Specific Power of Attorney for Multiple Security Owners
This specific Power of Attorney is designed to facilitate the transfer, redemption, sale, or liquidation of a security that is held by multiple
registered owners when all owners cannot be present to provide their signature(s) and secure a Medallion Signature Guarantee. Users
should consult state law for specific requirements that may apply to powers of attorney. Please print.
Section I. Registered Owner
I (Registered Owner’s name as registered) hereby
attest that I am a Registered Owner of the security listed below and am unable to be physically present to apply my
signature and to have my endorsement Medallion Signature Guaranteed to effect the transfer indicated in Section I V.
Section II. Power of Attorney Authorization
I also certify that (Name of co-owner) is a co-owner
of the security listed below, and authorize this person to act as power of attorney on my behalf for the specific reason
listed in Section IV.
Section III. Security Identification
Note: As evidence of ownership, a copy of the certificate face or a recent account statement from the issuer is
required.
Name of security:
CUSIP number (if available): Account number:
Certificate number(s): Number of (shares/units/principal amount):
Section IV. Transaction Type
Transfer of ownership Redemption/Sale/Liquidation
Section V. Signature of Registered Owner (Section I.)
Date:
Tax identification number:
Phone number:
Address:
Section VI. Medallion Signature Guarantee
Affix Medallion Guarantee in this space.
Medallion stamp must be fully legible
and must not be dated or annotated.
A Notary stamp is not acceptable.
POA-MSO 11/18
V3.1
