Transfer Form. Use this form to transfer funds from your existing ESA to your NuView IRA. Please note that your existing ESA custodian may require a Medallion Guarantee Stamp, which is much like a notary seal. Check with your bank to obtain this stamp. OR Annual Contribution NuView IRA Processing Office 000 X. Xxxxxx Xxxxxx Blvd. Longwood, FL 32750 Contact Us Office: (000) 000-0000 Toll Free: (000) 000-0000 Fax: (000) 000-0000 Email: Xxxxxxxxx@XxXxxxXXX.xxx Web: XxXxxxXxxxx.xxx Discover a new world of investment options. Xxxxxxxxx Educational Savings Account Adoption Agreement 000 X. Xxxxxx Xxxxxx Blvd. Longwood, FL 32750 P: (000) 000-0000 | F: (000) 000-0000 E: xxxxxxxxx@xxxxxxxxx.xxx 1 DEPOSITOR INFORMATION Legal Name (Required) Mr. Ms. Mrs. Dr. Date of Birth (MM/DD/YYYY) Social Security Number Address City, State, Zip Primary Phone Mobile Phone Email Address 2 BENEFICIARIES Designated Beneficiary Name Social Security Number Relationship Date of Birth Share % Address City State Zip In the event of the Designated Beneficiary's death, the balance shall be paid to the Primary Beneficiaries who survive the Designated Beneficiary in equal shares (or the specified shares, if indicated). If the Primary or Contingent box is not checked, the beneficiary will be deemed to be a Primary Beneficiary. If an account owner does not designate an account beneficiary, the assets of the account will be transferred to the estate upon the account owner's death. Select Beneficiary Type: Primary Contingent Name Social Security Number Relationship Date of Birth Share % Address City State Zip Select Beneficiary Type: Primary Contingent Name Social Security Number Relationship Date of Birth Share % Address City State Zip 3 ACCOUNT FUNDING Initial Contribution Amount Date Contributed Regular Contribution for tax year: Rollover from another Xxxxxxxxx ESA Transfer from another Xxxxxxxxx ESA from: Military Death Gratuity/ SGLI Payments 4 RESPONSIBLE INDIVIDUAL INFORMATION Legal Name (Required) Mr. Ms. Mrs. Dr. Date of Birth (MM/DD/YYYY) Social Security Number Address City, State, Zip Primary Phone Mobile Phone Email Address The Responsible Individual shall shall not continue to serve as the Responsible Individual after the Designated Beneficiary attains the age of majority pursuant to section 5.02 of the Custodial Agreement. The Responsible Individual may may not change the beneficiary designated under this Custodial Agreement pursuant to section 6.01 of the Custodial Agreement. Note: The Responsibl...
Transfer Form. Use this form to transfer funds from your existing HSA to your NuView IRA. Please note that your existing HSA custodian may require a Medallion Guarantee Stamp, which is much like a notary seal. Check with your bank to obtain this stamp. OR Annual Contribution NuView IRA Processing Office 000 X. Xxxxxx Xxxxxx Blvd. Longwood, FL 32750 Contact Us Office: (000) 000-0000 Toll Free: (000) 000-0000 Fax: (000) 000-0000 Email:XXXXxxxxxxxxx@XxxxxxXxxxx.xxx Web: XxXxxxXxxxx.xxx Discover a new world of investment options. Thank you for your interest in Self-Directing your IRA through NuView IRA, Inc. Please complete the sections below, sign and return with original signatures to our office. To initiate the account, we will need the original completed forms: IRA Account Application IRA Transfer or Direct Rollover Form (if transferring funds) Photocopy of your driver's license (Patriot Act requirement) For office use only: Account No.: Date Received: 1 PERSONAL INFORMATION Legal Name (Required) Mr. Ms. Mrs. Dr. Date of Birth (MM/DD/YYYY) Social Security Number Legal Address (Required) City, State, Zip Mailing Address (Optional) City, State, Zip Primary Phone Fax Mobile Email Address Marital Status Single Married (see Consent of Spouse) Widowed or Divorced Current/Most Recent Occupation (Required) Title Would you like to receive your quarterly statements online? Yes (no charge) No ($10 annual fee) Would you like to receive messages regarding your account from NuView via: Text How did you hear about us? Referred by: NuView Client Realtor CPA E-mail Attorney Referral name: Online via: ✔ Both Advisor Other: 2 NOTIFICATIONS ACCOUNT TYPE Please select one: Health Savings Account Check one: Self-only coverage Family coverage ACCOUNT FUNDING Annual Contribution Year contribution for: Transfer Contribution Transfer from existing HSA or Employer Sponsored Plan. Rollover Contribution Take receipt of the assets for up to 60 days before reinvesting in a new retirement plan.
Transfer Form. TO: Aurora Cannabis Inc. (the “Company”) AND TO: COMPUTERSHARE TRUST COMPANY OF CANADA 000 Xxxxxxx Xxxxxx, 0xx Xxxxx Xxxxxxxxx, Xxxxxxx Xxxxxxxx X0X 0X0 FOR VALUE RECEIVED, the undersigned transferor hereby sells, assigns and transfers unto (Transferee) (Address) (Social Insurance Number) ___________________ of the Warrants registered in the name of the undersigned transferor represented by the Warrant Certificate. DATED this ________ day of ______________, ____. Signature of Warrantholder (Transferor) Signature Guarantee Print name Address REASON FOR TRANSFER – for US residents only (where the individual(s) or corporation receiving the securities is a US resident). Please select only one (see instructions below). ☐ GIFT ☐ ESTATE ☐ PRIVATE SALE ☐ OTHER (OR NO CHANGE IN OWNERSHIP) DATE OF EVENT (DATE OF GIFT, DEATH OR SALE): VALUE PER WARRANT ON THE DATE OF EVENT: ☐☐/☐☐/☐☐☐☐ $ ☐☐☐.☐☐ ☐ CAD OR ☐ USD CERTAIN REQUIREMENTS RELATING TO TRANSFERS – READ CAREFULLY The signature(s) of the transferor(s) must correspond with the name(s) as written upon the face of this certificate(s), in every particular, without alteration or enlargement, or any change whatsoever. All securityholders or a legally authorized representative must sign this form. The signature(s) on this form must be guaranteed in accordance with the transfer agent’s then current guidelines and requirements at the time of transfer. Notarized or witnessed signatures are not acceptable as guaranteed signatures. As at the time of closing, you may choose one of the following methods (although subject to change in accordance with industry practice and standards):
Transfer Form. (a) Player(s) Loaned to or Recalled from a minor league club shall receive a transfer form. In order to make said Loan or Recall effective, the Club must send a copy to the NHLPA and NHL, in accordance with Exhibit 3 hereto, prior to that Player playing in an NHL Game and, in all other circumstances, immediately.
Transfer Form. FOR VALUE, RECEIVED, ____________________________ hereby sell, assign, and transfer unto warrants to purchase shares of the Common Stock of Viral Genetics, inc., represented by the within instrument, and do hereby irrevocably constitute and appoint: to transfer said warrants stock on the books of the within named Corporation with full power of substitution in the premises. Dated , . In presence of [Check Image Here]
Transfer Form. TO: Planet 13 Holdings Inc. c/o Odyssey Trust Company Suite 1230, 300 5th Avenue SW Calgary, Alberta T2P 3C4 FOR VALUE RECEIVED, the undersigned transferor hereby sells, assigns and transfers unto (Transferee) (Address) (Social Insurance Number) of the Warrants registered in the name of the undersigned transferor represented by the Warrant Certificate. In the case of a Warrant Certificate that contains a U.S. restrictive legend, the undersigned hereby represents, warrants and certifies that (one (only) of the following must be checked):
Transfer Form. Any transfer of Warrants will require compliance with applicable securities legislation. Transferors and transferees are urged to contact legal counsel before effecting any such transfer. FOR VALUE RECEIVED, the undersigned hereby sells, transfers and assigns to , Warrants represented by this Warrant Certificate and does hereby irrevocably appoint as its attorney with full power of substitution to transfer the said Warrants on the appropriate register of the Warrant Agent. DATED this day of , . Signature Guarantee Signature of Registered Holder Name of Registered Holder Instructions:
Transfer Form. To assign this Security or, in the event of conversion, shares of Bxxxxx CDT Inc. Common Stock, fill in the form below: I or we assign and transfer this Security or, shares of Bxxxxx CDT Inc. Common Stock, to (Insert assignee’s social security or tax identification number) (Print or type assignee’s name, address and zip code) and irrevocably appoint agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Security) Signature Guaranteed: SCHEDULE OF EXCHANGES OF SECURITIES The following exchanges, redemptions, repurchases or conversions of a part of this Global Security have been made: Principal Amount of Amount of Amount of this Global Security Decrease in Increase in Following Such Principal Principal Decrease Date of Authorized Signatory Amount of Amount of Exchange (or of Securities this Global this Global Increase) Custodian Security Security
Transfer Form. The transfer form shall:
Transfer Form. FOR VALUE RECEIVED, _______________________________________ hereby sell, assign, and transfer unto Options to purchase shares of the Preferred Stock of VG Energy, Inc., represented by the within instrument, and do hereby irrevocably constitute and appoint: to transfer said Options stock on the books of the within named Corporation with full power of substitution in the premises. Dated _____________________________, _________ ________________________ In presence of _______________________ Warrant No. 946 VIRAL GENETICS, INC. Warrant for the Purchase of Shares of Common Stock Par Value $0.0001 WARRANT AGREEMENT THE HOLDER OF THIS WARRANT, BY ACCEPTANCE HEREOF, BOTH WITH RESPECT TO THE WARRANT AND COMMON STOCK ISSUABLE UPON EXERCISE OF THE WARRANT, AGREES AND ACKNOWLEDGES THAT THE SECURITIES REPRESENTED BY THIS CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE "SECURITIES ACT"), OR UNDER THE SECURITIES LAWS OF ANY STATE. THESE SECURITIES HAVE BEEN ACQUIRED FOR INVESTMENT AND MAY NOT BE TRANSFERRED OR SOLD IN THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT OR OTHER COMPLIANCE UNDER THE SECURITIES ACT OR THE LAWS OF THE APPLICABLE STATE OR A "NO ACTION" OR INTERPRETIVE LETTER FROM THE SECURITIES AND EXCHANGE COMMISSION OR AN OPINION OF COUNSEL REASONABLY SATISFACTORY TO THE ISSUER, AND ITS COUNSEL, TO THE EFFECT THAT THE SALE OR TRANSFER IS EXEMPT FROM REGISTRATION UNDER THE SECURITIES ACT AND SUCH STATE STATUTES. This is to certify that, for value received, Xxxxxxx Xxxxxxx (the "Holder") is entitled to purchase from VIRAL GENETICS, INC., a Delaware corporation (the "Company"), on the terms and conditions hereinafter set forth, all or any part of 1,666,667 shares ("Warrant Shares") of the Company's common stock, par value $0.0001 (the "Common Stock"), at the purchase price of $0.06 per share ("Warrant Price"). This warrant represents the "Vendor Warrant" referred to in Section 2(c) of the Securities Purchase Agreement between Holder and Viral Genetics, Inc., a Delaware corporation, dated January 27, 2011. Upon exercise of this warrant in whole or in part, a certificate for the Warrant Shares so purchased shall be issued and delivered to the Holder. If less than the total warrant is exercised, a new warrant of similar tenor shall be issued for the unexercised portion of this warrant. By acceptance hereof, the Holder agrees to be bound by the terms and conditions of this warrant. This warrant is granted subject to the follo...
