Get Aflac Direct Registration System Form

Transfer to Broker Form Section I Transferor Information Account Name Account Number Address Address line 2 City State Social Security Number / Tax ID Number Phone Number ZIP Section II Brokerage Account Information Information DRS is an acronym for Direct Registration System. Aflac Incorporated does not charge a fee for this transaction however you should check with your broker to confirm if there will be any fees imposed by your broker for accepting shares through this system. The only other alternative to requesting Aflac Incorporated to transfer shares to your brokerage account is to have your broker initiate the pickup of shares via the same DRS Profile System from your AFL Stock Plan account. The brokerage firm will require you to provide your AFL Stock Plan Account Number and possibly other identifying information* If your brokerage firm is DRS eligible they can request for the shares electronically through the DRS Profile System* Please note that Aflac Incorporated Shareholder Services is a Stock Transfer Agent and not a brokerage firm* SSN/Tax ID Name of Brokerage Firm Brokerage Account Number Broker s DTC Depository Trust Company 4-digits Number of Share s to Transfer Please indicate number of share s not a dollar amount. Affix Medallion Signature Guarantee below Legal Shareholder Signature s IMPORTANT Transfer request will be rejected if Stock Assignment is not Medallion Guaranteed unless signer is surviving joint tenant or minor of age and is removing deceased or custodian names only. All owners must sign* If signer is not the owner he or she MUST STATE THE CAPACITY. Example Custodian Executor Administrator Trustee Guardian X Signature of registered owner. If Agent/Executor state capacity to act. Date Signature of additional registered owner s if jointly owned* Important Read Carefully The signature of the person executing this power must be guaranteed by an Eligible Guarantor Institution such as a Commercial Bank or Securities Broker/ Dealer participating in the Medallion Program pursuant to SEC Rule 17 Ad-15. NOTARIZED SIGNATURES ARE NOT ACCEPTABLE* Most major banks will provide this service. Be aware that each financial institution s Medallion Signature Guarantee contains a maximum dollar value that it covers. The Medallion Signature Guarantee must be sufficient to cover the value of shares being transferred* Additional information on this can be obtained from your financial institution* Mail to Attn Shareholder Services 1932 Wynnton Road Columbus GA 31999 Call us 800. The brokerage firm will require you to provide your AFL Stock Plan Account Number and possibly other identifying information* If your brokerage firm is DRS eligible they can request for the shares electronically through the DRS Profile System* Please note that Aflac Incorporated Shareholder Services is a Stock Transfer Agent and not a brokerage firm* SSN/Tax ID Name of Brokerage Firm Brokerage Account Number Broker s DTC Depository Trust Company 4-digits Number of Share s to Transfer Please indicate number of share s not a dollar amount. Affix Medallion Signature Guarantee below Legal Shareholder Signature s IMPORTANT Transfer request will be rejected if Stock Assignment is not Medallion Guaranteed unless signer is surviving joint tenant or minor of age and is removing deceased or custodian names only.