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Assignment of Stock Certificate (United States)

This is a form to transfer a stock certificate. The form provided here is simply a sample of what the actual form looks like.


For value received, I, ____________(1)______________,

of __________(2)___________,

assign to ________(3)_______,

of ________(4)__________,

assignee ______(5)_______

shares of stock of __________(6)___________, which shares stand in my name on the books of such corporation and are represented by

certificate No. ________(7)__________.

I warrant that the assigned certificate is genuine and, to my knowledge, valid, and that I have the legal right to transfer it.

I appoint assignee my attorney in fact to effect a transfer of the assigned shares on the books

of _______(8)_______ with full power of substitution in the premises.

Dated _________(9)___________, _______(10)________.


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