Draft Letter of Intent

Date

John Smith
Broker
ABC Securities
123 Smith St
Ottawa ON A1B 2C3

Dear Mr. Smith

It is my intent to donate ( number ) of ( name ) shares (or a sufficient number of shares to value approximately $_____ ) to The Ottawa Hospital Foundation. To my knowledge, these shares are not subject to restrictions on their sale or disposition and I am not aware of any material undisclosed information concerning the shares.

I request that the transfer of these shares from my account # ______ to RBC Dexia account # 162176001, CUID # RTRA [or account # 162176002, DTC # 901 if transferring US securities] occur by (date). It is also my wish that my donation be designated to (include name of campus/department/ endowment fund/project etc. ).

My current address and contact information is:

Address
City Prov
Postal Code
Home Telephone
Business Telephone
E-mail

The name and contact information of my financial representative is:

Name, Title
Company
Address
City Prov Postal Code

Business Telephone
Business Fax
E-mail

Signed by donor

cc: Susan McIntosh, Planned Giving Officer, The Ottawa Hospital Foundation (613-761-5014)