"Deposit/Substitution Request Form" - New Jersey

Deposit/Substitution Request Form is a legal document that was released by the New Jersey Department of Banking and Insurance - a government authority operating within New Jersey.

Form Details:

  • Released on June 1, 2015;
  • The latest edition currently provided by the New Jersey Department of Banking and Insurance;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the New Jersey Department of Banking and Insurance.

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Date______________
Rev. – DOBI 6.2015
DEPOSIT/SUBSTITUTION REQUEST FORM
To:
State of New Jersey - Department of Banking and Insurance
To:
TD Bank, National Association
Office of Solvency Regulation
Attn: Arlene Murphy
Attn: Robert L. Edge
Wealth Management, Institutional Trust
robert.edge@dobi.nj.gov
1006 Astoria Blvd.
P.O. Box 325
Cherry Hill, New Jersey 08034
Trenton, NJ 08625-0325
Re: Commissioner of Banking and Insurance of the State of New Jersey as Trustee
Account Number:
Company Name:
Phone Number:
Fax Number:
In accordance with the administration of the Custodian Deposits held by you as Custodian for the New Jersey
Department of Banking and Insurance, we request the following transaction(s):
Free Receive Securities
Free Deliver Securities
DVP (Delivery vs. Payment)
TD Bank to buy Securities
Substitution of Securities
Securities to be deposited:
Cusip:
Description:
Par/Current Face:
Original Face:
Price:
Principal:
Interest:
Net $:
Trade Date:
Settlement Date:
Broker:
Fed Wire Instructions:
Securities to be released:
Cusip:
Description:
Par/Current Face:
Original Face:
Price:
Principal:
Interest:
Net $:
Trade Date:
Settlement Date:
Broker:
Fed Wire Instructions:
Name and Telephone Number of Company Representative
Signature of Company Representative - Date
Company faxes/e-mail form to Department of Banking and Insurance (609) 454-8587
Required consent by the Commissioner of Banking and Insurance, State of New Jersey:
Signature of DOBI Representative - Date
DOBI faxes/e-mail form to TD Bank for Acknowledgement
TD Bank Representative acknowledges receipt of form:
Signature of TD Bank Representative - Date
TD Bank faxes/e-mail signed form to both the above company and DOBI
Comments:
Date______________
Rev. – DOBI 6.2015
DEPOSIT/SUBSTITUTION REQUEST FORM
To:
State of New Jersey - Department of Banking and Insurance
To:
TD Bank, National Association
Office of Solvency Regulation
Attn: Arlene Murphy
Attn: Robert L. Edge
Wealth Management, Institutional Trust
robert.edge@dobi.nj.gov
1006 Astoria Blvd.
P.O. Box 325
Cherry Hill, New Jersey 08034
Trenton, NJ 08625-0325
Re: Commissioner of Banking and Insurance of the State of New Jersey as Trustee
Account Number:
Company Name:
Phone Number:
Fax Number:
In accordance with the administration of the Custodian Deposits held by you as Custodian for the New Jersey
Department of Banking and Insurance, we request the following transaction(s):
Free Receive Securities
Free Deliver Securities
DVP (Delivery vs. Payment)
TD Bank to buy Securities
Substitution of Securities
Securities to be deposited:
Cusip:
Description:
Par/Current Face:
Original Face:
Price:
Principal:
Interest:
Net $:
Trade Date:
Settlement Date:
Broker:
Fed Wire Instructions:
Securities to be released:
Cusip:
Description:
Par/Current Face:
Original Face:
Price:
Principal:
Interest:
Net $:
Trade Date:
Settlement Date:
Broker:
Fed Wire Instructions:
Name and Telephone Number of Company Representative
Signature of Company Representative - Date
Company faxes/e-mail form to Department of Banking and Insurance (609) 454-8587
Required consent by the Commissioner of Banking and Insurance, State of New Jersey:
Signature of DOBI Representative - Date
DOBI faxes/e-mail form to TD Bank for Acknowledgement
TD Bank Representative acknowledges receipt of form:
Signature of TD Bank Representative - Date
TD Bank faxes/e-mail signed form to both the above company and DOBI
Comments: