Stock Power Form - Christian Medical Dental Associations
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1Stock Power Form
This Form must have a medallion signature
guarantee from your broker or bank
The undersigned hereby assigns and transfers to Christian Medical & Dental Associations:
Shares of Stock
__________Shares of the capital stock of ___________________________ represented by
certificate No.(s)___________________________________ inclusive, standing in the name of
the undersigned on the book of said corporation.
OR
Bond
_________bond of ____________________________________in the principal amount of
$___________, Certificate No.____________standing in the name of the undersigned on the
books of said Corporation.
The undersigned does (do) hereby irrevocably constitute and appoint Merrill Lynch
Attorney to transfer the said stock(s), bond(s), or debenture(s), as the case may
be, on the books of said Corporation with full power of substitution in the premises.
Signed___________________________________ Date________
Donor
Signed___________________________________Date_________
Donor(joint-owner)
(Affix Medallion Signature Guarantee imprint)------------>
Importance notice
The signature to this assignment must correspond with the name as written upon the face of the
certificate in every particular without alteration or enlargement or any change whatsoever. The
signature of the person executing this power must be guaranteed by an Eligible Guarantor Institution
such as a Commercial Bank, Trust Company, Securities Broker/Dealer, Credit Union, or a Savings
Association participating in a Medallion program approved by the Securities Transfer Association, Inc.
Unfortunately, no other form of signature verification can be accepted.
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