To assist Chalice in processing your donation in a timely manner, please fill out and submit this form online, or print it out and then fax or email it to us, prior to transferring securities.

Chalice (Canada)
101-26 Union Street
Bedford, NS   B4A 2B5
Attn: Marilyn Hall, Annual Giving Specialist
Toll Free: 1-800-776-6855, ext. 202
Fax: 1-902-252-3644
email: marilynhall@chalice.ca

Donor Information - Name of Owner of Securities for charitable receipting purposes:

Transfer Intent Form

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You will receive verbal or email confirmation when your donation is received in our office and a Gift-in-Kind charitable tax receipt through the mail recognizing the value of your donation in February of the calendar year following the year of donation.

*Please be advised that the value of the donation receipt will be based on the closing price of the securities on the day that they are received into our account in accordance with Canada Revenue Agency (CRA) regulations.
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