You must contact your broker with instructions to transfer a gift of securities to DePauw. The purpose of
this form is to notify DePauw of an anticipated transfer of securities and to indicate the designation of your
gift. Privacy statutes may prevent your broker from providing us with any personal information. This form allows
us to know who transferred a gift of securities and ensure timely and accurate processing of your gift.
Instructions: Please complete this form (you may fill in the form electronically or by hand) and e-mail or mail to
the address listed at the bottom of this form. Alternatively, you may provide this form to your broker and ask them
to complete and e-mail to the address below. If providing to your broker to complete, you must also grant
permission for them to send the form to DePauw. If you have additional questions regarding this form or about
making a gift of securities please contact a member of our Development staff at 800-446-5298. EIN#35-0869045
Securities gifts should be
directed to our brokerage:
DePauw University
Account #: IP-51937
DTC #: 0221
UBS Financial Services
8801 River Crossing Blvd, Indianapolis, IN 46240
Phone: 317-816-1817
Gif
t of Securities Transfer Notification Form
E-mail Form to: securitiesgifts@depauw.edu
or Mail to: DePauw University, Development Services, 201 E. Seminary St., Greencastle, IN 46135
Thank you for your generous investment in a DePauw education!
Name _____________________________________________________________________
Street address _______________________________________________________________
City _____________________________________________
State ______________ Zip code __________________
Tele
phone ________________________________________
E-mail ___________________________________________
Donor Broker Information
Brokerage firm ______________________________________________________________
Broker name ________________________________________________________________
Broker phone ________________________ Broker fax __________________________
Transfer of Securities Information
Anticipated date of transfer______________
**Description of securities being transferred: (Indicate the name of each security, number of shares, and the approximate dollar value)
**Designation of gift: (If the gift is to be split among accounts, also note how many shares or dollars for each designation)
Donor Information
