Share Transfer Form

Covenant House Toronto
20 Gerrard Street East
Toronto, ON M5B 2P3
Tel: (416) 598-4898
Donor Services: (800) 435-7308
Fax: (416) 204-7030
CovenantHouseToronto.ca

"*" indicates required fields

Transfer Instructions

Client Name:	Covenant House Toronto	Account#: 415-07722-10
Receiving Institution Information:	CIBC Wood Gundy BCE Place, 161 Bay Street, 4th Floor Toronto, Ontario M5J 2S8 Broker: Bryan Baker: (416) 594-7954
Delivery Instructions:	FINS#: T079 CUID: WGDB FEDWIRE: BK OF NYC/WGI DEALER#: 9280	DTC#: 5030 EUROCLEAR#: 10034 ABA#: 021000018

Please call Christine at 416-204-7062 to discuss valuation of a stock that is not easily liquidated or considered highly volatile. Covenant House Toronto reserves the right to decline a donation of securities.

Upon receipt the donated shares will be valued at their closing price as of the date of the donation and a tax receipt will be issued for this amount, in accordance with Canada Revenue Agency’s tax receipting guidelines.

Share Transfer Notification

It is important that you or your broker alert us via email or phone that the gift is being transferred to our account, as the stock will arrive in our account without identification.Please provide the information below to Christine Foisy-Monk, Director of Development at foisymonk@covenanthouse.ca or 416-204-7062⁠

This information will help us acknowledge your gift appropriately. An asterisk ("*") denotes required fields.

Donor Name*

First Last

Address*

Street Address City Province Postal Code

Phone Number

Email Address

Donated Security:

# of Shares

Donated Security:

# of Shares

Donated Security:

# of Shares

Date*

Signature*

The Standards Program Trustmark is a mark of Imagine Canada used under licence by Covenant House Toronto.
Charitable Registration Number 10699 0195 RR0001