PIN form
This personal identification number (PIN) form can be used to create a PIN for your EQ Shareowner Services account. Creating a PIN will allow
you to access your account and process transactions using the automated request line. You can take advantage of a variety of services over
the phone, including:
• Checking your share balances
• Reviewing dividend payment information
• Requesting tax information for prior year, including
duplicate Forms 1099DIV and 1099B
• Getting information on replacing a lost certificate
• Reviewing investment plan information
• Finding out how to change your account registration
• Withdrawing a certificate
• Speaking to a Customer Care Specialist
To create a PIN using this form, please fill out the information below, including your account name, company name, account number, and
four-digit numeric PIN in the boxes below (one digit in each box). Sign and date where indicated, then mail your completed form to the
address provided.
It is important to remember your PIN for processing future transactions over the phone. For your security, always store your PIN, account
number and other confidential account information in a safe location.
Automated Request Authorization
I hereby authorize Equiniti Trust Company to establish automated privileges for my account. Multiple owners (if applicable): I understand
that after all registered holders have signed, authorizing the account for automated privileges, any registered holder may solely authorize
Equiniti Trust Company to process the transaction.
Account number PIN
Account name/Registration Company name
Return this form to:
EQ Shareowner Services
Data M – PN
PO Box 64945
Saint Paul MN 55164-0945
PIN SOnL 11/18
V4
