Stock Power Template

For Value Received, the undersigned hereby sells, assigns, and transfers the shares described below and irrevocably appoints [Transfer Agent Name, if applicable] as attorney-in-fact to transfer the said shares on the books of the corporation.

1. Shareholder Information

Current Shareholder / Assignor Name: [Full Name]
Address: [Address]
City, State, ZIP Code: [City, State, ZIP Code]

2. Corporation Information

Corporation Name: [Company Name]
State of Incorporation, if known: [State]

3. Certificate Information

Stock Certificate Number: [Certificate Number]
Number of Shares Represented: [Number]

Class or Series of Shares, if applicable:

[Common Stock / Preferred Stock / Other]

4. Transferee Information

The shares described above are transferred to:

Transferee / Assignee Name: [Full Name / Company Name / Trust Name]
Address: [Address]
City, State, ZIP Code: [City, State, ZIP Code]

Tax ID, account number, or registration details, if applicable:

[Insert details]

5. Transfer Instructions

The undersigned assigns and transfers:

☐ all shares represented by the certificate listed above
☐ only [Number] shares represented by the certificate listed above

If less than all shares are transferred, additional issuance instructions are:

[Describe replacement certificate or remaining shares instructions]

6. Registration of New Ownership

The shares shall be registered in the following name and manner:

[Insert exact registration name]

If joint ownership, trust ownership, custodial ownership, or other special registration applies, describe it here:

[Insert details]

7. Authority and Representations

The undersigned states that:

the undersigned is the lawful owner of the shares being transferred;
the undersigned has the authority to transfer the shares;
the shares are transferred subject to any restrictions, agreements, legends, or applicable law that may apply;
the information in this Stock Power is true and correct to the best of the undersigned’s knowledge.

8. Signature

Date: [Date]

Shareholder / Assignor Signature: __________________________
Name: [Full Name]

Printed Name Exactly as Appears on Certificate:

[Printed Name]

9. Medallion Signature Guarantee or Transfer Authentication

If required for transfer, complete the following:

☐ Medallion Signature Guarantee attached
☐ Transfer agent authentication required
☐ Not applicable
☐ other: [Describe]

Institution Name, if applicable:

[Institution Name]

10. Witness or Notary

Witness Signature, if needed: __________________________
Name: [Full Name]
Date: [Date]

Notary, if required:

State of [State]
County of [County]

On this [Day] of [Month], [Year], before me, the undersigned notary public, personally appeared [Name of Signer], known to me or satisfactorily proven to be the person whose name is subscribed to this instrument, and acknowledged that they executed the same for the purposes stated herein.

Notary Public Signature: __________________________
Name: [Notary Name]
My Commission Expires: [Date]

11. Additional Transfer Notes

Additional notes, restrictions, or transfer instructions, if any:

[Insert details]