THE WALT DISNEY COMPANY STOCK POWER

THE WALT DISNEY COMPANY - STOCK POWER

Mailing Address (standard mail):

Mailing Address (registered, certified or

Disney Shareholder Services

overnight mail): Disney Shareholder Services

500 South Buena Vista - MC9722

611 N Brand Blvd, Suite 6100

Burbank CA 91521-9722

Glendale CA 91203

TRANSFER FROM EXISTING ACCOUNT

Questions: Phone: (818) 553-7200

Account Number

Account Name/Registration

NUMBER OF SHARES TO TRANSFER

Social Security # / EIN Daytime Phone#

Transfer ______ shares represented by the Transfer ______ book entry shares from the

enclosed stock certificates

WDIP or ESPP account (circle one)

Transfer ______ book entry shares from Direct Registration (DRS)

TRANSFER TO ANOTHER OR NEW ACCOUNT

Please print the name(s), address and Tax Payer ID # of the person(s) to whom these shares are to be transferred. Refer to

the "Transfer Options" (item 3) under the "Transfer Request Steps" for additional information.

Name of New Owner(s):

Address:

Tax Payer ID #:

Existing Account # (if applicable)

Check Applicable Transfer Box: Gift Transfer - OR - Inheritance Transfer Date of Death ____________________

AUTHORIZATION

I(we) hereby irrevocably constitute and appoint The Walt Disney Company attorney to transfer the said stock on the books of The

Walt Disney Company.

All Owners MUST sign. If NOT owner, MUST STATE CAPACITY. Examples: Custodian, Successor Custodian, Exec/Admin of Estate,

Conservator, Trustee, Successor Trustee, Guardian, Surviving Joint Tenant, Sole Heir in Small Estate, Awarded by Court, Power Of Attorney

Affix Medallion Signature Guarantee below Guarantors are required to retain all documentation

supporting this transfer request.

Legal Shareholder Signature(s):

X____________________________________________________________________ Signature of Registered Owner ? If Agent, STATE CAPACITY TO ACT Date

X____________________________________________________________________

Signature of additional Registered Owner(s) if jointly owned

Date

IMPORTANT: Unless signing in agent capacity, signature(s) must correspond with the name(s) exactly as shown on the Certificate or account and be signed in the presence of an authorized representative of a commercial bank, securities broker-dealer or other financial institution that participates in an approved Medallion Guarantee Program pursuant to SEC Rule 17 Ad-15. Notarized signatures are not acceptable.

IMPORTANT ? Transfer request may be rejected IF: Stock Power is NOT MEDALLION GUARANTEED Stock Power signed by someone other than the registered owner and there is NO STATED CAPACITY TO ACT. For a request where the owner(s) is deceased, there is no Inheritance Tax Waiver if required by State

GUARANTOR INSTITUTIONS ARE REQUIRED TO MAINTAIN ALL SUPPORTING LEGAL DOCUMENTATION LEGAL DOCUMENTATION WHICH ACCOMPANIES A TRANSFER REQUEST TO DISNEY WILL NOT BE REVIEWED OR RETURNED

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download