Instructions:
Please complete the form below as needed to indicate the action desired for owned issues.
All submissions must be on the participant's letterhead and must have that participant's medallion stamp.
I you can use a template form, one is available in the User Documents section of
You may submit completed forms via email to
or
Postal mail to
55 Water St.
New York, NY10041
Attn Proxy Demand and Dissent,
or
Via fax to any of the following numbers:
212-855-5181
212-855-5182
212-855-5183
813-470-1096
For questions or additional forms, send requests via electronic mail to:
DEMAND TO CALL A SPECIAL MEETING
(Participant Letterhead)
Date
The Depository Trust Company
55 Water Street
New York, NY 10041
Attn: Proxy Department
RE: (Insert description of issue with cusip number)
(Insert DTC Participant account number)
Gentlemen:
Please cause your nominee, Cede & Co., to sign the attached written request to call a special meeting of shareholders (The “Special Meeting Request”), with respect to (Amount of Shares) shares of the above-referenced securities credited to our DTC Participant account at (Date).
In addition to acknowledging that this request is subject to the indemnification provided for in DTC Rule 6, the undersigned certifies to DTC and Cede & Co., that the information and facts set forth in the attached Special Meeting Request are true and correct, including the following:
- The number of shares credited to our DTC Participant account that are beneficially owned by our customer.
- There have been no prior requests to DTC and Cede & Co., for the execution of a request similar to the attached Special Meeting Request with respect to the shares referred to therein; and
- The purposes for the call of the special meeting are as stated in the attached Special Meeting Request.
Please make the Special Meeting Request available for pick-up by (contact at Participant) or Federal Express to (Address & contact at Participant). Our Federal Express account number is .
Very truly yours,
(Insert name of Participant)
BY: (manual signature of authorized person)
(Type signer’s name)
(Type signer’s title)
Medallion Stamp
Cede & Co.
C/o The Depository Trust Company
55 Water Street
New York, NY 10041
Date
Name of Company
Address of Company
Contact Person and Title
Attention:
Cede & Co., the nominee of The Depository Trust Company (“DTC”), is a holder of record of shares of common stock (Name of Issue) (the “Company”). DTC is informed by its Participant, (Name of Participant) (the “Participant”), that on the date hereof (Amount) of such shares (the “Shares”) credited to Participant’s DTC account are beneficially owned by (Customer Name) a customer of Participant.
At the request of Participant, on behalf of (Customer), Cede & Co., as a holder of record of the Shares, hereby request that you call a special meeting of the shareholders of the Company for the purposes of (Reason for Meeting).
The undersigned further request that, at such time as the Company has received requests from other shareholders who, together, hold in excess of (Percentage) of the Company’s outstanding stock, the Company set a date for such a special meeting, to a date not greater than 35 days after receipt of sufficient shareholder requests, in order to allow sufficient time for the solicitation of proxies and dissemination of proxy materials for use at such meeting.
While Cede & Co., is furnishing this request as the shareholder of record of the Shares, it
Does so only at the request of Participant and only as a nominal party for the true party in
Interest, (Name of Customer). Cede & Co., has no interest in this matter other than to
Take those steps, which are necessary to ensure that (Customer) is not denied his rights as
The beneficial owner of the Shares, and Cede & Co., assumes no further responsibility in
this matter.
Very truly yours,
Cede & Co
Dated:BY:______