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This rule is no longer applicable. NASD Rule 11000 Series has been superseded by FINRA Rule 11000 Series.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.

(a) Due-Bill for Stock Dividend or Stock Distribution

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)

(b) Due-Bill for Rights

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)

(c) Due-Bill for Interest on When Issued Contract

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)

(d) Due-Bill for Dividend on When Issued Contract

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)

(e) Due-Bill Check

Consider this check as due-bill until payable date as shown below

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 __________________________________________