EX-99.2D 14 ex2-div.txt EXHIBIT 2(D)(IV) EXHIBIT (d)(iv) BROKER SPLIT REQUEST BOULDER GROWTH & INCOME FUND, INC. SUBSCRIPTION RIGHTS BROKER SPLIT REQUESTS Colbent Corporation Attn: Corporate Actions P.O. Box 859208 Braintree, Massachusetts 02185-9208 Telephone: (781) 843-1833 Ext. 203 Facsimile: (781) 380-3388 Confirm: (781) 575-4816 If you require that your Rights certificate be issued in various denominations, please indicate your request for breakdown below and return this form to us, either by facsimile at the above number or by mail at the above address. *Total Share Position __________________________________ (this will be verified on the Record Date) No. of Cards to be issued x No. of Rights Total Cards ____________ Total Rights ____________ Please advise us where to forward the Rights certificates, by completing the following information: Contact Name: ------------------------------------------ Address: --------------------------------------------- --------------------------------------------- --------------------------------------------- Telephone Number: -------------------------------------- *Please note: this number should not include any shares which are held by you through DTC.