US Holder Deceased Transfer Package ON RI 01
US Holder Deceased Transfer Package ON RI 01
US Holder Deceased Transfer Package ON RI 01
Computershare
PO Box 43078
Providence, RI 02940-3078
www.computershare.com/investor
The IRS requires that we report the cost basis of certain shares
acquired after January 1, 2011 and then sold. Shares
transferred out of an account will be done using our default cost
basis calculation of first in, first out (FIFO) unless otherwise
instructed. Please visit our website, review the enclosed FAQ,
or consult your tax advisor if you need additional information
about cost basis.
Dear Holder,
As requested, enclosed are the forms and instructions needed to transfer the decedent’s stock to a new account or another holder. We have also enclosed
answers to Frequently Asked Questions (FAQs) to assist you with completing the form and to answer transfer related questions you may have. You can find
additional helpful information in the “Help” section of our website, www.computershare.com/investor.
To request the transfer, you will need to complete the following steps:
Step 1: Transfer Request form – Complete the enclosed form. All surviving registered holders (if applicable) or a legally authorized representative must sign
the “Authorized Signatures” section (section 8), with a Medallion Signature Guarantee for each signature. An individual signing on behalf of the current
registered holder must indicate his or her capacity next to the signature on the form (e.g. John Smith, Executor or John Smith, Custodian). See the
enclosed FAQ document for additional information.
Note that a Medallion Signature Stamp is requested for us to process this transfer request. However, you may be eligible to utilize the Medallion Waiver
Option in place of the stamp if you are a US resident, your total account value for this stock is under $10,000 AND you submit your transfer paperwork
with a check payable to Computershare in the non-refundable amount of $50. Please also enclose a copy of a government issued picture identification
such as a license or passport if electing the Medallion Waiver option.
If the decedent held any certificated shares, you must include the original stock certificate(s) along with the Transfer Request form. If a certificate is
lost, please contact us at the customer service number listed on the top right corner of this letter to find out the cost and process for requesting a
certificate replacement. Lost certificates must be replaced prior to transferring the shares.
In the absence of direction from the holder or the issuer, or if the share amount in question does not match one of the classes, this transfer may be subject to
rejection or clarification.
Step 2: Form W-9, tax certification – The new holder should sign and date the Form W-9 included with the Transfer Request form. If the new holder is unable to
provide tax certification at this time, we will send him or her a Form W-9 (Request for Taxpayer Identification Number and Certification) once the transfer
request is processed. Computershare will be required to withhold taxes on any dividends or other cash distributions until tax certification is received by us.
Step 3: Additional tax documentation – Obtain either (a) or (b), as applicable:
(a) If the decedent resided in a state in which an inheritance tax waiver is required, an Inheritance Tax Waiver form.
(b) If the decedent did not reside in a state in which an inheritance tax waiver is required, either (i) a Notarized Affidavit of Domicile (blank form
enclosed), or (ii) an Inheritance Tax Waiver stamp affixed next to the signature on the Transfer Request form.
See the last page of the enclosed FAQ document for additional information on these items and how to obtain them.
Step 4: Send all required documents outlined above to:
Regular mail: Overnight/certified/registered delivery:
Computershare Computershare
PO Box 43078 150 Royall Street, Suite 101
Providence, RI 02940-3078 Canton, MA 02021
026E5A_PRV78_WEB (NTW)
.
It is important that you follow the steps above to ensure that your transfer can be completed. Depending on the type of transfer being requested, your transfer should
be completed within 10 business days of receipt. A statement will be sent to the new holder upon completion of the transfer. Please note, the statement cannot be
sent to a third party. If your transfer cannot be processed due to missing or incomplete documentation, we will contact you for more information.
Please note that if this stock has a book entry option, certificate requests may only be fulfilled by the owner entering requests via our Investor Center website or by
contacting a customer service agent, after this transfer has been completed on our records. Instructions requesting certificates that accompany a transfer request
will not be fulfilled if a book entry option exists. Note that certificate requests may have a fee requirement.
If the value of the shares you are transferring exceeds $14 million, or if you have any questions, please contact us at the customer service number listed on the top
right corner of this letter. You can also submit your questions online through the “Contact Us” section of the website.
Sincerely,
Computershare
Enclosures
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Computershare
PO Box 43078
Providence, RI 02940-3078
www.computershare.com/investor
Address
Company Name
PARTIAL TRANSFER:
4 DRS Book-Entry Shares (number of whole shares to transfer) 5 Certificated Shares (number of whole shares to transfer)
IMPORTANT:
Original certificate(s) must be submitted
for your transfer to be executed.
6 Investment Plan Book-Entry Shares (number of whole and/or fractional shares to transfer, if applicable)
IMPORTANT ► You must complete both sides of this form for it to be valid.
E278UTR +
0251OB_GEN_PRV78_WEB_ONLY
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Transfer Request — See enclosed instructions PLEASE PRINT CLEARLY
NEW HOLDER / RECIPIENT INFORMATION • Please complete for each new holder • Use additional pages as necessary
9 Account Type (mark only one box with an “X”):
Individual (complete A, B, C, G & H) Custodial with Minor (complete A, B, C, D, G & H) Trustee/Trust (complete A-H)
SSN EIN
Name (First, MI, Last) - Individual / Custodian / Trustee / Executor / Other (check one box above)
Name (First, MI, Last) - Joint Holder / Minor / Co-Trustee / Other (if applicable)
D
Trust / Estate Name - continued F Date of Trust (mm / dd / yyyy) (if applicable)
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Computershare
PO Box 43078
Providence, RI 02940-3078
www.computershare.com/investor
Name
Address
OR
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.
Sign Here Signature of U.S. Person - Please keep signature within the box Date (mm/dd/yyyy) Daytime Telephone Number
➥
Send form to Computershare. Do not send to the IRS.
E23UW9 +
022W0A_PRV78_TR_WEB
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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.
AFFIDAVIT OF DOMICILE
To be completed for decedent transfers only.
Name of Stock:________________________________________________________________________________________________
residing at____________________________________________________________________________________________________
that at the time of death the domicile (legal residence) of said decedent was at
____________________________________________________________________________________________________________
for _______ years prior to death and was not a resident of any (other) state within the United States of America at time of death.
Signature: ____________________________________________________________________________________________________
Signature: __________________________________________________________
(official administering oath)
Title: _______________________________________________________________
EQSAFF 12-04-07
00TH4A
How to Complete the Transfer Request Form SEE FAQs FOR MORE INFORMATION
If you are transferring to multiple new holders, feel free to photocopy the Enter Purpose for Transfer/Cost Basis Data instructions for shares
10 acquired
“New Holder/Recipient” page of the form prior to completion. This page after 12/31/2010. Please check off the applicable purpose of the
must be completed for each new holder. Please be sure to clearly note the transfer. If this section is not fully completed, all transfers will be treated as
top of each page with the number of shares (not a percentage) to be Gifts, unless we receive documentation that this is a decedent transfer (i.e.
transferred to each recipient. Affidavit of Domicile) in which case the transfer will be treated as an
inheritance. We recommend that you consult with your tax advisor regarding
Account Type – Mark only one box with an “X” indicating the type of the tax implications for each type of transfer.
9 account into which you are transferring shares. Complete additional sections
■ Private Sale: Include the Date of Sale and the Cost Per Share.
as indicated.
■ Gift: Include the Date of Gift was received or the gift date will default to
Definitions of Account Types:
the date that the transfer is processed.
■ An individual registration, e.g. John T. Smith, is used if there is only one
■ Inheritance: Include the Date of Death and Cost per Share or it will
account holder. There is only one individual listed on the account.
default to the date that the transfer is processed.
■ A joint tenant registration with right of survivorship, e.g. John T. Smith and
■ No Change of Ownership: Change of name in cases of marriage or
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” divorce, minor coming of age, addition of spouse to registration, etc.
cannot appear in the registration. In the event of the death of one of the Existing cost basis of shares will be carried over to the new account.
listed holders, the securities in the account become the property of the
surviving joint holder.
■ A trust registration, e.g. John T. Smith and Jane T. Doe TR UA 4-3-66 Smith
Family Trust, is used to allow the appointed trustees to handle the
securities. All acting trustees are listed on the account, which also names
the legal name and date of the trust agreement. To register shares under a
trust, a legal trust agreement must exist.
00THUB_WEB (REV. 6/20)
.
Note: Reference to our website – www.computershare.com/investor – is made throughout this document. If you do not have Internet access, you can obtain the
same information by calling the customer service number listed on the top right corner of the enclosed Transfer Request form.
00THDC_WEB
Frequently Asked Questions (FAQs)
Uncashed Checks Tax Certification, Form W-9
Can you reissue uncashed checks in the name of the new holder? What is a Form W-9? Why do I have to complete the form?
No. If any uncashed checks have been lost, we can reissue a check in Form W-9 is an Internal Revenue Service tax form that certifies an
the name of the original holder. To replace those checks, check box 7 on individual's Taxpayer Identification Number. Submitting a completed form
the Transfer Request form. Holders may also be able to replace checks will prevent earnings and sale proceeds paid to the new account from
online via Investor Center: refer to the Investor Center information being subject to backup withholding. Without the completed form,
provided in this FAQ. Computershare would be legally required to withhold a percentage of
each payment to ensure that tax is collected and paid to the Internal
Revenue Service.
Transfer Request Form Where can I obtain one?
Who can I call for help completing the form? The enclosed Transfer Request form includes a Form W-9. The new
Please call us at the customer service number listed on the top right holder can fulfill this requirement by signing and dating the included
corner of the enclosed Transfer Request form. Form W-9. The complete Form W-9 can also be downloaded from
the “Help” section of the website listed at the beginning of this
I can’t fit all the information in the space provided. What should I do?
FAQ document.
Please feel free to attach additional pages as needed.
What if I do not have the information for the new holder, or the new
What are examples of other account type choices for the new holder?
holder is not available to sign the included Form W-9?
Other common account types include community property, Limited
If the new holder is unable to provide tax certification at this time,
Liability Company (LLC), nominee, partnership, tenants by entireties and
Computershare will be required to withhold taxes on any dividends or
unincorporated association.
other cash distributions until certification is received. Once we process
the transfer request and set up the new account, we will send the
appropriate tax certification form (Form W-9) to the new holder.
Stock Certificates
What if I can’t find a stock certificate?
Please contact us at the customer service number listed on the top right Inheritance Tax Waiver Form and Affidavit of Domicile
corner of the enclosed Transfer Request form to find out the cost and
When is an Inheritance Tax Waiver form required? How can I
process for requesting a replacement. The certificate must be replaced
obtain one?
prior to transferring the shares.
An Inheritance Tax Waiver form may be required depending on the
How should I send the certificate? Should I insure the mailing? decedent’s state of legal residence and date of death. A list of the
We recommend using registered mail or a courier service that provides a locations that may require this form is below. You can obtain an
return receipt. We also suggest that you insure the mailing with the Inheritance Tax Waiver form and instructions on how to complete the
carrier for 3% of the stock’s market value, which is the approximate cost form from the state tax agency of the decedent’s state of residence.
to replace a certificate in the event that it is lost in transit.
Alabama Missouri Oklahoma
Should I sign the back of the certificate before I send it? Arizona Montana Puerto Rico
No. For your protection, we suggest that you do not sign the back of the California New Jersey Rhode Island
certificate when presenting it to us for a transfer. Hawaii New York Tennessee
Illinois North Dakota West Virginia
Indiana Ohio
Medallion Signature Guarantee
What is a Medallion Signature Guarantee? Where can I obtain one? What if the decedent’s state of legal residence does not require an
A Medallion Signature Guarantee is a special stamp provided by a bank, Inheritance Tax Waiver form?
broker or credit union (guarantor institutions) that indicates that the Complete the enclosed Affidavit of Domicile attesting to the decedent’s
individual signing a form is legally authorized to conduct the requested state of residency, and have the completed form notarized. The form is
transaction. The guarantor institution should verify the medallion stamp is also available through the “Printable Forms” section of the website listed
sufficient to cover the value of assets being transacted upon. Please at the beginning of this FAQ document.
refer to the note on the cover letter to this form to see if you may be Alternatively, you can obtain an Inheritance Tax Waiver stamp, which
eligible to utilize the Medallion Waiver Option. certifies that no inheritance tax waiver is required. The stamp should
placed next to the authorized signature on the Transfer Request form
(section 8) and may be obtained from the same financial institution
providing the Medallion Signature Guarantee.
Frequently Asked Questions (FAQs)
Managing Your Account Online (Investor Center)
I am a new account holder. Can I access my account online? How do I start using Investor Center?
Yes. Non-business entity accounts can gain access through “Investor Center” To access your account, just follow these easy steps:
at www.computershare.com/investor. Step 1: Go to www.computershare.com/investor
Computershare's Investor Center is a free online service that provides you and click “Create Login”
with a wide variety of self-service tools to help track and manage your
Step 2: Fill in the required information
personal holdings in the companies we service. Investor Center allows you to
manage your holdings in several different companies simultaneously. Please Step 3: Read and accept the terms and conditions
note that Computershare does not permit online access to accounts registered Step 4: Select your member details including a unique user ID
as a business such as corporations, banks, associations, some trusts, and password
nominees, etc.
Following the initial registration steps, most Investor Center users are
What can I do with Internet account access? immediately granted full member access to their account and will receive an
Here are some of the things you can accomplish through Investor Center: Investor Center welcome letter by mail. In some cases, additional verification
■ View current account balances will be required before access to your account can be granted. Don’t worry,
■ Sign up to receive statements and documentation electronically this is only temporary, and is done for your protection based upon your
(where available) account and validation information. In these cases, we will mail you a notice of
■ Where available, issue certificates from book positions (may require registration, which includes a verification code. Once you receive your
payment of a fee) verification code, simply log on to Investor Center with your user ID and
■ View transaction history password. Enter the verification code when prompted and you will be
■ View payment history granted full member access immediately.
■ View stock prices
■ Change your mailing address Is my Investor Center account information secure?
■ Certify your tax status online (Form W-9 certification) Yes. All communication between our Web server and your computer use
■ Update your bank account details to have funds directly deposited into industry-standard Secure Sockets Layer (SSL) 2048-bit encryption when you
your bank account are viewing any details of your holding(s). This is the same type of encryption
■ Replace checks used by financial institutions worldwide.
■ Review information on available investment plans
■ Enroll in an investment plan, such as a dividend reinvestment plan
(where available)
■ Buy shares through a direct stock purchase plan (where available)
■ Sell book-entry shares held by Computershare
■ Download forms
■ Access a comprehensive list of frequently asked questions