I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and

3.I am a U.S. citizen or other U.S. person (defined on reverse).

4.The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct (defined on reverse).

Certification Instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.

This form must be signed and dated for us to accept as proper certification. Send form to Computershare. Do not send to the IRS.

Signature - Please keep signature within the box.

Date (mm / dd / yyyy)

Telephone Number (do not use hyphens)

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How to complete this form

Backup Withholding

The Internal Revenue Service (IRS) requires us to withhold taxes for the applicable rate of backup withholding for U.S. persons without a W-9 tax certification who are not otherwise exempt. Parties acting as disbursement agents, such as Computershare, must withhold and pay to the IRS the applicable tax rate of such payments under certain conditions. This is called “backup withholding.” Payments that may be subject to backup withholding include interest, dividends, broker and barter exchange transactions, and royalties. Supplying us with your correct Taxpayer Identification Number (TIN), and signing this form will generally allow you to receive your payments without being subject to backup withholding. Failure to supply your TIN, or supplying us with an incorrect TIN, could result in a $50.00 penalty being assessed by the IRS.

Receipt of a completed Form W-9 will discontinue backup withholding unless otherwise required.

What Name and Number To Give the Requester

	For this type of account:	Give name and SSN of:
1.	Individual	The individual
2.	Two or more individuals (joint account)	The actual owner of the account or, if
		combined funds, the first individual on
		the account
3.	Custodian account of a minor	The minor
	(Uniform Gift to Minors Act)
4.	a. The usual revocable savings	The grantor-trustee
	trust (grantor is also trustee)	The actual owner
	b. So-called trust account that is	The actual owner
	not a legal or valid trust under state
	law
5.	Sole proprietorship or disregarded	The owner
	entity owned by an individual
6.	Grantor trust filing under Optional	The grantor
	Form 1099 Filing Method 1
	(see Regulation section
	1.671-4(b)(2)(i)(A))

	For this type of account:	Give name and EIN of:
7.	Disregarded entity not owned by an	The owner
	individual
8.	A valid trust, estate, or pension trust	Legal entity
9.	Corporation or LLC electing	The corporation
	corporate status on Form 8832 or
	Form 2553
10.	Association, club, religious,	The organization
	charitable, educational, or other tax-
	exempt organization
11.	Partnership or multi-member LLC	The partnership
12.	A broker or registered nominee	The broker or nominee
13.	Account with the Department of	The public entity
	Agriculture in the name of a public
	entity (such as a state or local
	government, school district, or
	prison) that receives agricultural
	program payments
14.	Grantor trust filing under the Form	The trust
	1041 Filing Method or the Optional
	Form 1099 Filing Method 2 (see
	Regulation section
	1.671-4(b)(2)(i)(B))

Exempt payee code. Generally, individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends. Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions.

Note. If you are exempt from backup withholding, you should still complete this form to avoid possible erroneous backup withholding.

The following codes identify payees that are exempt from backup withholding:

1 -- An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2)

2 -- The United States or any of its agencies or instrumentalities

3 -- A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities

4 -- A foreign government or any of its political subdivisions, agencies, or instrumentalities 5 -- A corporation

6 -- A dealer in securities or commodities required to register in the United States, the District of Columbia, or a possession of the United States

7 -- A futures commission merchant registered with the Commodity Futures Trading Commission 8 -- A real estate investment trust

9 -- An entity registered at all times during the tax year under the Investment Company Act of 1940 10 -- A common trust fund operated by a bank under section 584(a)

11 -- A financial institution

12 -- A middleman known in the investment community as a nominee or custodian 13 -- A trust exempt from tax under section 664 or described in section 4947

Limited Liability Company or Other Classification

If you are a Limited Liability Company or Other entity, complete an IRS Form W-9 found on the IRS website www.irs.gov. Be sure to include the information required in the IRS instructions for a Limited Liability Company (LLC) or for Other entities on page 2. Return the completed form to the address below.

Definition of a U.S. Person. For federal tax purposes, you are considered a U.S. person if you are:

●An individual who is a U.S. citizen or U.S. resident alien,

●A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States,

●An estate (other than a foreign estate), or

●A domestic trust (as defined in Regulations Section 301.7701-7).

Exemption from FATCA reporting: If you are submitting this form for an account that is maintained in the United States, you are exempt from FATCA reporting.

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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.

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.

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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