Registration

Reliant Life Shares Fractional Interest Position Holder Registration Form

Please complete the form on this page to provide the Receiver with your current contact information.

Please READ the following guidelines BEFORE completing this form:

  • ALL Reliant Investors must register to confirm their contact information.
  • The purpose of the form is to provide the Receiver with your current contact information, NOT your account information.
  • Your User Name will be the email address you enter in the Registration form.
  • Your Password will be necessary to access the Investor Access area of the website when it is activated.
  • You do NOT need to provide any information about your account with Reliant. Please complete each field with ONLY the information it requires.
  • You do NOT need to provide information about any third-party custodian holding assets in a qualified plan account (e.g., an IRA, Roth IRA, SEP, etc.).
  • You do NOT need to provide any information about your account type (e.g., IRA) in any field on this form.
  • You do NOT need to enter information for each account you have with Reliant unless your contact information is different for each account.
  • Please DO NOT enter a “1” at the beginning of your telephone number.
  • Please DO NOT use dashes, slashes, periods or other symbols or punctuation when entering your phone number; just enter your ten (10) digit phone number.
  • The Company field should be used only if the address at which you receive mail is an actual company’s address.
    • It should NOT be used to enter a description of your account type (e.g., Roth IRA is NOT a company name, it is an account type).
    • It should NOT be used to enter the name of an Additional Account Holder.
    • It should NOT be used to enter the abbreviation for a country (e.g., USA).
    • It should NOT be used to enter the name of a trust.
    • DO NOT enter your name in this field.
    • DO NOT enter your employment status (e.g. “self-employed”) in this field.
  • You DO need to enter the contact information for any other person who can be contacted about your account(s) with Reliant. There is an Additional Account Holder form for this purpose.
Registration Form

Primary Account Holder Details

Primary Account Holder Address

Additional Account Holder Details