What do do if you lose your stock certificate

Do not despair if you want to sell or transfer your shares, but are unable to locate your original stock certificates. You may download an Affidavit of Lost Stock Certificate(s) to replace your original stock certificate(s).

NOTE: you may be required to provide the Company with a Lost Securities Bond. Contact us if you have any questions about a lost securities bond.

If you are unable to locate your original stock certificates, you may use an Affidavit of Lost Stock Certificate(s) in its/their place. This affidavit may be used in lieu of one or more original stock certificates for the following cases:

• Transfering ownership of the stock
• Selling (tendering) your stock to the Company

REMEMBER: If you are unable to locate the original certificates you may be required to provide the Company with a Lost Securities Bond. Contact us for further information about the requirements for a lost securities bond.

ADDITIONAL NOTE: An Affidavit of Lost Stock Certificate(s) must be signed by the owner of the certificate(s) and his/her/their signature(s) must be witnessed by a valid Notary Public.

• Open the Affidavit of Lost Stock Certificate(s) form below in Adobe Acrobat Reader;
• Fill out the fields in the form and then print it out;
• Have a Notary Public witness your signature;
• Mail the form to the Company home office: American Savings Life Insurance Company
  935 East Main Street,  Suite 100
  Mesa,  AZ  85203-8849

If you have any questions, please Contact Us.