Notice of Intent to Transfer Stock to the National Academies

Complete this form and send a copy to both Bear Sterns and the Development Office.

David Blinder Account Executive for National Academies Bear Stearns and Companies, Inc. 3424 Peachtree Road NE, Suite 1700 Atlanta, GA 30326-9983 Phone: 1-800-235-3162 or 404-842-4400 Fax: 404-842-4535 Assistant: Mary Carol MacDonald Fax: 404-995-4904 Account # 05048145 DTC # 352

Cheryl Czapp Office of Development The National Academies 2101 Constitution Avenue NW Washington DC 20418 cczapp@nas.edu Phone: 202-334-2431 Fax: 202-334-2229 National Academies Tax IDs # 53 0196932 - IOM/NAS/NRC # 23 7284092 - NAE

Donor Information

Donor’s Name: ___________________________________________________

Donor’s Address: _________________________________________________

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________________________________________________________________

Donor’s Telephone Number: _________________________________________

Does the donor wish to remain anonymous? _______________

Gift Information

Date Securities Transferred: ________________________________________

Name of Security(ies) and Number of Shares:

________________________________________________________________

________________________________________________________________

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Gift Designation and Purpose, if any (e.g. NAS Endowment, NRC Program Support):

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Transferring Broker Information

Broker’s Name: __________________________________________________

Brokerage: ______________________________________________________

Telephone: ______________________________________________________