Donation of Securities or Mutual Funds

Donation of Securities or Mutual Funds

Thank you so much for your contribution!
Full Name*

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Funds Designation
What is the name of the project you will be directing funds to?
YesNo
Please transfer the following securities as a donation from my brokerage account to the account of Small Change Fund, 747 Manning Ave, Suite 200, Toronto, ON M6G 2W5.
Transferring Institution*
Security Name*
Security Symbol*
Number of shares to be transferred*
Approximate amount in $*
Date of Transfer*

MonthDayYear
Date
Signature of Donor*
Transfer Information: National Bank Financial CUID#: NBCS; DTC#: 5008

Account number:

11-Z1Y2-A – CAD
11-Z1Y2-B – USD

Broker Contact at National Bank Financial:

Mark de Pencier

Email: mark.depencier@nbc.ca
Telephone: (416) 507-9189
Fax: (416) 869-9223

Please notify Mark de Pencier of the transfer of the Securities. The shares will be sold and a report of the donation will be provided, together with a charitable tax receipt made to the name of donor above.

Please contact me for any additional information.

Our sincerest thanks!

Contact Kim Bilous at Small Change Fund for any additional information at (416)305-6776 or kim@smallchangefund.ca
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