Thank you for your interest in making a gift of corporate US stock to Gates Philanthropy Partners (GPP).

To initiate the process, please complete the form below.

Donor information

First Name

Last Name

Street address

City

State

Zip code

Country

Phone number

Email address

Additional information or notes:

Stock Information

Brokerage firm

Broker name

Broker phone number

Number of shares

US Stock Ticker Symbols

Donor Acknowledgment

By signing below, I confirm that:

I am the legal owner of the shares described above and have the authority to donate them.

The shares are not "restricted securities" under Rule 144."

The shares have been held for more than one year and were not acquired from from the issuer or an affiliate privately.

The shares are freely tradeable and not restricted under law or contract.

I am not an affiliate of the company and possess no material nonpublic information.

I understand the GPP's policy is to sell donated securities as soon as possible after receipt.

Donor signature

Date

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