Donations of Securities Form

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*Form revised March 2024 
 
Gifts of Publicly Listed Securities 
Share Transfer Form 
Donor 
 
Name: _____________________________________________________________________________________________ 
 
Address: ___________________________________________________________________________________________ 
 
City, Province: _____________________________________________________ Postal Code: ____________________ 
 
Daytime Phone Number: __________________________ E-mail: ___________________________________________ 
 
Donor’s Account 
 
Financial Institution: _____________________________________________ Account Number:___________________ 
 
Name of Financial Advisor: _______________________________ Contact Phone Number: ____________________ 
 
Donation 
 
Name of Security: __________________________________ Quantity: _________ CUSIP/ISN: __________________ 
 
Name of Security: __________________________________ Quantity: _________ CUSIP/ISN: __________________ 
 
Allocation of Donation (optional): _____________________________________________________________________ 
 
 
 
 
 
 
 
 
 
Islands Trust Conservancy 
Receiving Firm:  iA Private Wealth Inc. 
Dealer/Rep #: 7923/SBW1        FINS: T089        DTC #: 5008 
CUID: NBCS       CLEARSTREAM: 37220 
Account Number:   37B8HGA 
Name of Account:  Islands Trust Conservancy 
Charitable Registration Number:  12201 3576 RR0001 
 
 
 
 
 
 
 
 
 
 
 
Thank you for your generous support of Islands Trust Conservancy! 
Islands Trust Conservancy      Phone: (250) 405-5191        Fax: (205) 405-5155 
200 – 1627 Fort Street, Victoria, BC   V8R 1H8      Email: kemmings@islandstrust.bc.ca 
 
Freedom of Information 
Personal information contained on this donation form is collected under the authority of the Islands Trust Act Section 42 (2) (a),and is subject to the Freedom of Information and 
Protection of Privacy Act. The personal information will be used for purposes associated with the Islands Trust Conservancy’s Strategic Charitable Giving Program. Enquiries 
about the collection or use of information in this form can be directed to the Islands Trust Conservancy Manager at (250) 405-5191. 
 
I understand that I will receive a gift-in-kind tax receipt for these securities from Islands Trust Conservancy for the 
closing price on the date these securities are received in the charity’s account.  These securities have been donated to 
Islands Trust Conservancy without restriction and can be sold by the charity at their discretion. 
Signature of Donor:                                                                                              Date:                                                   
A checklist for your reference: 
 
     Please call Islands Trust Conservancy prior to initiating the transfer of securities, to ensure that your gift is handled 
smoothly and efficiently.   (250) 405-5191 
     Notify your financial advisor of your intention to make a gift of securities. 
     Give your financial advisor autho

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