Welcome to our Medallion Forms page.  Here you will find a variety of forms that may be required to complete the transfer of your securities.  We are providing these forms to help assist in the smooth and timely transfer of securities.

Basic Information Concerning the Transfer

These documents and forms are needed in almost every transfer of securities.

• Certificate copy:  If you are depositing a physical certificate into a brokerage account, or otherwise transferring it, we will need to a see copy of the front and back of the certificate.  Please do not send us the original certificate.
• Book Entry Statement:  We will need to see a copy of the book entry statement.
• Stock Power:  We will need an original copy of the stock power that has been signed.  The stock power must be completed to reflect the nature of the transfer or sale of the securities.  If you are in need of help filling out the stock power, please fee free to contact our office and we gladly offer our assistance.  A Generic Stock Power is available for your use
• Photo ID:  US Anti-Money Laundering (AML) laws require transfer agents, and us to verify the identity of the person transferring the shares. We will need a current, photo ID issued by a government entity in order to verify your identity.  This is generally a drivers license or a passport photo.
• Letter of Instruction:  This is generally a letter instructing the transfer agent to process the transfer.

Tax ID Verification Forms

A variety of US Anti-Money Laundering regulation and the Patriot Act require that all transfer agents obtain appropriate TAX ID verification on security holders.  The following forms are available for your use.

• IRS Form W-8: A sample IRS Form W-8BEN
• IRS Form W-9: A sample IRS Form W-9

Corporate Medallion Forms

Corporate shareholders are required to provide certain documents to verify the authority of the person signing on behalf of the corporate entity.  The relevant documents are as follow:

• Limited Liability Certification:  This certifies who has authority to sign on behalf of the limited liability company.  A sample is available here. 
• Limited Partnership Certification:  This certifies who is authorized to sign on behalf of the limited partnership.  A sample is available here.
• Secretary’s Certificate:  This certifies who is able to sign on behalf of the corporation.  A sample is available here.
• Trust Agreement:  We will need to see a copy of the trust agreement, which will specify who is authorized to sign on behalf of the trust.

Estate Transfers:

• Affidavit of Domicile:  This is an affidavit that attests to the who died, and where their legal residence was at the time of their death.  A sample copy is available here.
•  Waiver of Probate:  This form is utilized when an estate is not probated.  A sample copy is available here

Transfer following a divorce

• Divorce Decree:  For obvious reasons, we do not have a sample copy.  However, you will need to provide the transfer agent, brokerage firm, or other appropriate party a copy of your divorce decree signed by the judge.

Additional information about our Medallion Signature Guarantee Stamp program may be found (here).  If you are interested in obtaining a Medallion Signature Guarantee Stamp please feel free to contact our offices via. telephone # (404)-816-8240 or submit an online inquiry.  We are here to be of help and assistance with your needs.