IM-11630. Sample Due-Bill Forms
This rule is no longer applicable. NASD Rule 11000 Series has been superseded by FINRA Rule 11000 Series. Please consult the appropriate FINRA Rule.
| For value received, the undersigned hereby assigns, transfers and sets over to __________________________________ the stock distribution of ______ ( ) shares of _____________________ stock of ______________________________ to be issued on ___________________ to the registered holder of ___________ ( ) shares of _________________ stock of ___________________ represented by certificate number ___________________ , to which the undersigned is entitled as a stock dividend, and hereby irrevocably constitutes and appoints __________________________________ attorney to transfer the shares representing said stock dividend on the books of said corporation, with full power of substitution in the premises. | |
| Dated_________________________________ | |
| _________________________________ | |
| (Official Signature) | |
| For value received, the undersigned hereby assigns, transfers, and sets over to _____________________________________________________ the warrant and/or fractional warrant to which the undersigned is entitled, evidencing the rights to subscribe for _____________________ _________________________ , which warrant and/or fractional warrant is to be issued to the holder of record at the close of business _________________________ of ______________ ( ) shares of ________________________ stock of _______________________ represented by certificate No. _________________ | |
| Dated_________________________________ | |
| _________________________________ | |
| (Official Signature) | |
| This is to certify that, upon issuance of _______________________ in accordance with the plan approved by _________________________ , the undersigned will pay to ______________________________________ $ __________ representing (contingent)(income) interest for ___________ on $ _____ principal amount of said bonds sold to him when, as, and if issued on _____ 19 _____ This due-bill shall become null and void if the contract for sale of said bonds can not be completed in accordance with the plan approved by ___ , on _______________________ | |
| Dated_________________________________ | |
| _________________________________ | |
| (Official Signature) | |
| This is to certify that, upon issuance of _____________________ in accordance with the plan approved by _________________________ , the undersigned will pay to _______________________ $ _____ , representing the dividend of $ _____ per share declared for the period ending 19 _____ , on _____________ shares of _______________________ stock of ____ sold to him when, as, and if issued on _______________________ 19 _____ This due-bill shall become null and void if the contract for sale of said stock cannot be completed in accordance with the plan approved by ____ , on _________________________ | |
| Dated_________________________________ | |
| _________________________________ | |
| (Official Signature) | |
| NEW YORK _________________ , 19 _____ No. 1999 | ||
| X Y Z BANK | ||
| 1-2 ___ 210 | ||
| Pay To The Order Of __________________________________________________ | ||
| $ __________________________________________________ | ||
| DOLLARS | ||
| In Payment of Dividend or Interest | Dividend Account | |
| Interest Account | ||
| On _________________________________________________ | ||
| NOT PAYABLE BEFORE | ___________________ | |
| Record Date __________________________________________ | ||
