eShares, Inc. dba Carta, Inc. (“Carta”) is NOT a qualified custodian. Please use this form to instruct digitally
issued certificates to be converted to paper and sent to your qualified custodian. Please be aware of the
following when converting a digitally issued certificate into a paper certificate:
This security will exist on Carta’s platform with a ‘COPY’ watermark and will not be allowed to be
modified should any transaction occur (e.g. stock split, merger, acquisition, corporate action)
The printed certificate will be exactly what is represented on Carta’s platform including the digital
signatures but excluding the “COPY” watermark
The converted paper version will supersede the digitally issued copy on the Carta platform
Email Recipient Details
Recipient Name
Recipient Email Address
Recipient Phone Number
Investment Details (multiple holdings please attach a spreadsheet w/ below info)
Company Name
Investor (Fund) Name
Certificate Number
Qualified Custodian Details
Qualified Custodian Name
Contact at Custodian
Email Address
Phone Number
Account Number
Mailing Address
In consideration of Carta or any of its affiliates accepting the instructions on this document, I release and discharge Carta and its affiliates from
any liability or claims in connection with these instructions and agree to indemnify and hold Carta harmless against any losses from any action,
claim, or demand of any person based upon Carta acting under these instructions.
For transfers to third party accounts in which you have no ownership interest, you agree that by signing this document that you are irrevocably
relinquishing all rights, title, and interest to the asset(s) listed on this document. It is your responsibility to verify the accuracy and the
legitimacy of the source of instructions provided by third parties. I acknowledge that I have read and understand the terms of this request to
convert and transfer assets and further acknowledge that the terms of this request are binding regardless of any other agreement(s) between
me and the recipient(s) of these assets.
Provide Signature(s) and Date
Authorized Signature
Print Name
Please email the completed documents or any questions to