Transfer Form. Use this form to transfer funds from your existing ESA to your NuView IRA. Please note that your existing ESA custodian may require a Medallion Guarantee Stamp, which is much like a notary seal. Check with your bank to obtain this stamp. OR Annual Contribution NuView IRA Processing Office 000 X. Xxxxxx Xxxxxx Blvd. Longwood, FL 32750 Contact Us Office: (000) 000-0000 Toll Free: (000) 000-0000 Fax: (000) 000-0000 Email: Xxxxxxxxx@XxXxxxXXX.xxx Web: XxXxxxXxxxx.xxx Discover a new world of investment options. Xxxxxxxxx Educational Savings Account Adoption Agreement 000 X. Xxxxxx Xxxxxx Blvd. Longwood, FL 32750 P: (000) 000-0000 | F: (000) 000-0000 E: xxxxxxxxx@xxxxxxxxx.xxx 1 DEPOSITOR INFORMATION Legal Name (Required) Mr. Ms. Mrs. Dr. Date of Birth (MM/DD/YYYY) Social Security Number Address City, State, Zip Primary Phone Mobile Phone Email Address 2 BENEFICIARIES Designated Beneficiary Name Social Security Number Relationship Date of Birth Share % Address City State Zip In the event of the Designated Beneficiary's death, the balance shall be paid to the Primary Beneficiaries who survive the Designated Beneficiary in equal shares (or the specified shares, if indicated). If the Primary or Contingent box is not checked, the beneficiary will be deemed to be a Primary Beneficiary. If an account owner does not designate an account beneficiary, the assets of the account will be transferred to the estate upon the account owner's death. Select Beneficiary Type: Primary Contingent Name Social Security Number Relationship Date of Birth Share % Address City State Zip Select Beneficiary Type: Primary Contingent Name Social Security Number Relationship Date of Birth Share % Address City State Zip 3 ACCOUNT FUNDING Initial Contribution Amount Date Contributed Regular Contribution for tax year: Rollover from another Xxxxxxxxx ESA Transfer from another Xxxxxxxxx ESA from: Military Death Gratuity/ SGLI Payments 4 RESPONSIBLE INDIVIDUAL INFORMATION Legal Name (Required) Mr. Ms. Mrs. Dr. Date of Birth (MM/DD/YYYY) Social Security Number Address City, State, Zip Primary Phone Mobile Phone Email Address The Responsible Individual shall shall not continue to serve as the Responsible Individual after the Designated Beneficiary attains the age of majority pursuant to section 5.02 of the Custodial Agreement. The Responsible Individual may may not change the beneficiary designated under this Custodial Agreement pursuant to section 6.01 of the Custodial Agreement. Note: The Responsibl...
Transfer Form. Use this form to transfer funds from your existing HSA to your NuView IRA. Please note that your existing HSA custodian may require a Medallion Guarantee Stamp, which is much like a notary seal. Check with your bank to obtain this stamp. OR Annual Contribution NuView IRA Processing Office 000 X. Xxxxxx Xxxxxx Blvd. Longwood, FL 32750 Contact Us Office: (000) 000-0000 Toll Free: (000) 000-0000 Fax: (000) 000-0000 Email: Xxxxxxxxx@XxXxxxXXX.xxx Web: XxXxxxXxxxx.xxx Discover a new world of investment options. Thank you for your interest in Self-Directing your IRA through NuView IRA, Inc. Please complete the sections below, sign and return with original signatures to our office. To initiate the account, we will need the original completed forms: IRA Account Application IRA Transfer or Direct Rollover Form (if transferring funds) Photocopy of your driver's license (Patriot Act requirement) For office use only: Account No.: Date Received: 1 PERSONAL INFORMATION Legal Name (Required) Mr. Ms. Mrs. Dr. Date of Birth (MM/DD/YYYY) Social Security Number Legal Address (Required) City, State, Zip Mailing Address (Optional) City, State, Zip Primary Phone Fax Mobile Email Address Marital Status Single Married (see Consent of Spouse) Widowed or Divorced Current/Most Recent Occupation (Required) Title 2 NOTIFICATIONS Would you like to receive your quarterly statements online? Yes (no charge) No ($10 annual fee) How did you hear about us? Referral name: Referred by: NuView Client Online via: Realtor CPA Attorney Advisor Other: 3 ACCOUNT TYPE Please select one: Traditional IRA SEP IRA (please attach employer plan documents) Employer Name: SIMPLE IRA (please attach employer plan documents) Employer Name: Xxxx XXX Beneficiary/Inherited IRA Check one: Trad Xxxx SEP SIMPLE ■ Health Savings Account Check one: Self-only coverage Family coverage Original XXX Xxxxxx Name: 4 ACCOUNT FUNDING Annual Contribution Year contribution for: Transfer Contribution Transfer from existing HSA or Employer Sponsored Plan. Rollover Contribution Take receipt of the assets for up to 60 days before reinvesting in a new retirement plan.
Transfer Form. TO: Aurora Cannabis Inc. (the “Company”) AND TO: COMPUTERSHARE TRUST COMPANY OF CANADA 000 Xxxxxxx Xxxxxx, 0xx Xxxxx Xxxxxxxxx, Xxxxxxx Xxxxxxxx X0X 0X0 FOR VALUE RECEIVED, the undersigned transferor hereby sells, assigns and transfers unto (Transferee) (Address) (Social Insurance Number) of the Warrants registered in the name of the undersigned transferor represented by the Warrant Certificate. DATED this day of , . Signature of Warrantholder (Transferor) Signature Guarantee Print name Address REASON FOR TRANSFER – for US residents only (where the individual(s) or corporation receiving the securities is a US resident). Please select only one (see instructions below). ☐ GIFT ☐ ESTATE ☐ PRIVATE SALE ☐ OTHER (OR NO CHANGE IN OWNERSHIP) DATE OF EVENT (DATE OF GIFT, DEATH OR SALE): VALUE PER WARRANT ON THE DATE OF EVENT: ☐ CAD OR ☐ USD CERTAIN REQUIREMENTS RELATING TO TRANSFERS – READ CAREFULLY The signature(s) of the transferor(s) must correspond with the name(s) as written upon the face of this certificate(s), in every particular, without alteration or enlargement, or any change whatsoever. All securityholders or a legally authorized representative must sign this form. The signature(s) on this form must be guaranteed in accordance with the transfer agent’s then current guidelines and requirements at the time of transfer. Notarized or witnessed signatures are not acceptable as guaranteed signatures. As at the time of closing, you may choose one of the following methods (although subject to change in accordance with industry practice and standards):
Transfer Form. (a) Player(s) Loaned to or Recalled from a minor league club shall receive a transfer form. In order to make said Loan or Recall effective, the Club must send a copy to the NHLPA and NHL, in accordance with Exhibit 3 hereto, prior to that Player playing in an NHL Game and, in all other circumstances, immediately.
Transfer Form. TO: Planet 13 Holdings Inc. c/o Odyssey Trust Company Suite 1000, 000 0xx Xxxxxx XX Calgary, Alberta T2P 3C4 FOR VALUE RECEIVED, the undersigned transferor hereby sells, assigns and transfers unto (Transferee) (Address) (Social Insurance Number) of the Warrants registered in the name of the undersigned transferor represented by the Warrant Certificate. In the case of a Warrant Certificate that contains a U.S. restrictive legend, the undersigned hereby represents, warrants and certifies that (one (only) of the following must be checked):
Transfer Form. FOR VALUE, RECEIVED, ____________________________ hereby sell, assign, and transfer unto warrants to purchase shares of the Common Stock of Viral Genetics, inc., represented by the within instrument, and do hereby irrevocably constitute and appoint: to transfer said warrants stock on the books of the within named Corporation with full power of substitution in the premises. Dated , . In presence of [Check Image Here]
Transfer Form. To assign this Security or, in the event of conversion, shares of Bxxxxx CDT Inc. Common Stock, fill in the form below: I or we assign and transfer this Security or, shares of Bxxxxx CDT Inc. Common Stock, to (Insert assignee’s social security or tax identification number) (Print or type assignee’s name, address and zip code) and irrevocably appoint agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Security) Signature Guaranteed: SCHEDULE OF EXCHANGES OF SECURITIES The following exchanges, redemptions, repurchases or conversions of a part of this Global Security have been made: Principal Amount of Amount of Amount of this Global Security Decrease in Increase in Following Such Principal Principal Decrease Date of Authorized Signatory Amount of Amount of Exchange (or of Securities this Global this Global Increase) Custodian Security Security
Transfer Form. The transfer form shall:
Transfer Form. Any transfer of Warrants will require compliance with applicable securities legislation. Transferors and transferees are urged to contact legal counsel before effecting any such transfer. FOR VALUE RECEIVED, the undersigned hereby sells, transfers and assigns to , Warrants represented by this Warrant Certificate and does hereby irrevocably appoint as its attorney with full power of substitution to transfer the said Warrants on the appropriate register of the Warrant Agent. DATED this day of , . Signature Guarantee Signature of Registered Holder Name of Registered Holder Instructions:
Transfer Form. FOR VALUE RECEIVED, the undersigned transferor hereby sells, assigns and transfers unto (Transferee) (Address) the Warrant Certificate registered in the name of the undersigned transferor. THE UNDERSIGNED TRANSFEROR HEREBY CERTIFIES AND DECLARES that the transferee is a subsidiary of the undersigned transferor or an entity of which the undersigned transferor is a subsidiary, and that the Warrant Certificate is not being offered, sold or transferred to, or for the account or benefit of, a "U.S. person" (as defined in Regulation S under the United States Securities Act of 1933, as amended (the "U.S. Securities Act")) or a person within the United States unless registered under the U.S. Securities Act and any applicable state securities laws or unless an exemption from such registration is available. DATED this day of , . Signature of Registered Holder (Transferor) Signature Guarantee Print name of Registered Holder Address
