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
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Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

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Funds Designation
What is the name of the project you will be directing funds to?
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*

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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 donation receipt made to the name of donor above.
Please contact me for any additional information.

Our sincere thanks,

Burkhard Mausberg

burkhard@smallchangefund.ca
(416) 898-9510
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