Certification of Medallion Signature Guarantee Form

Certification of Medallion Signature Guarantee Form


The Certification of Medallion Signature Guarantee form is required to be submitted with all requests for Mutual Securities, Inc. (“MSI”) to provide a Medallion Signature Guarantee stamp on transaction related paperwork.  An Adviser may request a signature guarantee on behalf of an MSI client.


The Adviser must attest that:

1) He/She has verified the identity of the client

2) The client signed the document in question in his/her presence

3) The client is the owner of the account with the legal capacity to execute the document

4) The transaction does not exceed $1,000,000 which is MSI’s guarantee limit

Advisers requesting a Medallion Signature Guarantee from MSI must agree to indemnify and hold harmless MSI from any liability arising out of the execution of the transaction.

Once complete, please mail in the original documents to Mutual Securities home office (address below) along with this form. Please add a stamped/prepaid envelope with the address it needs to be mailed to. 

Mutual Securities, Inc.
807-A Camarillo Springs Road
Camarillo, CA 93012

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