EX-4.1 2 ex4_1.htm ENROLLMENT FORM - DRIP (HOLDERS OF COMMON SHARES) Unassociated Document

Exhibit 4.1
 
9th Floor, 100 University Avenue
Toronto, Ontario M5J 2Y1 Canada
Telephone 1-800-564-6253
www.computershare.com
 
 
 
 
 
 


Amended and Restated Dividend Reinvestment Plan – Declaration and Enrollment Form
 



The Proceeds of Crime (Money Laundering) and Terrorist Financing Act (Canada) and the Regulations made thereunder (collectively, the “Act”) require that Computershare Trust Company of Canada (“Computershare”) collect and record specified information on accounts it opens for individuals or entities under a plan.
Please read the Instructions below before completing the Declaration and Enrollment Form.


 
INSTRUCTIONS
In order that Computershare may comply with its legal obligations under the Act, this Declaration and Enrollment Form must be completed in full and signed by all registered holder(s). Otherwise Computershare cannot process your enrollment.


Part A – PARTICIPANT DECLARATION
If a plan account is registered to:
1)
an individual account holder or more than one holder – each individual must complete their Date of Birth and Principal Business or Occupation.

2)
a Corporation – it must mail or hand-deliver this Declaration and Enrollment Form along with a copy of its official corporate records relating to the authority to operate this account. Neither Date of Birth nor Principal Business or Occupation is required to be completed. Mark the applicable account holder status box.

3)
a Trust, Partnership, or an unincorporated Fund or Organization – complete the field for Principal Business or Occupation. Date of Birth is not required to be completed. Mark the applicable account holder status box. As space on this form is limited to two holder declarations and signatures, photocopies of this form may be made if required.


Part B – THIRD PARTY DETERMINATION

In order that Computershare may comply with its legal obligations under the Act, you must check one of the two boxes provided with regard to any third party interest in the account, and fill in the additional fields if required, including a description of the relationship. For example, are you an agent, custodian, attorney, or legal guardian, or otherwise holding the account on behalf of a spouse, relative, business partner or friend?


Part C – ENROLLMENT PARTICIPATION

This section must be completed to process your request for enrollment.

 
 

 
 
9th Floor, 100 University Avenue
Toronto, Ontario M5J 2Y1 Canada
Telephone 1-800-564-6253
www.computershare.com

Registered Name in which account is held (e.g. John Smith)
TOCQ

 
Amended and Restated Dividend Reinvestment Plan – Declaration and Enrollment Form
 

 A – PARTICIPANT DECLARATION

I/We, the account holder(s) named above, hereby certify as follows:

        1) Date of Birth:
   
Principal Business or Occupation:
 
 
Day          Month          Year
   
(e.g. cashier, student, retired, accounting firm)

        2) Date of Birth:
   
Principal Business or Occupation:
 
 
Day          Month          Year
   
(e.g. cashier, student, retired, accounting firm)

and that the account holder is (Check the appropriate account holder status box, if applicable):

o
a Corporation, Trust, Partnership, or an unincorporated Fund or Organization (Required documents enclosed, as applicable)
o
a Financial Entity or Securities Dealer and is exempt from Third Party Determination in Section B below. (Proceed to part C)

B – THIRD PARTY DETERMINATION – Check one of the two boxes below. If the second box is marked, you must provide the information

o
This account is not
intended to be used
by, or on behalf of, a
3rd party.
o
This account is intended to be used by, or on behalf of, a 3rd party and I have completed the required information fields below.
   
Name of 3rd party:                                                                                                                                                                                               
   
Address of 3rd party:                                                                                                                                                                                          
   
Date of Birth of 3rd party (if an individual):                                                                                                                                                    
     
Nature of Principal Business or Occupation of 3rd party:                                                                                                                            
     
If 3rd party is a Corporation, provide incorporation number and place of issue:                                                                                      
     
Describe relationship between account holder and 3rd party, in respect of the account:                                                                       
 
C – ENROLLMENT PARTICIPATION

I/We wish to participate in FULL Reinvestment. I/We acknowledge that all dividends/distributions payable by Thomson Reuters Corporation on all common shares of Thomson Reuters Corporation now held or any future holdings in this account will be reinvested.

By enrolling and participating in the Amended and Restated Dividend Reinvestment Plan of Thomson Reuters Corporation (the “plan”), I/we confirm that I/we are a holder of common shares and I/we have read, fully understand and agree to be bound by the terms and conditions of the plan, along with the prospectus or brochure that governs the plan. I/We agree that participation in the plan will continue until I/we notify Computershare in writing that I/we desire to terminate participation. I/We acknowledge that participation in the plan, including withdrawals from the plan, will be subject to the terms and conditions of the plan, along with the prospectus or brochure that governs the plan. I/We also confirm the completeness and accuracy of the information I/we have provided in this Declaration and Enrollment Form.

To be valid, this form must be signed by all registered account holder(s) or applicable authorized individual(s). If you do not sign and return this form, you will continue to receive dividend/distribution payments in cash.
 
Signature 1 - Please keep signature within the box
 
Signature 2 - Please keep signature within the box
 
Day Month Year
   
 
Privacy Notice

Computershare is committed to protecting individuals’ personal information. In the course of providing our services, we receive non-public personal information - from transactions we perform for investors, forms sent to us, other communications we have with investors or representatives, etc. This information could include name, address, social insurance number, social security number, securities holdings and other financial information. We use this to administer investor accounts, to better serve investors’ and clients’ needs and for other lawful purposes relating to our services. We have prepared a Privacy Code to tell you more about our information practices and how personal information is protected. It is available at our website, www.computershare.com, or by writing us at 100 University Avenue, Toronto, Ontario, M5J 2Y1, Canada.


Please return completed form to:
Computershare, 9th Floor, 100 University Ave, Toronto, Ontario M5J 2Y1, Canada