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David Do, Commissioner Office of Legal Affairs 33 Beaver Street, 22nd Floor New York, NY 10004AFFIDAVIT OF NONRELIANCEMedallion No. ___ State of New York)County of ___)) SS:___, an officer / member
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How to fill out affidavit of non-reliance medallion

01
Obtain the affidavit of non-reliance medallion form from a financial institution or notary public.
02
Fill in your personal information as requested on the form, including your name, address, and contact information.
03
Read the statement on the form carefully and make sure you understand the implications of signing it.
04
Sign the form in the presence of a notary public or other authorized official who can witness and stamp the medallion.
05
Submit the completed and notarized form as required by the institution requesting the affidavit.

Who needs affidavit of non-reliance medallion?

01
Individuals who are transferring ownership of securities or financial assets may need to provide an affidavit of non-reliance medallion as a way to verify their identity and authorize the transfer.
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Affidavit of non-reliance medallion is a legal document where a person swears that they do not have a medallion signature guarantee and cannot obtain one.
Individuals who need to transfer stocks or securities but do not have a medallion signature guarantee are required to file an affidavit of non-reliance medallion.
To fill out an affidavit of non-reliance medallion, one must provide their personal information, detailed explanation of why a medallion signature guarantee is not available, and sign the document in front of a notary public.
The purpose of affidavit of non-reliance medallion is to provide a legal alternative for individuals who are unable to obtain a medallion signature guarantee when transferring stocks or securities.
The affidavit of non-reliance medallion must include personal information of the individual, detailed explanation of why a medallion signature guarantee is not available, and signature in front of a notary public.
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