Change, Update or Request a Replacement Stock Certificate

If you need to change, update or request a replacement stock certificate, please download and fill out the Notification Form below and return it to the address listed.

Notification Form

UTG
Stock Transfer Department
P.O. Box 13080
Springfield, IL 62791-3080

Download

Please note, to process a change in registration, you will need the following:

  • A valid stock certificate(s) of the shares to be transferred.
  • Medallion Signature Guarantee

    All requirements for transfer of securities include the Medallion Signature Guarantee. The Medallion Signature Guarantee is an insurance backed, mechanically affixed medallion image. Through an arrangement between the Stock Transfer Association and the American Bankers Association the Medallion Signature Guarantee Program was created.Members of the program obtain stamps with a seal bearing the words “Medallion Signature Program”, the name of the guarantor, and identification numbers. The impression has specially colored ink.

    Participating members are issued a tamper-proof machine and an exclusively numbered medallion plate. When presented with the stock, the guarantor affixes the medallion impression on each certificate. This procedure replaced the manual signature guarantee when the law became effective in 1992. The program has surety bond coverage.Someone in our Shareholder Relations Department can assist you in locating a member of the Medallion Guarantee Program.

    If you wish to see the Securities and Exchange Commissions rule on the Medallion Signature Guarantee requirement, please click on the link below.

    Rule 17Ad-15 under the Securities Exchange Act of 1934

  • Completed Stock Power

    You may download these forms below.
    Stock Power Form
    Interactive Stock Power Form
    Note: Adobe Acrobat Reader is required to view these forms. If you do not have Acrobat installed on your machine, you can download it for free from the Adobe site here.To complete the form:

    1. Complete name and address of the new owner(s)/transferee or heir(s). If selling shares back to the Company, write in UTG, Inc. on this line.
    2. Complete social security number of new owner(s) or tax identification number if business If selling to the Company, leave blank.
    3. Check type of registration, if selling to the Company do not complete.
      • IND – Individual – registered in an individual’s name only
      • JT TEN – Joint Tenants – Upon death of one tenant, the surviving party takes title immediately without the necessity of Court Orders or Letters of Testamentary.
      • TOD – Transfer on Death – Upon the death of the owner, the shares may be transferred to the designated Beneficiary (only one beneficiary may be named) without the necessity of Court Orders or Letters of Testamentary.
      • CORP – Corporation – registered to a corporation.
    4. Number of shares owned
    5. Fill in certificate number(s)
    6. Signature of old owner(s) or Executor(s)
    7. IMPORTANT: The signature(s) are the assignor(s) must be guaranteed by an eligible guarantor institution (bank, stock broker, savings and loan association or credit union) with membership in an approved signature guarantee medallion program pursuant to Securities and Exchange Commission Rule 17Ad-15.Please contact our stock transfer department at 1-217-241-6410, extension 410 if you are unable to locate a participant in your area. Then mail the completed form to:Stock Transfer Department
      UTG
      5250 South Sixth Street
      P.O. Box 5147
      Springfield, IL 62705

In the case of a Shareholder’s Death (Joint Tenants), you will need:

  • Certified Copy of the Death Certificate
  • Valid Stock Certificate
  • W-9 Form
  • Affidavit of Domicile

    You may download these forms below.
    Affidavit of Domicile Form
    Example Form filled out
    Interactive Affidavit of Domicile FormNote: Adobe Acrobat Reader is required to view these forms. If you do not have Acrobat installed on your machine, you can download it for free from the Adobe site here.To complete the form:
    Insert the State and County names where indicated.

    1. The authorized signer must insert his name and address where indicated.
    2. Indicate the title of the signer by marking one: Executor, Administrator, or survivor.
    3. Insert the name of the decedent and the date of death.
    4. Paragraphs two and three are for the legal residence of the decedent and the number of years at that residence.
    5. The registered name on the stock goes on the blank in paragraph five.
    6. The authorized signer must sign on the line indicated and have his signature notarized.

    Then mail the completed form to:
    Stock Transfer Department
    UTG
    5250 South Sixth Street
    P.O. Box 5147
    Springfield, IL 62705

For additional assistance, you can contact us at (217)241-6410 or by e-mail at stock.transfer@utgins.com.

How do I request policy information, including policy values?