Fillable University of new haven Gift of Securities Transfer

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University of new haven Gift of Securities Transfer

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Gift of Securities Transfer
To:
Name of broker or financial advisor: ______________________________________________________________
Brokerage or financial institution: ________________________________________________________________
Broker’s phone number: ________________________________________________________________________
From:
Donor’s Name(s): _____________________________________________________________________________
Donor’s Address: _____________________________________________________________________________
____________________________________________________________________________
Donor’s Phone: (________) __________________________________________________________________
I/we hereby authorize you to transfer the following securities from account name and number:
____________________________________________________________________________________________
Issuer name: 1) _____________________________________ # of Shares: ___________ Basis _______________
2) _____________________________________ # of Shares: ___________Basis ________________
To be given to: University of New Haven Development Fund
Account #LH27101 DTC number: 0221
_____ Unrestricted Gift
_____ Restricted Gift designated for: _____________________________________________________________
Signature:
X ___________________________________________________ Date __________________________________
(All stockowners must please sign)
Please email or mail a copy of this authorization to the University’s investment account manager:
Denise Rasicot, Sr. Registered Client Service Associate
UBS Financial Services, Inc.
One State Street
Suite 1600
Hartford, CT 06103
Phone: 860-275-8072
Email: denise.rasicot@UBS.com
To ensure proper credit for your gift, please also email or mail a copy of this authorization to
Darcy Turner, Sr. Director for advancement services Office of Advancement, University of New Haven, 300
Boston Post Road, West Haven, CT 06516 / (203) 479-4730 or daturner@newhaven.edu
Rev 10-1-2019
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University of new haven Gift of Securities Transfer

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Completed 8 December 2019

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