NGC Ancients Us

ANCIENT COIN SUBMISSION FORM
NGC • P.O. Box 4776 • Sarasota, FL 34230

1-800-642-2646 • FAX 941-360-2553
Service@NGCcoin.com • NGCcoin.com
NGC is the official grading service
of the ANA and PNG.
CUSTOMER RESPONSIBILITIES AND CHECKLIST

WHEN SUBMITTING COINS:
• To vault your collectibles with PWCC after grading, select this option in • Sign the Consent to Remove Coins (on the back of this cover sheet)
Box 2 (SHIP TO) and enter your PWCC Vault address. This selection applies if applicable, and include with submission.
to all collectibles on the form. You must have an account with PWCC for • Sign and return all required forms with submission.
vaulting. For more information and to sign up, visit ngc.click/pwcc
• In most cases you cannot reroute your submission once it has shipped.
• Place raw coins up to 40.6 mm diameter in 2.5" x 2.5" non-PVC plastic flips. This restriction helps protect the security of your submission / package.
Use larger flips for larger coins. Coins should insert easily into a flip. Placing
a coin in a flip that is too small may result in damage to the coin. Remove all • Fragile Coins Note
plastic sleeves or any other packaging before placing a coin in a flip. Certain collectibles may be more susceptible to damage due to the state in
which they are provided by the submitter to NGC (for example, collectibles
• Place only one coin in a flip and fold the other half of the flip over. that are enameled, colorized, painted, jeweled, or have holograms or other
Do not cut, tape, staple or glue flips as this can damage the coins. specialty applications; collectibles that are extremely thin; collectibles that
• NCS conservation is optional. If NCS conservation is desired, choose are extremely fragile or brittle (including many collectibles struck prior to
Standard Conservation and also choose ONE NGC grading tier. If NCS 1700); and collectibles that exhibit “bronze disease”). NGC will use reason-
conservation is not desired, choose only ONE NGC grading tier. able care with respect to collectibles submitted to it for services. However,
NGC will only be responsible for damage or loss to a collectible in the event
• If you have an NGC member credit, it will be automatically applied to your
NGC determines that such damage or loss was due to NGC’s negligence
submission fees. You must still provide a method of payment to be used
while the collectible was in its possession, in which case the submitter’s sole
for any amount due above the member credit.
remedy will be compensation based upon NGC’s good faith determination
• Package your coins in the order that they are listed on the submission form. of the fair market value of the collectible, in light of what NGC believes to be
Write the submission / invoice number (located in red in the upper right reliable current market information. The amount of the compensation will
hand corner of the form) and the line number for each coin (e.g. 5591421-001 not necessarily be based upon, but in no event will exceed, the submitter’s
for the first coin, 5591421-002 for the second coin, etc.) on a small label and stated declared value of the collectible set forth in this submission form.
attach it to the flip. Collect your coins in the same order and secure them
carefully with a rubber band. Turnaround times are approximate and are not guaranteed.
IMPORTANT: If paying by check, make check payable to NGC and indicate check number in the appropriate area.
If paying by wire transfer, indicate that in the appropriate area. If paying by credit card, include credit card information and sign on the appropriate line.
Note: Boxes 12 (if applicable) and 13 must be signed in order to process your order.
Incomplete forms will result in a delay in processing.
Questions? Need more submission forms?
Call NGC Customer Service toll-free at 1-800-NGC-COIN (642-2646) or email Service@NGCcoin.com
RETURN SHIPPING AND INSURANCE INFORMATION

Shipments to US Addresses: NGC will generally ship via FedEx with insurance coverage of up to $100,000 per package procured by NGC. If NGC is shipping to a
US PO Box, NGC will generally ship via USPS Mail with insurance coverage of up to $100,000 per package procured by NGC. USPS Mail will generally be slower than
FedEx. NGC is not responsible for the speed of shipping services. Contact NGC if you are shipping collectibles valued over $100,000 per package.
US Return Shipping & Insurance Rates
Owner’s Declared Value $1 to $25,000 $25,001 to $50,000 $50,001 to $100,000
Shipping Method FedEx Ground w / Direct Signature FedEx Ground w / Direct Signature FedEx Standard Overnight w / Adult Signature
1 to 10 coins $28 $105 $150
11 to 25 coins $35 $110 $160
26 to 50 coins $41 $115 $170
51 to 100 coins $47 $120 $180
If submitting more than 100 coins, add $0.25 for each additional coin sent via FedEx Ground or add $0.50 for each additional coin sent via FedEx Standard Overnight. Additional charges may apply for extended or remote service
areas, Oversize Holders, heavier packages, added items, etc. Contact NGC before submitting if you would like to ship collectibles valued over $100,000 per package. Enter the total shipping fees on line 6 of box 11 (“Total Fees”).
Shipments to International Addresses: NGC will generally ship via FedEx with insurance coverage of up to $50,000 per package procured by NGC. If Customer
requests that USPS Mail be used, package(s) will NOT be insured and the risk of loss or damage during shipment will be assumed by Customer.
International Return Shipping & Insurance Rates
Owner’s Declared Value $1 to $25,000 $25,001 to $50,000
Shipping Method FedEx Economy w / Direct Signature FedEx Priority w / Direct Signature
1 to 10 coins $80 $120
11 to 25 coins $100 $150
26 to 50 coins $120 $180
51 to 100 coins $150 $225
If submitting more than 100 coins, add $1.00 for each additional coin sent via FedEx Economy or add $2.00 for each additional coin sent via FedEx Priority. Additional charges may apply for extended or remote service areas, Oversize
Holders, heavier packages, added items, custom fees and tariffs, etc. Contact NGC before submitting if you would like to ship collectibles valued over $50,000 per package. Enter the total shipping fees on line 6 of box 11 (“Total Fees”).
If Customer does not select a carrier, package(s) will be returned via FedEx. Customers wishing to use their own FedEx, UPS or USPS Express Mail account must have a completed
CCG Shipping Information Form on file. Shipments on Customer’s own account are NOT insured and the risk of loss or damage during shipment will be assumed by Customer.
Effective 2/21/2023 0223 7969

ANCIENT COIN SUBMISSION FORM
1-800-642-2646 • FAX 941-360-2553
of the ANA and PNG.
CONSENT TO REMOVE ANCIENT COIN(S) FROM HOLDER(S)

To be completed only if submitted coin(s) were previously graded and
encapsulated by a third-party grading service other than NGC.
I have submitted one or more holdered coins to Numismatic Guaranty Company (NGC) for grading. The submitted coin(s) were previously graded and encapsulated
by a third-party grading service other than NGC. I understand that the submitted coin(s) are NOT eligible for NGC’s CrossOver service. Nonetheless, I am submitting
the coin(s) to NGC for grading and agree as follows:
1. I consent to NGC removing the submitted coin(s) from the holder(s) for purposes of grading the coin(s) in raw state.
I understand that this will likely void any guarantee that was provided by the original third-party grading service.
2. I understand that NGC’s determination of grade, authenticity and coin attribution may differ from the other grading company’s determination, and that NGC
does not warrant the grade, authenticity or coin attribution that may have appeared on a certification issued by another grading company.
3. I understand that if the submitted coin(s) are determined by NGC to be gradable, then NGC will grade and encapsulate the coin(s), even if the result is
materially different from the certification issued by the other grading company.
4. I understand that if the submitted coin(s) are determined by NGC to be Not Genuine, Questionable Authenticity or otherwise ungradable, the coin(s) will be
labeled as such and will not be graded or encapsulated.
5. I understand that NGC will use reasonable care in removing the coin(s) from the holder(s), but agree that NGC will not have any liability for damage to the
coin(s) in connection with this removal.
6. I understand that the Services Terms and Conditions on the NGC Submission Form apply to this coin submission as well. If there is a conflict between this
Consent and the Services Terms and Conditions, then this Consent will control.
Printed Name of Submitting Customer
Invoice Number from NGC Submission
/ /
Date
Signature of Submitting Customer
Effective 2/21/2023 0223 7969

ANCIENT COIN SUBMISSION FORM 6826403
1-800-642-2646 • FAX 941-360-2553
of the ANA and PNG.
1 SUBMITTER’S NAME ACCOUNT # CS291615

2 SHIP TO (Choose one.)  My Address Below  PWCC Vault 3 SHIP METHOD US Addresses:  Ground  Overnight (insured up to $100,000)
Int’l Addresses:  FedEx (insured up to $50,000)  USPS (NOT insured)
 Ship With
Name Graciela Villacreses (List Form #s)
If you are using your own account with the following carriers, you MUST provide your
own account # and insurance limits below. If your own account is not on file with NGC, FedEx
Address will be automatically selected.
 FedEx  UPS Account # (Required)
 USPS Express Mail Insurance limit $ (Required)
Address  Other (Call Customer Service)
Specify delivery:
Phone Email pkbl2001@hotmail.com  Next day a.m.  Next day p.m.  2-day  Ground  Saturday delivery
4 NCS CONSERVATION SERVICE (Applies to all coins 5 NGC GRADING TIER Choose only one — use a separate form for each tier level.
on form. Choose only one.) An evaluation fee of $5 per coin applies to all NCS
conservation submissions. Choose ONE NGC grading tier in Box 5.
Coin Grading Tier Value (per coin) Fee Includes
 Unlimited WalkThrough Over $25,000 $400 + 2% FMV Comprehensive description, grade and weight
Conservation Tier Maximum Coin Value Fee per Coin
 Decline Conservation  WalkThrough Up to $25,000 $300 Comprehensive description, grade and weight
NCS Standard 4% FMV
↑ All tiers above include Scratch-Resistant Holders for no additional fee ↑
 Unlimited  ↓ Upgrade to Scratch-Resistant Holders for the following tiers for an additional $5 per coin / Standard Holder ↓
Conservation ($25 minimum)
Express Up to $10,000 $135 Comprehensive description, grade and weight
6 NGC ADD-ON SERVICES OPTIONAL. Applies to all coins

on form.  Standard Up to $3,000 $55 Comprehensive description, grade and weight

 NGC Thick Holder (Tier + $5) Coins requiring thick holders.  Economy Up to $300 $33 Basic description / grade only
 Pedigree (Tier + $5)  Bulk (50+ coins of similar type) Up to $300 $27 Basic description / grade only
7 OTHER NGC SERVICES OPTIONAL. 8 NGC REHOLDERS OPTIONAL. Do not select an 9 NGC IMAGING SERVICES OPTIONAL. Applies to all
NGC grading tier. Choose only one. Applies to all coins on form. coins on invoice. Contact NGC Imaging for special imaging requests.
 Expanded Grade Description (NGC-graded coins only) $20 10-day estimated turnaround.
Weighed and analyzed for grade, strike, surface and style, and are placed in a new holder.
 ReHolder $13 Valued up to $10,000  Internet Imaging $5 each
 Return Packaging $5 (per submission plus shipping)  igh Value ReHolder $50 Valued over $10,000
H  NGC PhotoVision Plus $8 each
10 Complete the following section as applicable to your coins. Declared value is required for all submission processing.
Qty. Description Declared Value
(REQUIRED)
10
11
12
13
14
15
$
TOTAL
CUSTOMER NOTES DECLARED
VALUE
NGC USE ONLY Date Received # of Coins Register #
11 TOTAL FEES 12 PAYMENT AND SIGNATURE This section must be completed fully and signed for credit card payment.
1. NCS Conservation Fees: Total # of coins x tier $ ____________ = $ ____________ In the amount of my TOTAL NOW DUE at left, bill my  Visa  MasterCard  AmEx
2. NGC Grading Fees: Total # of coins x tier $ ____________ = $ ____________ I prefer to pay by the enclosed check:  Check # payable to: NGC
Credit Card #
3. NGC Services Fees: Total # of coins x tier $ ____________ = $ ____________
Cardholder Name Expires
4. NGC Imaging Fees: Total # of coins x tier $ ____________ = $ ____________
Billing Address
5. Handling Fee 10
= $ ____________
Signature X
Cardholder Name and Billing Address are needed only if different than the Ship To address listed above.
Date / /
6. Shipping Fees (table on cover sheet) = $ ____________  Wire Transfer: Wire Amount: $
Beneficiary Bank: Bank of America, New York, NY
7. Add appropriate lines to reach your total: TOTAL NOW DUE = $ ____________ ABA Code: 026009593 Account Name: Numismatic Guaranty Company
Routing #: 063100277 Account #: 003760307448
13 EXECUTION OF AGREEMENT (Required - Order will not be processed without signature.) I acknowledge and agree that all services are provided subject to the NGC Guarantee Terms and Conditions
(NGCcoin.com/guarantee), any Membership Agreement signed by the submitter of these coins, the current Services Terms and Conditions (NGCcoin.com/terms), the Terms of Use of the NGC website (NGCcoin.com/legal),
and the NGC Privacy Policy (NGCcoin.com/privacy). If paying by credit card, I agree to the Credit Card Approval and Release found on this Submission Form.
AUTHORIZED SIGNATURE REQUIRED X Print Name Date / /
ACCOUNTING COPY
Effective 2/21/2023 0223 7969
1-800-642-2646 • FAX 941-360-2553
of the ANA and PNG.

 Ship With
Specify delivery:
NCS Standard 4% FMV


(REQUIRED)
10
11
12
13
14
15
$
TOTAL
VALUE
Credit Card #
Billing Address
5. Handling Fee 10
= $ ____________
Signature X
Date / /
Routing #: 063100277 Account #: 003760307448
NGC COPY
Effective 2/21/2023 0223 7969
1-800-642-2646 • FAX 941-360-2553
of the ANA and PNG.

 Ship With
Specify delivery:
NCS Standard 4% FMV


(REQUIRED)
10
11
12
13
14
15
$
TOTAL
VALUE
Credit Card #
Billing Address
5. Handling Fee 10
= $ ____________
Signature X
Date / /
Routing #: 063100277 Account #: 003760307448
NGC COPY
Effective 2/21/2023 0223 7969
1-800-642-2646 • FAX 941-360-2553
of the ANA and PNG.

 Ship With
Specify delivery:
NCS Standard 4% FMV


(REQUIRED)
10
11
12
13
14
15
$
TOTAL
VALUE
Credit Card #
Billing Address
5. Handling Fee 10
= $ ____________
Signature X
Date / /
Routing #: 063100277 Account #: 003760307448
SUBMITTER COPY
Effective 2/21/2023 0223 7969
For current estimated turnaround times, visit NGCcoin.com/submit/services-fees/ngc/. Turnaround times are estimates and are NOT guaranteed.
Coins accepted from most Western ancient civilizations up to circa A.D. 500 and the Byzantine Empire (up to A.D. 1453).
NCS CONSERVATION SERVICES REQUIREMENTS (Maximum values are per coin)

NCS Standard Conservation All coins. 4% Fair Market Value (FMV) ($25 minimum fee). Also select an applicable NGC grading tier. NGC grading fees additional. If NCS believes that
conservation will not benefit a coin submitted under the Standard Conservation tier, it will be transferred to NGC for grading and a $5 per coin NCS
evaluation fee will apply.
NGC GRADING TIERS REQUIREMENTS (Maximum values are per coin)

Unlimited WalkThrough Coins valued over $25,000. Coins receive full attribution, are weighed, and are analyzed for grade, strike, surface and style.
WalkThrough Coins valued up to $25,000. Coins receive full attribution, are weighed, and are analyzed for grade, strike, surface and style.
↑ All tiers above include Scratch-Resistant Holders for no additional fee (excludes NGC Thick Holders). ↑
↓ Upgrade to Scratch-Resistant Holders for the following tiers for an additional $5 per coin (excludes NGC Thick Holders). ↓
Express Coins valued up to $10,000. Coins receive full attribution, are weighed, and are analyzed for grade, strike, surface and style.
Standard Coins valued up to $3,000. Coins receive full attribution, are weighed, and are analyzed for grade, strike, surface and style.
Economy Coins valued up to $300 receive a basic description / grade. Esoteric, challenging and / or high-relief types may be moved to a higher tier.
Bulk Coins valued up to $300 receive a basic description / grade. Minimum 50 coins of similar type. Esoteric, challenging and / or high-relief types may be
moved to a higher tier.
At the sole discretion of NGC Ancients, coins submitted in Standard or higher tiers that are not eligible for encapsulation because of size, fragility, physical characteristics, etc. will be
provided with a laminated Photo Certificate providing label information and high quality images of the coin’s obverse and reverse in lieu of encapsulation at the regular tier fee.
NGC ADD-ON SERVICES REQUIREMENTS
NGC Thick Holder High relief coins that do not fit in NGC’s standard holder will be placed in a Thick Holder. There are two Thick Holder sizes: one for coins up to 7 mm in
thickness and one for coins up to 9 mm in thickness. The default is the 7 mm holder.
Pedigree A pedigree can be added to the certification label to indicate a coin’s past or present ownership. NGC must receive sufficient evidence to confirm the
requested pedigree. Examples of evidence include photographic records from an auction catalog or a sealed flip / holder from the original collection or
auction house. Recognition of pedigrees is at NGC’s sole discretion; the Pedigree fee applies when requested regardless of whether NGC determines the
coin to have a recognized pedigree. To add a pedigree to a coin already encapsulated in an NGC holder, also select an applicable NGC ReHolder service.
See NGCcoin.com/Pedigrees for complete information.
OTHER NGC SERVICES REQUIREMENTS
Expanded Grade Description NGC-graded coins only. Ancient coins previously graded and encapsulated by NGC are weighed and analyzed for grade, strike, surface and style, and are
placed in a new holder.
Return Packaging Examples: Auction tags, Certificate of Authenticity. (If sending auction tag for verification purposes, please send a copy. Do not send original.)
NGC REHOLDERS REQUIREMENTS
ReHolder Coins valued under $10,000 in NGC Ancients holders with superficial damage are placed in a new holder.
High Value ReHolder Coins valued over $10,000 in NGC Ancients holders with superficial damage are placed in a new holder.
NGC IMAGING SERVICES
Internet Imaging Digital imaging for coins submitted under any of NGC’s grading and service tiers. Consists of accurate high-resolution images of the obverse and
reverse of the coin, shown encapsulated in its NGC holder. Sent to you by email. Not available for on-site services.
NGC PhotoVision Plus High-resolution JPG images of the obverse and reverse and a side-by-side JPG with the NGC logo and NGC submission
number. Sent to you by email. Not available for on-site services.
CREDIT CARD APPROVAL AND RELEASE

I, the submitter named on the front of this submission form, authorize Numismatic Guaranty Company (NGC) to charge the card account I provide for the amount on section 11, line #7 TOTAL NOW DUE on the front of this Submission Form upon receipt
of my request for grading services. I acknowledge that by completing and signing this Submission Form, I agree to pay NGC the full amount of the requested grading fees and, if applicable, conservation and services fees on the card number I provide
regardless of the final grading opinion provided. I understand that if I disregard this provision, I shall be subject to immediate discharge from Collectors or Authorized Dealer Membership and loss of all rights and entitlements therein. I also agree that if a
dispute arises in regard to the fees charged, I must give written notice of such dispute to NGC within 14 days of receipt of said graded items. With notification by email, fax or phone call, I understand that NGC reserves the right to post additional charges to
my credit card account if extra or different services are required to fulfill requested services.
IMPORTANT:
• NGC Ancients’ services may be governed by the terms of the NGC Guarantee, a copy of which is available at NGCcoin.com or by written request addressed to NGC, P.O. Box 4776, Sarasota, FL 34230.
Effective 2/21/2023 0223 7969

NGC Ancients Us

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ANCIENT COIN SUBMISSION FORM

NGC • P.O. Box 4776 • Sarasota, FL 34230

CUSTOMER RESPONSIBILITIES AND CHECKLIST

RETURN SHIPPING AND INSURANCE INFORMATION

Effective 2/21/2023 0223 7969

CONSENT TO REMOVE ANCIENT COIN(S) FROM HOLDER(S)

Printed Name of Submitting Customer

Invoice Number from NGC Submission

Signature of Submitting Customer

Effective 2/21/2023 0223 7969

1 SUBMITTER’S NAME ACCOUNT # CS291615

on form.  Standard Up to $3,000 $55 Comprehensive description, grade and weight

AUTHORIZED SIGNATURE REQUIRED X Print Name Date / /

1 SUBMITTER’S NAME ACCOUNT # CS291615

on form.  Standard Up to $3,000 $55 Comprehensive description, grade and weight

AUTHORIZED SIGNATURE REQUIRED X Print Name Date / /

1 SUBMITTER’S NAME ACCOUNT # CS291615

on form.  Standard Up to $3,000 $55 Comprehensive description, grade and weight

AUTHORIZED SIGNATURE REQUIRED X Print Name Date / /

1 SUBMITTER’S NAME ACCOUNT # CS291615

on form.  Standard Up to $3,000 $55 Comprehensive description, grade and weight

AUTHORIZED SIGNATURE REQUIRED X Print Name Date / /

NCS CONSERVATION SERVICES REQUIREMENTS (Maximum values are per coin)

NGC GRADING TIERS REQUIREMENTS (Maximum values are per coin)

CREDIT CARD APPROVAL AND RELEASE

Effective 2/21/2023 0223 7969

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