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Securities Donation

Use this form to allow National Financial Services LLC (“NFS”) to facilitate the processing of your certificate(s). This form takes the place of an original signature on the certificate. Original form must be mailed to the appropriate party. Type on screen or fill in using CAPITAL letters and blue ink. If you need more room for information or signatures, use a copy of the relevant page.

1. Registration

Provide the name(s) exactly as they appear on the certificate.

2. Irrevocable Stock or Bond Power for Value Received

The undersigned does (do) hereby sell, assign and transfer to the person listed the following attached stock or bond, as applicable.

If stocks, complete this portion:

Common Stock
Preferred Stock

If bonds, complete this portion: