Irrevocable Stock or Bond Power (PDF) . This page - Fidelity
Irrevocable Stock or Bond Power (PDF) . This page - Fidelity
Irrevocable Stock or Bond Power (PDF) . This page - Fidelity
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<strong>Irrevocable</strong> <strong>Stock</strong> <strong>or</strong> <strong>Bond</strong> <strong>Power</strong><br />
To allow <strong>Fidelity</strong> Brokerage Services LLC to facilitate the processing of your certificate(s) in the absence of your<br />
end<strong>or</strong>sement on the certificate(s), please complete and sign this stock/bond power, which we will then attach<br />
to the certificate(s).<br />
Return the completed f<strong>or</strong>m to <strong>Fidelity</strong> Investments, Attn.: Banking Services, 100 Crosby Parkway, Mailzone KC1N,<br />
Covington, KY 41015. If you have any questions, call our Control and Restricted <strong>Stock</strong> Services Group, Monday–Friday,<br />
8:30 a.m.–8:00 p.m. Eastern time, at 1-800-544-6161, <strong>or</strong> visit us at <strong>Fidelity</strong>.com.<br />
All fields in BOLD are required.<br />
1 CUSTOMER INFORMATION<br />
Name of Owner (<strong>or</strong> Trust/Business/Min<strong>or</strong>) Account Number<br />
1.738847.110 013200301<br />
–<br />
CID Number (if known)<br />
Name of Co-Owner (<strong>or</strong> Trustee/Auth<strong>or</strong>ized Person) Daytime Phone<br />
2<br />
( ) –<br />
IRREVOCABLE STOCK OR BOND POWER FOR VALUE RECEIVED<br />
The undersigned does (do) hereby sell, assign, and transfer to<br />
Name of person <strong>or</strong> entity who will receive the securities<br />
The undersigned does (do) hereby irrevocably constitute and appoint National Financial Services LLC, att<strong>or</strong>ney to transfer the said<br />
stock <strong>or</strong> bond(s) as the case may be, on the books of said Company, with full power of substitution in the premises.<br />
3 SIGNATURE<br />
Note: If the stock is registered in m<strong>or</strong>e than one name, please have all parties sign below exactly as each name appears on<br />
the certificate(s).<br />
X ______________________________________________________________ X ______________________________________________________________<br />
Signature of OWNER/TRUSTEE Signature of JOINT OWNER/TRUSTEE<br />
F<strong>or</strong> Broker/NFS use only<br />
MEDALLION SIGNATURE GUARANTEE (BROKER USE ONLY) MEDALLION SIGNATURE GUARANTEE (BROKER USE ONLY)<br />
<strong>Stock</strong>s <strong>Bond</strong>s<br />
shares of the bonds of<br />
Number of Shares Common/Preferred Number of <strong>Bond</strong>s Description of Company <strong>or</strong> Municipality<br />
stock of in the principal amount of $<br />
Company Name Face Amount<br />
represented by Certificate(s) No.(s): represented by Certificate(s) No.(s):<br />
Certificate Nos. Certificate Nos.<br />
Certificate Nos. (cont.) Certificate Nos. (cont.)<br />
inclusive, standing in the name of the undersigned on the inclusive, standing in the name of the undersigned on the<br />
books of said Company books of said Company<br />
411649.4.0
411649.4.0 <strong>Fidelity</strong> Investments, Attn: Banking Services, 100 Crosby Parkway, Mailzone KC1N, B.401-FORM-0910<br />
Covington, KY 41015 1.738847.110<br />
Brokerage services provided by <strong>Fidelity</strong> Brokerage Services LLC,<br />
Member NYSE, SIPC.
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