

Security Holder Forms This form is used to transfer the ownership of a security from the registered shareholder to another. In most cases, the new registered owner receives the certificate and the Power of Attorney and presents them to the transfer agent for registration. If the new registered owner is a person, he/she should provide their taxation identification number. The Power of Attorney itself is a legal document that enables a shareholder to designate another person, called the attorney, to act on his/her behalf to register the securities. When completing the form, it is important to leave the space following “hereby irrevocably constitutes and appoints” blank as Capital Transfer Agency Inc. is the attorney which will cause the registration. If this part of the panel is completed Capital will require a Release Power of Substitution. Please note that the registration of the security requires the Power of Attorney to be guaranteed by a Schedule I Canadian Chartered Bank or guaranteed by a financial institution that is a member of a recognized Medallion Signature Guarantee Program. Also, if the security is registered in the name of a company, the Power of Attorney must be accompanied with a Corporate Signing Resolution and a Certificate authorizing the transfer of the security.
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Estate Transfers This form is to be used by an Executor or Administrator of the estate to transfer securities registered in the name of the deceased to the Estate of the Deceased or to a Beneficiary of the Estate. The Declaration must be sworn before a Judge, Justice of the Peace, Notary or any person that is permitted to take affidavits to be used in Provincial or Federal courts. The original certificate must be provided with the completed Declaration and the Certificate must be endorsed by the executor and guaranteed by a Schedule I Canadian Bank or a financial institution that is a member of a recognized Medallion Signature Guarantee Program. The form must be accompanied with an original or notarised Copy of the Letters Probate or a Probate Bond of Indemnity. To transfer the securities to the beneficiary, the executor must complete the registration panel indicating that the securities are to be transferred directly to the beneficiary.
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Cost Basis Reporting for US Companies All Shareholders and Issuers must fill out the form below when transferring shares.
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