123 Smith St
Ottawa ON A1B 2C3
Dear Mr. Smith
It is my intent to donate ( number ) of ( name ) shares (or a sufficient number of shares to value approximately $_____ ) to The Ottawa Hospital Foundation. To my knowledge, these shares are not subject to restrictions on their sale or disposition and I am not aware of any material undisclosed information concerning the shares.
I request that the transfer of these shares from my account # ______ to RBC Dexia account # 162176001, CUID # RTRA [or account # 162176002, DTC # 901 if transferring US securities] occur by (date). It is also my wish that my donation be designated to (include name of campus/department/ endowment fund/project etc. ).
My current address and contact information is:
The name and contact information of my financial representative is:
City Prov Postal Code
Signed by donor
cc: Heather McLean Vice President, Development and Corporate Philanthropy, The Ottawa Hospital Foundation (613-761-5014)