15 GCA § 863: Notice of Effect of Registration.

A registering entity shall provide to an owner requesting registration of a security in beneficiary form a written statement describing the legal effects of the registration not later than the date on which the owner registers the security. The statement shall be printed in all capital twelve (12) point boldfaced type, and shall be signed by the registering owner at the time of registration. The following statement will suffice if signed by the registering owner:

‘IMPORTANT NOTICE REGARDING YOUR RIGHTS

‘ON PROOF OF DEATH, YOUR SECURITY IN BENEFI-

CIARY FORM WILL BE TRANSFERRED TO YOUR

NAMED BENEFICIARY, OR BENEFICIARIES, WITHOUT

BEING PART OF YOUR ESTATE UNDER YOUR WILL OR

BY INTESTACY. YOU SHOULD MAKE SURE BEFORE

YOU REGISTER YOUR SECURITY IN BENEFICIARY

FORM THAT THE REGISTRATION DOES NOT CONFLICT

WITH ANY OTHER PROVISION IN A DOCUMENT THAT

YOU HAVE AUTHORIZED AND SIGNED, INCLUDING A

WILL OR TRUST AGREEMENT. IF YOU HAVE ANY

DOUBT ABOUT WHETHER A CONFLICT EXISTS, YOU

SHOULD ALSO NOTE THAT REGISTERING YOUR

SECURITY IN BENEFICIARY FORM MAY NOT AFFECT A

CREDITOR'S CLAIM AGAINST YOUR ESTATE OR

AFFECT THE ESTATE OR INHERITANCE TAX

LIABILITY OF YOUR ESTATE OR OF YOUR

BENEFICIARY OF BENEFICIARIES.’

‘I HAVE READ THE ABOVE NOTICE AND UNDERSTAND ITS

CONTENTS.

(signature of registering owner)’