Class C (Children) StockInformation and Instruction Booklet1Doyon Place, Ste. 300, Fairbanks, Alaska 99701Toll Free: (888) 478-4755 ext. 2040In Fairbanks: (907) 459-2040
Class C (Children) StockInformationEligibility CriteriaCHILD of an ORIGINAL* DOYON CLASS A, B, C or D shareholder and;ONE-QUARTER OR MORE ALASKA NATIVE blood quantum and;BORN AFTER DECEMBER 18, 1971.MAY NOT BE ENROLLED TO ANOTHER REGIONAL CORPORATION,ARCTIC VILLAGE, VENETIE, TETLIN OR METLAKATLA* Original shareholders received their shares directly from Doyon not through gifting orinheriting. Required Documents CLASS C APPLICATION -Application is available online at www.doyon.com ORIGINAL BIRTH CERTIFICATEAn original certified birth certificate is the only document that will be accepted. You canobtain an original certified birth certificate by contacting your localVital Statistics Office.Doyon CANNOT For Alaska vital records contact: Juneau 907-465-3391 oraccept photocopies orapply online for an Alaska birth certificate at:notarized copies .htmbirth certificates, birth For births outside of Alaska, apply online at:certificates will turned. If allrequireddocuments are notAdditional Documents, if applicablereceived theapplication will be CERTIFICATE OF INDIAN BLOOD (CIB) – if biologicalreturned. Allparent(s) is Alaska Native, and not enrolled to Doyon, contactpersonal informationthe Bureau of Indian Affairs at 101 12th Ave., Room 166,will be keptFairbanks, AK 99701 or call toll free at (800) 822-3596 or inconfidential.Fairbanks at (907) 456-0522. PROOF OF NAME CHANGE – if NAME is DIFFERENT thanlisted on birth certificate PROOF OF CUSTODIANSHIP – if not a biological or adoptive parent PATERNITY AFFIDAVIT – if father is not listed on child’s birth certificate ADOPTION COURT ORDER – if adopted by one or both parents. Documentsmust show the biological parent(s) name(s). If your adoption court order does notshow biological parents, contact Shareholder Records at (888) 478-4755 ext. 2040or in Fairbanks at (907) 459-2040.Continued on back
Class C (Children) StockInstructionsENROLLEE INFORMATION Provide all requested enrollee information. Failure to provide a social securitynumber will result in distribution withholdings. If enrollee is 18 or older they must submit their own application. If adopted by one or both parents, an ADOPTION FORM must also be completed.BIOLOGICAL PARENTS Provide biological parent(s) information. If biologicalparent(s) are unknown, contact Shareholder Records.DIRECT DEPOSIT OF DIVIDENDS/DISTRIBUTIONSAlaska Native blood quantumCAN ONLY be establishedthrough biological parent(s) andCANNOT be met throughadoptive parent(s). Please note: To be eligible for direct deposit you must have a valid mailing address onfile at all times. Shareholders that are subject to a dividend withholding, i.e., childsupport or Internal Revenue Service (IRS), will not qualify for direct deposit.TERMS, CONDITIONS AND RESTRICTIONS Please read section thoroughly before moving on.CERTIFICATION AND SIGNATURE If you are the enrollee completing this application AND are 18 years of age or older,SKIP TO SIGNATURE. If the enrollee is a minor AND you are the parent, legal custodian or concernedparties complete this section. Sign, date and print your name and indicate your relationship to enrollee. Mail toDoyon, Limited 1 Doyon Place, Suite 300, Fairbanks, AK 99701.
Original Birth Certificate MustAccompany ApplicationCLASS C (CHILDREN) STOCK APPLICATION(For Alaska Natives Born after December 18, 1971)ENROLLEE INFORMATIONMIDDLE NAMESUFFIX/MAIDENGENDERMAILING ADDRESSZIP CODEE-MAIL ADDRESS (IF OVER 18)Is Enrollee a US Citzen?YesCheck box to receive your annual meeting materials electronically,if email is provided you will also receive an E-NewsletterNoIF NO, please specify:Is Applicant enrolled to any Regional Corporation or Arctic Village, Venetie, Tetlin or Metlakatla?IF YES, list all that apply:ADOPTED?YES (If adopted by one or both parents you must also complete ADOPTION FORM)BIOLOGICAL PARENTSCLASS C (CHILDREN) STOCK APPLICATIONDoyon, LimitedAlaska Native blood quantum CAN ONLY be established through biological parent(s).BIOLOGICAL MOTHERUNKNOWNFIRST NAMEMIDDLE NAMEOTHER NAMES KNOWN BY (SUCH AS MAIDEN)ALASKA NATIVE?LAST NAMESUFFIXSOCIAL SECURITY NUMBERYESNODATE OF BIRTH (MM/DD/YYYY)Is biological mother enrolled to any Regional Corporation or Tribe listed?YESIF YES, check all that apply:NO13th Regional CorporationArctic VillageVenetie Tribal GovernmentNative Village of TetlinBIOLOGICAL FATHERMetlakatla Indian CommunityUNKNOWNFIRST NAMEMIDDLE NAMEOTHER NAMES KNOWN BYLAST NAMESUFFIXSOCIAL SECURITY NUMBERALASKA NATIVE?YESNODATE OF BIRTH (MM/DD/YYYY)Is biological father enrolled to any Regional Corporation or Tribe listed?YESNOIF YES, check all that apply:13th Regional CorporationArctic VillageVenetie Tribal GovernmentNative Village of TetlinMetlakatla Indian Community1 Doyon Place, Suite 300, Fairbanks, AK 99701 Toll Free 888-478-4755 ext. 2040 In Fairbanks 459-2040 E-mail firstname.lastname@example.org
CLASS C (CHILDREN) STOCK APPLICATIONDIRECT DEPOSIT OF DIVIDENDS/DISTRIBUTIONSNo, I do not want Direct Deposit (SKIP TO PART 4)Yes, I would like Direct Deposit (CONTINUE PART 3)I hereby authorize Doyon, Limited to initiate credit entries and, if necessary, debit entries and adjustments for any credit entriesaccount. By signing this application, I certify that I am the owner of this account. This authority remains in full force and effect until Doyon hasreceived written notice from me of its termination in such manner as to afford Doyon and my bank reasonable opportunity to act on it.Please Note: If enrollee is NOT listed on account provided, the bank reserves the right to refuse the deposit.Bank NameIf availableattachVoided checkBank Routing NumberChecking ORSavingsBank Account NumberName as it appears on Bank DITIONSRESTRICTIONSThe following Terms, Conditions and Restrictions are accepted by the enrollee and his/her custodian once the Class C stock is received: Class C stock shall be life estate which means upon death of that shareholder, the stock is cancelled without compensation to the heirs. Class C stock and the right to receive dividends and distributions may not be sold, pledged, assigned in present or future, transferred by gift, even ifrestrictions on transfer end for Class A, B, C, D or E stock. Class C stock cannot be voted until the shareholder reaches the age of 18 unless Alaska law changes the age of majority. Class C shareholders may not now nor in the future own stock in another regional corporation unless the other regional corporation stock is obtainedby inheritance, gift or purchase. Class C shareholders may not now nor in the future be tribally enrolled to Arctic Village, Venetie, Tetlin or Metlakatla. Any person who already owns Class C stock will not be eligible for more shares. Class C stock will revert to Doyon without compensation if it is later determined that the recipient was not eligible to receive the stock or violates anycondition holding the stock.CERTIFICATION AND SIGNATUREIs child living with you?YESNOI am the enrollee and age 18 years or older (SKIP TO SIGNATURE)I am the biological or adoptive parent of enrollee in Part 1 (CONTINUE BELOW)I am the legal custodian of enrollee byCourt Order ORPower of Attorney (Attach Document)YOUR FIRST NAMEMAILING ADDRESSMIDDLE NAMEAddress updateLAST NAMECITYSUFFIXSTATEZIP CODEE-MAIL ADDRESSHOME PHONEI certify that all the information provided is true to the best of my knowledge. I authorize Doyon to verify enrollment elligibilitywith the Bureau of Indian Affairs and any other sources as needed. I have read and accepted the terms, conditions and restrictionsof the Class C Stock.DATERELATIONSHIP TO ENROLLEE21 Doyon Place, Suite 300, Fairbanks, AK 99701 Toll Free 888-478-4755 ext. 2040 In Fairbanks 459-2040 E-mail email@example.com
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