Microsoft Word - v2 draft securities donation form 2020.docx

RayjonShareCare–GiftsofPubliclyTradedSecurities&MutualFunds

Thisformistobecompletedbythedonorandauthorizesyourbrokertocompletethetransferofsecuritiesto

RayjonShareCareofSarniaInc.Youwillreceiveataxreceiptforthefairmarketvalue,whichistheselling

priceofthesecuritiesonthedatethegiftissold.

DONORINFORMATION

Donor First Name: _____________________________Donor Last Name: _________________________

StreetAddress:_________________________________________________________________________

City:_______________________ Province:______________ PostalCode:_____________________

Telephone: __________________ Email:_______________________________________________



DELIVERINGINSTITUTIONINFORMATION(DONOR’SBROKER)

DeliveringInstitutionName:________________________________________________________

AccountName:___________________________________Account#:_____________________________

DeliveringInstitutionCUIDorDTC:________________________ContactName:______________________

Signature:____________________________________Phone#:___________________________________

RECEIVINGINSTITUTIONINFORMATION

Receiving Institution Name: TD Direct Investing

Account Name: Rayjon Share Care of Sarnia Inc. CRA Charity Reg.: 11910 9460 RR0001

Account # (CAD Securities): 53BL48A Account # (USD Securities): 53BL48B

You are hereby authorized and directed to transfer in kind the following securities from the above noted

account to the address and the account number noted above.

SecurityDescription(i.e.CUSIP,common,preferred,Exchange,symbol,etc.)

#ofshares/units

_______________________________________________________________

______________

_______________________________________________________________

______________

_______________________________________________________________

______________

Signatureofdonor:__________________________________________Date:__________________________



ADDITIONALINFORMATION

Pleasehave your Broker/FinancialAdvisorcomplete this form and fax to:

TD CLIENT TRANSFER SERVICES: 1 877 639 4547 or 416 983 5696

Address: 77 Bloor St. W., 6th Floor, Toronto, Ontario M4Y 1T2

andmailore‐mailacopyto:

RAYJON SHARE CARE OF SARNIA INC.

Attn: John Spinozzi, Financial Director

PO BOX 2482 STN MAIN

SARNIA ON

N7T 7T1