Descendant RegistrationForm - PDF document

Descendant Registration Form Descendant registration is available to the lineal descendants (e.g., the children, grandchildren, great grandchildren, etc.) of CIRI shareholders who do not own CIRI shares themselvesRegistration allows CIRI and The CIRI Foundation (TCF) the opportunity to communicate with descendants on items of RT I - APPLICANT INFORMATION: DescendantFull Name(First)(Middle) (Last) (Suffix)Address __________________________________________Descendant’sDate of Birth____________________________________________ (MM/DD/YYYY) (City) (State) (Zip) Home Ph. To reduce paper waste and costs and deliver news faster, CIRI primarily communicates with descendants electronically.Please add maillist@ciri.com and the domain “ciri.com” to your approved senders list and promptly notify CIRI if the email address changes. Email AddressList the full address (e.g.,descendant@hotmail.com, n (First)(Middle) (Last) (Suffix)PART II PROOF OF DESCENDANCY: List the full name of one CIRI shareholder from whom applicant is descended. If applicant is descended from two shareholders but only one is an original shareholder, 1 list the original shareholder below and attach a separate sheet with information regarding the other shareholder. Shareholder’sFull Name(First)(Middle) (Last) (Suffix) RelationshipShareholderto applicant (e.g., mother, grandmother, great grandmother, etc.) Date of Birth (MM/DD/YYYY) Required documentation: A copy of the state-issued birth certificate 2 establishing the applicant’srelationship to the shareholder listed above must accompany this application. Iapplicant’s Optional documentation: A copy of the applicant’s Certificate Degree of Indian Blood (CDIB). 3 Fax it: 907- (call ASAP to ensure receipt)QUESTIONS?Call CIRI Shareholder Relations: -2474 or 907-263- 1