Fillable EQ Shareowner Services (Shareowner Online)

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EQ Shareowner Services (Shareowner Online)

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EQ Shareowner Services
PO Box 64874
Saint Paul MN 55164-0874
1-800-468-9716 or 651-450-4064
shareowneronline.com
Authorization to Establish Standing Instructions for Electronic Delivery of Shares to Broker/Dealer
Completion of this form is necessary to provide EQ Shareowner Services (EQ or Shareowner Services) with your Broker/Dealer
information for future transactions to deliver shares to your Broker/Dealer. Separate instructions must be submitted for each issue of
stock. This form must be signed by all registered owners and Medallion Signature Guaranteed. These instructions will expire in three
years. A new instruction must be provided and signed for renewal. NOTE: Available for U.S. Residents only. See reverse for details.
1. I authorize Shareowner Services to maintain the following information on my account:
Broker/Dealer Firm Name
Broker/Dealer Account Number
Broker/Dealer Account Registration You are advised to consult with your
professional advisors if your Shareowner Services account registration does
not match your Broker/Dealer Account Registration because it may have
significant legal and tax implications.
Broker/Dealer DTC Participant Number
Company of Stock
Shareowner Services Account Number
Shareowner Services Registration
2. I authorize Shareowner Services to deliver shares to my broker/dealer electronically as indicated below.
Automatic Delivery
• Delivery of full shares (Direct Registration shares and Plan shares) will be initiated to the broker/dealer acco
unt
i
ndicated above once shares have been credited to your Shareowner Services account.
• Choose only one of the options below for any fractional share remaining in your account; if no fractional shares optio
n
is selected fractional shares will be kept in the account*:
Sell all fractional shares remaining in the account
Keep the fractional shares in the account
Sell all fractional shares and terminate dividend reinvestment on the account
* To view terms and conditions or service fees of a Plan or DRS transaction, visit shareowneronline.com and select Sell Shares.
OR
Request Delivery of Shares
• Broker/Dealer account instructions will be added to your account. Delivery of shares will occur only when requested by
the shareowner(s). The request can be initiated by signing into your Shareowner Online account or by calling
Shareowner Services.
See reverse side
BA DOM 12/18
V5
Shareowner Services and the company you invest in are not responsible for incomplete or incorrect information supplied by you.
IMPORTANT: All current owners or authorized individual(s) must sign their name and have the signature guaranteed by a member of
a Medallion Stamp Program. An authorized individual must write their capacity (title) in the space below. The Medallion Guarantor
may require additional documentation. The undersigned does (do) irrevocably constitute and appoint Equiniti Trust Company,
attorney to transfer the said stock on the books of said Company with full power of substitution in the premises. Medallion Signature
Guarantees can be obtained from financial institutions, including commercial banks, brokers, and credit unions.
Signature of the Registered Owners:
All owners must sign as they are registered on the account
Med
allion Signature Guarantee. Note to Guarantor: Medallion
Stamp must be fully legible and must NOT be dated or noted.
A Notary Stamp is not acceptable.
How to complete an Authorization to Establish Standing Instructions form
Section 1: Information to Maintain on Shareowner Account
Please contact your broker if you need help filling out the broker account information.
• The Broker Authorization Form is available for U.S. shareowners only. If you reside outside of the U.S., please work with your
securities dealer to have the shares moved electronically through the DRS Profile System.
• Broker/Dealer Firm Name: Name of your brokerage firm
• Broker/Dealer Participant Number: A number that identifies your brokerage firm. Please ask your broker for their DTC Participant
Number
• Broker/Dealer Account Registration: Your account registration at your brokerage firm
• Broker/Dealer Account Number: Your account number at your brokerage firm
• Company of Stock: Company name of issue of stock
• Shareowner Services Account Number: Your account number with Shareowner Services
For joint owners: Completing this form will allow Shareowner Services to deliver shares to the broker pursuant to instructions of
other joint owners on the account without further approval or other action on my part.
There is a $75 servicing fee for maintaining standing instructions on your account. Please include payment when submitting this
form.
Mail your completed Authorization Form
along with payment of $75 to:
EQ Shareowner Services
PO Box 64874
Saint Paul MN 55164-0874
If using a courier, please mail your completed
Authorization Form along with payment of $75 to:
EQ Shareowner Services
ATTN: Imaging Services
1110 Centre Pointe Curve Suite 101
Mendota Heights MN 55120
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Completed 23 September 2021

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