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Change Request Form CHANGE REQUEST FORM Please contact the Gift Fund for additional information by calling (888) 213-7605 during normal business hours (Monday-Friday, 8:30am-5:00pm ET) or sending an email to [email protected]. When your form is complete, please review it, sign it, and send it via mail, email, overnight delivery or fax to: Women’s Foundation of Southwest Florida Donor Advised Fund Program c/o BNY Mellon Charitable Gift Fund 201 Washington Street Suite 024-0062 Boston, MA 02108 Email: [email protected] Fax to (866) 231-7663 Change Requested (Select All That Apply): Address/Contact Account Name (can only be changed by Donor/Primary Adviser or Joint Adviser) Investments (can only be changed by Donor/Primary Adviser or Joint Adviser) 1. DONOR ADVISED FUND ACCOUNT Donor Advised Fund Account Name: Donor Advised Fund Account Number: - 1 - 2. CHANGE OF ADDRESS/CONTACT INFORMATION Name: (First) (Middle) (Last): Home/Legal Street Address (no P.O. Boxes): City, State, Zip Code: Country (if not United States): Mailing Address (if different from above): City, State, Zip Code: Country (if not United States): Home Telephone Number: Business Telephone Number: Email Address: 3. CHANGE OF DONOR ADVISED FUND ACCOUNT NAME The Donor/Primary Adviser and Joint Adviser have the option to change the name of the Account. The Gift Fund will review and must approve the name for an Account. The Gift Fund recommends using “Fund” in the name to signify the separate nature of the Account. To preclude certain legal implications, the words “Foundation,” “Trust,” or “Endowment,” should not be used to designate Accounts. Grants made by the Gift Fund to a charitable recipient are accompanied by an acknowledgment letter, which will reference the Account name, unless anonymity is specifically requested. Proposed New Account Name: - 2 - 4. CHANGE OF RECOMMENDED INVESTMENTS The Donor/Primary Adviser and Joint Adviser have the option to change the investment alternative every 6 months. The Gift Fund invests the proceeds of contributions pursuant to the Gift Fund’s Investment Policy outlined in the Gift Fund’s Policies and Guidelines and has the sole responsibility and authority for investing the Account’s assets. The Gift Fund reserves the right to review the recommended investment alternative and allocation and reserves the right to modify, in whole or in part, such recommendation. Investment Alternatives Investment % (+/- 10%) Cash Reserve 100% Cash Maximum Income 100% Fixed Income Income 30% Equity / 70% Fixed Income Growth and Income 60% Equity / 40% Fixed Income Growth 70% Equity / 30% Fixed Income Aggressive Growth 80% Equity / 20% Fixed Income *ESG Maximum Income 100% Fixed Income *ESG Income 30% Equity / 70% Fixed Income *ESG Growth and Income 60% Equity / 40% Fixed Income *ESG Growth 70% Equity / 30% Fixed Income *ESG Aggressive Growth 80% Equity / 20% Fixed Income Total Percentage Must Equal 100% BNY Mellon, N.A. is the investment manager of the Fund and makes available to the Fund investment products that are sponsored, distributed, or provided by companies that are affiliates of BNY Mellon, N.A. - 3 - 5. SIGNATURE I hereby certify that all information represented in this Change Request Form is accurate, true, and complete. Printed Name Signature Date BNY MELLON CHARITABLE GIFT FUND is a service mark of The Bank of New York Mellon Corporation. ©2017 BNY MELLON CHARITABLE GIFT FUND. All rights reserved. - 4 - .
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