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.
Account Name
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
X _____________________________________________
Signature of additional registered owner(s), if jointly owned.
Date
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:
Aflac Incorporated
Attn: Shareholder Services
1932 Wynnton Road
Columbus, GA 31999
Call us:
800.227.4756
Visit us:
investors.aflac.com