Shareholder Service
Stock Power Form

 To complete the form:

1. Complete name and address of the new owner(s)/transferee or heir(s). If selling shares back to the Company, write in UTG, Inc. on this line.
   

2. Complete social security number of new owner(s) or tax identification number if business If selling to the Company, leave blank.
   

3. Check type of registration, if selling to the Company do not complete.
   

• IND – Individual - registered in an individual’s name only
  




• JT TEN – Joint Tenants – Upon death of one tenant, the surviving party takes title immediately without the necessity of Court Orders or Letters of Testamentary.
  




• TOD – Transfer on Death – Upon the death of the owner, the shares may be transferred to the designated Beneficiary (only one beneficiary may be named) without the necessity of Court Orders or Letters of Testamentary.
  




• CORP – Corporation – registered to a corporation.
  

 

4. Number of shares owned
   

5. Fill in certificate number(s)
   

6. Signature of old owner(s) or Executor(s)
   

7. IMPORTANT: The signature(s) are the assignor(s) must be guaranteed by an eligible guarantor institution (bank, stock broker, savings and loan association or credit union) with membership in an approved signature guarantee medallion program pursuant to Securities and Exchange Commission Rule 17Ad-15.
   
   Please contact our stock transfer department at 1-800-248-8841, extension 410 if you are unable to locate a participant in your area. Then mail the completed form to:

   Stock Transfer Department UTG 5250 South Sixth Street P.O. Box 5147 Springfield, IL 62705

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