Joint holder registrations are limited to no more than 4 joint holders.
024YMA
CURRENT SHAREHOLDER INFORMATION
Shares to be Transferred
See the following Frequently Asked Questions (FAQs) section for more information about
number and type of shares.
Shares of the company are transferred in certificated form only. For transferring certificated
shares to a stockbroker, please contact Computershare for the proper instructions. Do not
use this form for such transfers.
Consideration Money:
Consideration Nil: If the consideration money paid for the transfer is Nil there will be no Stamp
Duty payable. Write “Nil” in section 1.
Transfer exempt: If the transfer is exempt from Stamp Duty, for example, transfer in
connection with divorce or dissolution of a civil partnership, or if the consideration given is
not chargeable consideration, complete Certificate 2 under section 7.
Consideration paid – under the equivalent value of £1000: If the consideration money paid
for the transfer is, in the equivalent value, between £0.01 and £1000, please write the
amount paid in section 1 and complete Certificate 1 under section 7.
Consideration paid – over the equivalent value of £1000: If the consideration money paid for
the transfer is above the equivalent value of £1000 then Stamp Duty needs to be paid to the
UK Stamp Office in Birmingham. Please write the amount paid in section 1 as well as the
foreign exchange rate from US$ to Pounds Sterling and the Pounds Sterling equivalent. The
foreign exchange rate used MUST be the foreign exchange rate noted on the date the Stock
Transfer Request Form was executed under section 6.
Please refer to the FAQ for more information regarding Stamp Duty.
Enter a daytime telephone number where we can attempt to contact you should we have
any questions regarding this transfer request.
Check this box only if you wish to transfer all of the shares in your account. Please also
enter the number of shares being transferred. If this box is checked, do not complete
section 4.
Only if you do not complete Section 3, enter the number of certificated shares you wish to
transfer, in numbers and words. IMPORTANT: You must submit the original certificates with
this form. If the number of shares to transfer is less than the number of shares on the
certificate, a certificate for the balance of shares on the submitted certificate will be returned
to the registered holder.
If the registered owner is deceased indicate the date of death.
Authorized Signatures – This section must be completed for your transfer to be executed.
After reviewing the form to ensure that all information provided is correct, please sign and
date the form in the appropriate boxes. Please note, if you are signing on behalf of the
current registered holder you must indicate your capacity (e.g. John Smith, Executor).
Signature(s) must be stamped with a Medallion Signature Guarantee from a qualified
financial institution, such as a commercial bank, savings bank, savings and loan, US
stockbroker and securities dealer, or credit union that is participating in an approved
Medallion Signature Guarantee Program. A Notary Seal is NOT acceptable.
If the Custody service is offered and if the holder is a Custody account holder(s). Please
note that if you are a Custody account holder the new certificate may only be issued in your
name. A Medallion Signature Guarantee is not required for such an issuance.
Form of Certificate Required - Transfers not liable to Stamp Duty. If consideration is
paid in connection with the transfer that is between the equivalent values of £0.01 and
£1,000 then section 7, certificate 1 must be completed.
If the transfer is exempt from Stamp Duty, for example, for transfers in connection with
divorce or the dissolution of a civil partnership, or if the consideration given is not
chargeable consideration, then section 7, certificate 2 must be completed.
Failure to complete certificate 1 or 2 for transfers applicable under section 7 will
cause the transfer to be rejected. If the transfer is liable to Stamp Duty, the completed
Stock Transfer Request Form must be submitted to the UK Stamp Office. Please see the
FAQ for details.
NEW HOLDER INFORMATION
If you are transferring to multiple new holders, feel free to photocopy the “New
Holder/Recipient” page of the form prior to completion. This page must be completed for
each new holder. Please be sure to clearly note the top of each page with the number of
shares (not a percentage) to be transferred to each recipient.
If you are requesting a certificate to brokerage account transfer, please do not use this form
for that component of the transfer. Contact Computershare for information on certificate to
brokerage account transfers.
Account Type – Mark only one box with an “X” indicating the type of account into which
you are transferring shares. Complete additional sections as indicated.
Definitions of Account Types:
■ An individual registration, e.g. John T. Smith, is used if there is only one account holder.
There is only one individual listed on the account.
■A joint tenant registration with right of survivorship, e.g. John T. Smith and Jane T. Doe JT
TEN, is used if there are two or more equal holders listed on the account. Please note, the
registration must read “and.” The word “or” cannot appear in the registration. In the event of
the death of one of the listed holders, the securities in the account become the property of
the surviving joint holder.
■A custodial with minor registration under the Uniform Gifts to Minors Act (UGMA) or
Uniform Transfer to Minors Act (UTMA) of your state, e.g. John Doe Custodian for Jonathan
Doe UTMA NY, is used if the securities are held by a custodian on behalf of a minor. The
named custodian is given the legal authority to act on the account on behalf of the minor.
The Social Security number associated with the account is that of the minor.
■ An estate registration, e.g. John Smith Executor for the Jane Doe Estate, is used to allow a
court-appointed legal representative to act on the account. The account is registered in the
decedent’s estate.
■A transfer on death (TOD) registration, e.g. John Smith TOD Mary Smith, is used to allow
an individual (John Smith) or joint owners with rights of survivorship (John Smith and Mary
Smith JT TEN) to designate one individual (Mary Smith) or entity as the beneficiary of the
account upon the death of the registered holder (John Smith). Please note, the assigning of
stock to the beneficiary is not automatic and will require a written request at the time of
transfer. NOTE: Only one TOD can be named per account. The TOD registration may not be
available for all companies or for all states.
■ Other common registrations include community property, Limited Liability Company (LLC),
nominee, partnership, tenants by entireties and unincorporated association. Please note that
trust registrations are not an acceptable registration.
If the new holder already owns stock in the company under the exact account name being
requested, transfer the shares to the existing account by entering the new holder’s 11–digit
Computershare account number, which starts with a “C”.
Enter the new holder’s 9-digit Social Security Number (SSN) or Employer Identification
Number (EIN). Do not include hyphens. If the new account will be in more than one person’s
name, provide the information for the first name on the account or for the person who will be
responsible for paying taxes. If the account is being registered as a custodial account,
provide the Social Security Number of the minor.
Enter the new holder’s name (first, middle initial, last) if the account type is individual,
custodial, executor or other.
Enter the name (first, middle initial, last) of the second new holder on the account if the
account type is joint, minor, TOD beneficiary or other (if applicable).
Enter the name of the estate (if applicable).
Enter the street address or PO Box for the new holder whose Social Security Number or
Employer Identification Number was entered in section 8A. If applicable, enter apartment or
unit number.
Enter the new holder’s city, 2-letter state abbreviation and 5-digit postal zip code.
Tax Certification: The new holder should sign and date Form W-9 for tax purposes. This
section must be completed to avoid backup withholding while a certified W-9 is in effect.
How to Complete the Stock Transfer Request Form
SEE FAQs FOR MORE INFORMATION
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