Donations of Securities Form 2026
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[[page 1]] Gifts of Publicly Listed Securities ISLANDS TRUST CONSERVANCY Share Transfer Form 200-1627 Fort Street, Victoria, BC V8R 1H8 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): | understand that | will receive a donation-in-kind tax receipt for these securities from Islands Trust Conservancy. These securities have been donated to Islands Trust Conservancy without restriction and can be sold by them at their discretion. Signature of Donor: Date: Islands Trust Conservancy Receiving Firm: iA PRIVATE WEALTH INC., ACCOUNT TRANSFERS DEPARTMENT 26 WELLINGTON STREET EAST, SUITE 600 TORONTO, ONTARIO, M5E 182 FAX: 1-833-253-3764 EMAIL: accounttransfers@iagto.ca DEALER/REP: 7923/SBW1_ FINS: T080 DTC #:5008 CUID: NBCS CLEARSTREAM: 37220 Account Number: 37B8HGA Name of Account: ISLANDS TRUST CONSERVANCY Qualified Donee: Business #122013576 RT0001. The Islands Trust Conservancy is a Crown agent and therefore considered a Qualified Donee under section 149.1 (1) of the Income Tax Act. A checklist for your reference: O _s~Prior to initiating the transfer of securities, please contact the Islands Trust Conservancy, to ensure that your gift is handled smoothly and efficiently. See below for contact information. O Notify your financial advisor of your intention to make a gift of securities. O_— Give your financial advisor authorization to initiate the transfer on your behalf. This form, completed and signed, should be sufficient for authorization, or your advisor may be required to use a form provided by their firm. Thank you for your generous support of Islands Trust Conservancy! Islands Trust Conservancy Phone: (250) 405-5191 200 — 1627 Fort Street, Victoria, BC V8R1H8 Email: itcmail@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. Form revised July 2026
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