E-DIVIDEND MANDATE ACTIVATION FORM

Transcription

1 Write your name at the back of your passport photograph (to be stamped by your banker) ONLY CLEARING BANKS ARE ACCEPTABLE INSTRUCTION Please complete all section of this form to make it eligible for processing and return to the address below. The Registrar Africa Prudential Registrars Plc 220B, Ikorodu Road, Palmgrove, Lagos. I/We hereby request that henceforth, all my/our Dividend Payment(s) due to me\us from my/our holdings in all the companies ticked at the right hand column be credited directly to my /our bank detailed below: (BVN): : : : D D M M Y Y Y Y SHAREHOLDER ACCOUNT INFORMATION Surname/Company s Name First Name Other Name Address City State Country Previous Address (if any) Clearing House Number (CHN) (if any) C Name of Stockbroking Firm Address Signature: Signature: Joint/Company s Signatories Company Seal (if applicable) CLIENTELE 1. AFRICA PRUDENTIAL REGISTRARS PLC 2. ABBEY MORTGAGE BANK PLC 3. AFRILAND PROPERTIES PLC 4. A & G INSURANCE PLC 5. MIXTA REAL ESTATE PLC (formerlyarm Properties Plc) 6. A.R.M LIFE PLC 7. ADAMAWA STATE GOVERNMENT BOND 8. BECO PETROLEUM PRODUCTS PLC 9. BUA GROUP 10. BENUE STATE GOVERNMENT BOND 11. CAP PLC 12. CAPPA AND D'ALBERTO PLC 13. CEMENT COY OF NORTHERN NIG. PLC 14. CSCS PLC 15. CHAMPION BREWERIES PLC 16. COMPUTER WAREHOUSE GROUP 17. EBONYI STATE GOVERNMENT BOND 18. GOLDEN CAPITAL PLC 19. INFINITY TRUST MORTGAGE BANK PLC 20. INTERNATIONAL BREWERIES PLC 21. INVESTMENT & ALLIED ASSURANCE PLC 22. JAIZ BANK PLC 23. KADUNA STATE GOVERNMENT BOND 24. NEM INSURANCE PLC 25. NEXANS KABLEMETAL NIG. PLC 26. OMOLUABI SAVINGS AND LOANS PLC 27. PERSONAL TRUST & SAVINGS LTD 28. P.S MANDRIDES PLC 29. PORTLAND PAINTS & PRODUCTS NIG. PLC 30. PREMIER BREWERIES PLC 31. RESORT SAVINGS & LOANS PLC 32. ROADS NIGERIA PLC 33. SCOA NIGERIA PLC 34. TRANSCORP HOTELS PLC 35. TRANSCORP PLC 36. TOWER BOND 37. THE LA CASERA CORPORATE BOND 38. UACN Plc 39. UBA BALANCED FUND 40. UBA BOND FUND 41. UBA CAPITAL PLC 42. UBA EQUITY FUND 43. UBA MONEY MARKET FUND 44. UNITED BANK FOR AFRICA PLC 45. UNIC PLC 46. UAC PROPERTY DEVELOPMENT COMPANY PLC 47. UTC NIGERIA PLC 48. WEST AFRICAN GLASS IND PLC A/C No. DISCLAIMER "InnoeventshallAfricaPrudentialRegistrarsbeliableforanydamages, lossesorliabilities includingwithoutlimitation, directorindirect, special, incidental, consequential damages, losses or liabilities, in connection with your use of this form or your inability to use the information, materials, or in connection with any failure, error, omission, defect, delay in operation or transmission, or system failure, even if you advice us of the possibility of such damages, losses of expenses, whether express or implied in respect of such information." Africa Prudential Registrars

2 Write your name at the back of your passport photograph (To be stamped by Bankers) Please complete all section of this form to make it eligible for processing TICK NAME OF COMPANY SHAREHOLDER S ACCOUNT NO. BOC GASES NIGERIA PLC GREIF NIGERIA PLC The Registrar, ALL CROWN REGISTRARS LIMITED 190, Ikorodu Road, Onipanu, Shomolu, Lagos. I\We hereby request that henceforth, all my\our Dividend Payment(s) due to me\us from my\our holdings in all the companies ticked at the right hand column be credited directly to my \ our bank detailed below: Surname / Company s Name First Name Other Names Address : City State Country Company Seal (If applicable) Joint\Company s Signatories Help Desk Telephone No/Contact Centre Information for Issue resolution or clarification: ALL CROWN REGISTRARS LIMITED website: aallcrownregistrarslimited@yahoo.com

3 TICK NAME OF COMPANY ACORN PET. PLC AFRIK PHARMACEUTICALS PLC AG HOMES SAVINGS & LOANS AG LEVENTIS ARBICO PLC ASHAKACEM PLC BANKERS WAREHOUSE BETA GLASS CAPITAL HOTEL PLC ELLAH LAKES EVANS MED PLC FCMB BOND FCMB GROUP PLC FIDSON BOND G. CAPPA PLC GUINEA PLC IMB ENERGY MASTER FUND JOS INT. BREWERIES PLC KOGI SAVINGS & LOAN LTD LAFARGE AFRICA PLC LAFARGE BOND LAW UNION & ROCK PLC LEGACY FUND LIVESTOCK FEEDS PLC MORISON PLC MRS OIL PLC NAHCO BOND NAHCO PLC NEWPAK PLC N.G.C PLC NGC STERILE NPF MICROFINANCE BANK NULEC INDUSTRIES PLC OKOMU OIL PALM PLC PREMIER PAINT PLC REAN PLC SKYE BANK PLC TOTAL NIG. PLC TRANEX PLC WOMEN INVESTMENT FUND SHAREHOLDER S ACCOUNT NO.

4 (To be stamped by Bankers) Write your name at the back of your passport photograph s Please complete all section of this form to make it eligible for processing The Registrar Centurion Registrars 33C, Cameron Road, Ikoyi, Lagos Lagos State I\We hereby request that henceforth, all my\our Dividend Payment(s) due to me\us from my\our holdings in all the companies ticked at the right hand column be credited directly to my \ our bank detailed below: TICK NAME OF COMPANY SHAREHOLDER A/C NO. DIAMOND BANK PLC C & I LEASING PLC LINKAGE ASSURANCE PLC NIGERIA WIRE INDUSTRIES PLC UNION DICON SALT PLC VITAL PRODUCTS LIMITED SURNAME FIRSTNAME OTHERNAMES ADDRESS CITY STATE COUNTRY PREVIOUS ADDRESS (IF ANY) CHN (IF ANY) MOBILE TELEPHONE 1 MOBILE TELEPHONE 2 ADDRESS SIGNATURE COMPANY SEAL (IF ANY) JOINT\COMPANY S SIGNATORIES Help Desk: customercare.centurionregistrars.com Tel no: , , , web: // customercare@centurionregistrars.com

5 Photo (To be stamped by bankers) Please write your name at the back of your passport photograph E-MANDATE ACTIVATION FORM Please complete all sections of this form to make it eligible for processing The Registrar, DataMax Registrars Limited 2C, Gbagada Expressway, By Beko Ransome Kuti Park, Anthony Oke Bus Stop, Gbagada, P.M.B 10014, Shomolu, Lagos State. I/ We hereby request that you forward until further notice, all future dividend/ interest to which I/we become entitled for the company indicated, to the branch of the Bank named below. * Surname / Company s Name First Name Other Names Kindly tick & quote your shareholder account no in the box below Tick Name of Company AXA Mansard Insurance Plc. Guaranty Trust Bank Plc. IFC - Naija Bond Imperial Mortgage Bank Limited Kogi State Bond Mainstream Energy Solutions Seplat Petroleum Development Plc. Sterling Assurance (Sterling Trust Fund). Shareholder Number * Please ensure that the name on your Bank Account corresponds with that in our records as any contrary Name(s) would void your request Address: City State Country ** ** The signature(s) must correspond with your specimen held in our records as any contrary signature(s) or non-existence in our records would void your request. Joint\Company s Signatories Company Seal/ Incorporation Number (Corporate Shareholder) When completed on behalf of corporate body, each signatory should state the representative capacity e.g. Company Secretary, Directors etc. I/We confirm that all information supplied is to the best of my/our knowledge correct and hereby covenant to indemnify and forever keep indemnified the security issuer, the directors, the security registrar, the directors and officers of the security registrar from and against all losses in respect thereof and all claims, actions, proceedings, demands, cost, expenses whatsoever which may be made or brought against them by reason of compliance with this request. Help desk, Telephone No , 0700DATAMAX or send to datamax@datamaxregistrars.com DATAMAX REGISTRARS LIMITED Website: ; - info@unitedsecuritieslimited.com or the completed update form can also be submitted through any Access Bank PLC nearest to you. Website: datamax@datamaxregistrars.com or the completed form can be submitted through any GTBank nearest to you. ansmitted electronically DataMax Registrars Limited hereby disclaims liability or responsibility for any errors/omissions in any document transmitted electronically.

6 (To be stamped by Bankers) Please write your name at the back of your passport photograph E-DIVIDEND ACTIVATION FORM EDC REGISTRARS LIMIITED : Please complete all sections of this form to make it eligible for processing THE REGISTRAR EDC REGISTRARS LIMITED RC IKORODU ROAD, ONIPANU, LAGOS I/We hereby request that henceforth, all my/our Dividend Payment(s) due to me/us from my/our holdings in all the companies ticked at the right hand column be credited directly to my/our bank detailed below: Bank Branch/Address Kindly tick & quote your shareholder account no. in the box below: Tick Name of Company Shareholder Number Adswitch Plc Afromedia Plc Courteville Bus. Solutions Plc Cutix Plc Dangote Flour Mills Plc Imo State Government Bond Plateau State Government Bond Resourcery Plc Surname/Company name First name Other Names Address: City State Country Mobile Telephone (1) Tel (2) Address Company Seal (if applicable) Joint/Company s Signatories Authorised Signature of Bank/Stamp For enquiries, please call or send to EdcRegComplaints@ecobank.com

7 (To be stamped by Bankers) FORM Write your name at the back of your passport photograph Please complete all section of this form to make it eligible for processing The Registrar, Apel Capital & Trust Ltd. 8, Alhaji Bashorun Street Off Norman Williams Str, S.W Ikoyi Lagos. I\We hereby request that henceforth, all my\our Dividend Payment(s) due to me\us from my\our holdings in all the companies ticked at the right hand column be credited directly to my \ our bank detailed below: TICK NAME OF COMPANY SHAREHOLDER S ACCOUNT NO. ABACUS MONEY MARKET FUND ANINO INT L PLC CHAPEL HILL DENHAM MONEY MARKET FUND EQUITY ASSURANCE PLC FIRST ALUMINUM PLC Surname / Company s Name First Name Other Names Address : City State Country INTERLINKED TECHNOLOGIES PLC INTERNATIONAL BREWERIES PLC LASACO ASSURANCE PLC LEAD UNIT TRUST SCHEME MBA MUTUAL TRUST SCHEME MASS TELECOM INNOVATION PLC NCR (NIGERIA) PLC NEM INSURANCE PLC PARAMOUNT EQUITY Company Seal (If applicable) PHARMA DEKO PLC Joint\Company s Signatories THE INITIATES PLC registrars@apel.com.ng Tel : +234 (1) Address : 8, Alhaji Bashorun Street, W: (0) Company 6698 Name Off Norman Williams Crescent, w.xxxxxxxx.com; info@xxxxxxxxxxx.com S.W. Ikoyi Lagos

8 (To be stamped by Bankers) E-DIVIDEND E-DIVIDEND ACTIVATION FORM Please complete all section of this form to make it eligible for processing The Registrar, First Registrars & Investor Services Ltd. 2, A b e b e V i l l a g e R o a d, I g a n m u P. M. B Lagos. Nigeria. I\We hereby request that henceforth, all my\our dividend Payment(s) due to me\us from my\our holdings in all the companies ticked at the right hand column be credited directly to my \ our bank detailed below: Bank Branch Bank Address Account Type (Tick) Savings Surname Address : City Mobile Telephone 1 Joint\Company s Signatories Write your name at the back of your passport photograph State First Name Company s Seal Country Mobile Telephone 2 Other Names First Registrars & Investor Services Limited...connecting you to your wealth. website: info@firstregistrarsnigeria.com TICK NAMES OF COMPANY ABC TRANSPORT PLC ACAP CANARY GROWTH FUND AFRICAN DEVELOPMENT BANK BOND AFRICAN PAINTS PLC ASSET & RESOURCE MANAGEMENT COMPANY LTD(FUND) ARM AGGRESSIVE GROWTH FUND ARM ETHICAL FUND ASO-SAVINGS AND LOANS PLC AUSTIN LAZ AND COMPANY PLC BANK PHB PLC (NOW KEYSTONE BANK LIMITED) BAYELSA STATE GOVERNMENT BOND BCN PLC-MARKETING COMPANY BOC GASES NIGERIA PLC CADBURY NIGERIA PLC CHAMS PLC COSTAIN WEST AFRICA PLC CORE INVESTMENT SCHEME (COINS) CORE VALUE ACCOUNT (COVA) CR SERVICES (CREDIT BUREAU) PLC CROSS RIVERS STATE GOVT BOND DAAR COMMUNICATIONS PLC DEAP CAPITAL MANAGEMENT & TRUST PLC DELTA STATE GOVT BOND DV BALANCED FUND EDO STATE GOVT BOND FAMAD NIGERIA PLC FBN FIXED INCOME FUND FBN HOLDINGS PLC FBN HERITAGE FUND FBN MONEY MARKET FUND FBN NIGERIA EUROBOND (USD) FUND FBN NIGERIA SMART BETA FUND FIDELITY BANK PLC FIDELITY BANK PLC BOND FORTIS MICROFINANCE BANK PLC FRIESLANDCAMPINA WAMCO NIGERIA PLC HONEYWELL FLOUR MILLS PLC INDORAMA ELEME PETROCHEMICALS COMPANY STAFF COOP SOCIETY LTD JULI PLC LAGOS STATE BOND BILLION 2 ND DEBT ISSUANCE PROGRAMME N80 BILLION 4% (SERIES 1 BOND) LAGOS STATE BOND BILLION 2 ND DEBT ISSUANCE PROGRAMME N87.5 BILLION 13.5% (SERIES 2 BOND) LEARN AFRICA PLC LOTUS HALAL EQUITY EXCHANGE TRADED FUND NIGERIA POLICE MORTGAGE BANK PLC NIGERIAN BREWERIES PLC OANDO PLC ONDO STATE GOVT BOND OYO STATE GOVT BOND PARTNERSHIP INVESTMENT CO.PLC PRESCO PLC PRESTIGE ASSURANCE PLC PZ-CUSSONS NIGERIA PLC RAK UNITY PETROLEUM PLC REDEEMED GLOBAL MEDIA COMPANY SIM CAPITAL ALLIANCE VALUE FUND STACO INSURANCE PLC STANBIC IBTC BANK PLC FLOATING RATE& FIXED RATE SUBORDINATED UNSECURED NOTES BOND TRANCHE A & B STANBIC IBTC BOND FUND STANBIC IBTC ETF 30 FUND STANBIC IBTC ETF 40 FUND STANBIC IBTC BALANCED FUND STANBIC IBTC DOLLAR FUND STANBIC IBTC ETHICAL FUND STANBIC IBTC GUARANTEED INCOME FUND STANBIC IBTC HOLDINGS PLC STANBIC IBTC MONEY MARKET FUND STANBIC IBTC NIGERIAN EQUITY FUND STANDARD ALLIANCE INSURANCE PLC STARCOMMS PLC UBA FIXED RATE SUBORDINATED UNSECURED NOTES BOND UNION DIAGNOSTIC AND CLINICAL SERVICES PLC UPDC REITS VANTAGE BALANCED FUND (INCOME & ACCUMULATED) VANTAGE GUARANTEED INCOME FUND WEST AFRICAN ALUMINIUM PRODUCTS (WAAP) ZAMFARA STATE BOND SHAREHOLER S ACCOUNT NUMBER

9 (To be stamped by Bankers) Write your name at the back of your passport photograph TICK NAME OF COMPANY SHAREHOLDER S ACCOUNT NO. Please complete all section of this form to make it eligible for processing The Registrar, Flour Mills Registrars Limited 34, Eric Moore Road, Iganmu (Bagco Building) Surulere P.O.Box 341, Apapa, Lagos State. I\We hereby request that henceforth, all my\our Dividend Payment(s) due to me\us from my\our holdings in all the companies ticked at the right hand column be credited directly to my \ our bank detailed below: Surname / Company s Name First Name Other Names Address : City State Country Company Seal (If applicable) Joint\Company s Signatories Help Desk Telephone No/Contact Centre Information for Issue resolution or clarification: Flour Mills Registrars Limited website: registrars@fmnregistrar.com

10 (To be stamped by Bankers) Write your name at the back of your passport photograph Please complete all section of this form to make it eligible for processing and return to the address below The Registrar GTL REGISTRARS LIMITED No 2, Burma Road Apapa Lagos I\We hereby request that henceforth, all my\our Dividend Payment(s) due to me\us from my\our holdings in all the companies ticked at the right hand column be credited directly to my \ our bank detailed below: TICK COMPANY NAME SHAREHOLDERS ACCOUNT NO. Abplast Products PLC Aluminium Extrusion PLC Cashew Nut Processing Industries PLC Chellarams PLC Christlieb PLC DANA Group Of Companies Plc Series Tranche 1 & 2 DN Meyer PLC DN Tyre & Rubber PLC Ecobank Transnational Incorporated Ekiti State Bond Tranche 1 & 2 EKOCORP PLC Eterna Oil PLC First Aluminium PLC General Telecoms PLC GlaxoSmithKline Nigeria PLC Global Biofuels Nigeria Limited Surname/Company Name First Name Other Name Great Nigeria Insurance PLC Ikeja Hotels PLC Impresit Bakolori PLC Industrial &General Insurance PLC IPWA PLC Address John Holts PLC Julius Berger Nigeria PLC Kajola Integrated &Investment Company PLC Lennards Nigeria PLC City State Country Local Contractors Receivables Bond Tranche 1,2 & 3 Mobil Oil Nigeria PLC Nestle Nigeria PLC Nigeria Cement Company PLC Nigeria Reinsurance CSCS Clearing House Number Nigerian Enamelware Company PLC Nigerian Lamps Industries Nigerian Wire & Cable PLC Okitipupa Oil Palm PLC *Mobil Number 1 *Mobil Number 2 Oluwa Glass COMPANY Seven-Up Bottling Company PLC The Tourist Company of Nigeria PLC Tripple Gee & Company PLC Shareholder s Signature Company Seal (If applicable) UBA Fixed N20 Billion Bond Series 1 Bond UBN Property Limited Unilever Nigeria PLC Joint/Companies Signatures Help Desk Telephone No/Contact Centre Information for Issue resolution or clarification: 234-(0) , +234-(0) Union Assurance Company Limited (NOW Ensure Insurance) Union Bank of Nigeria PLC Union Homes REITS Union Homes Savings & Loans PLC University Press PLC WEMA Bank PLC GTL Registrars Limited Website: info@gtlregistrars.com

11 Write your name at the back of your passport photograph TICK NAME OF COMPANY SHAREHOLDER ACCOUNT NO CORNERSTONE INSURANCE PLC Please complete all section of the forms to make eligible for processing The Registrar, Lighthouse Registrars Limited Kingsway Building, 3 rd Floor, 2/4 Davies Street P.O. Box Lagos Nigeria. I/We hereby request that henceforth, all my/our dividend payment due to me/us from our holdings in Cornerstone Insurance plc be credited to my/our bank detailed below: Clearing House No Bank Verification No Bank Branch Bank Address Account Type (Tick) Savings Shareholders Account Information Surname First Name Other Names Address: City State Country Previous Address (if any) Company s Seal(If applicable) Joint/Company s Signatories Help Desk Telephone No/Contact Centre Information for Issue resolution or clarification: Lighthouse Registrars Ltd Website: info@lighthousereg.com

12 (To be stamped by Bankers) MainstreetBank Registrars Ltd Write your name at the back of your passport photograph Please complete all section of this form to make it eligible for processing The Registrar, MainstreetBank Registrars Limited 2A Gbagada Expressway, Anthony, P.M.B Lagos. I\We hereby request that henceforth, all my\our Dividend Payment(s) due to me\us from my\our holdings in all the companies ticked at the right hand column be credited directly to my \ our bank detailed below: TICK NAME OF COMPANY AFRICAN ALLIANCE INSURANCE PLC UNIVERSAL INSURANCE PLC GOLDEN GUINEA BREWERIES PLC MULTIVERSE RESOURCES PLC OMATEK VENTURES PLC NIGERIAN ROPES PLC NIGER STATE GOVERNMENT BOND SHAREHOLDER S ACCOUNT NO. Surname / Company s Name First Name Other Names Address : City State Country Company Seal (If applicable) Joint\Company s Signatories Help Desk Telephone No/Contact Centre Information for Issue resolution or clarification: or Company Name website: mainstreetregistrars@yahoo.com

13 (To be stamped by Bankers) Write your name at the back of your passport photograph Please complete all sections of this form to make it eligible for processing The Registrar Meristem Registrars Limited 213, Herbert Macaulay Way Adekunle-Yaba Lagos State I\We hereby request that henceforth, all my\our Dividend Payment(s) due to me\us from my\our holdings in all the companies ticked at the right hand column be credited directly to my \ our bank account detailed below: Surname/Company s Name First Name Other Names Address: City State Country Joint\Company s Signatories Company Seal (If applicable) TICK NAME OF COMPANY SHARE SHAREHOLDER S ACCOUNT A/C NO. NO AFRINVEST EQUITY FUND AIRLINE SERVICE & LOGISTICS PLC BERGER PAINTS NIG PLC CHELLARAMS BOND CONOIL PLC CONSOLIDATED HALLMARK INS. PLC CUSTODIAN & ALLIED PLC COVENANT SALT NIGERIA LIMITED EMPLOYEE ENERGY LIMITED ENERGY COMPANY OF NIGERIA PLC [ENCON] etranzact INTERNATIONAL PLC FIDSON HEALTHCARE PLC FOOD CONCEPTS PLC FREE RANGE FARMS PLC FTN COCOA PROCESSORS PLC GEO-FLUIDS PLC JUBILEE LIFE MORTGAGE BANK LTD MAMA CASS RESTAURANTS LIMITED MCN DIOCESE OF REMO MCN LAGOS CENTRAL MCN TAILORING FACTORY [NIGERIA] LIMITED MULTI-TREX INTEGRATED FOODS PLC MUTUAL BENEFITS ASSURANCE PLC NASSARAWA STATE GOVT BOND NASCON ALLIED INDUSTRIES PLC NEIMETH INT L PHARMS PLC NIGER INSURANCE PLC NIGERIA MORTGAGE REFINANCE COMPANY [NMRC] PLC NIGERIA MORTGAGE REFINANCE COMPANY PLC [NMRC] BOND ONWARD PAPER MILLS PLC PACAM BALANCED FUND PAINTS & COATINGS MANUFACTURERS NIG PLC PROPERTYGATE DEVT. & INVEST. PLC R.T. BRISCOE NIGERIA PLC REGENCY ALLIANCE INSURANCE PLC SMART PRODUCTS NIGERIA PLC SOVEREIGN TRUST INSURANCE PLC TANTALIZERS PLC THE BGL NUBIAN FUND THE BGL SAPPHIRE FUND THOMAS WYATT PLC VITAFOAM NIGERIA PLC VONO PRODUCTS PLC ZENITH EQUITY FUND ZENITH ETHICAL FUND ZENITH INCOME FUND TICK NAME OF COMPANY Help Desk Telephone No/Contact Centre Information for Issue resolution or clarification: Meristem Registrars Limited Meristem Registrars Limited Web: info@meristemregistrars.com website: info@meristemregistrars.com

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15 (To be stamped by Bankers) Write your name at the back of your passport photograph e-dividend ACTIVATION FORM INSTRUCTION: RC Please complete all section of this form to make it eligible for processing and return to the address above. Only Clearing Banks are Acceptable PLEASE COMPLETE IN BLOCK LETTERS Date Others D D M M Y Y Y Y) Title: Mr. Mrs. Miss. I/We, hereby request that henceforth, all my/our dividend/coupon payment due to me/us from the paying company indicated below be paid to my/our bank account stated hereunder. (BVN) Bank Account No: Kindly Select the Company(s) in which Shares are held: TICK NAME OF COMPANY SHAREHOLDER S ACCOUNT NUMBER Avon Crown Caps & Con. (Nig.) BEMIL Nigeria Limited Capital Oil Plc. Channel Petroleum Plc. Stokvis Nigeria Plc D D M M Y Y Y Y FUMMAN Agric. Prod. Plc SHAREHOLDER S ACCOUNT INFORMATION INDIVIDUAL JOINT SHAREHOLDER CORPORATE SHAREHOLDER Surname / Company s Name Heritage Bank Ltd. Int l Energy Insurance Plc. Naturelle Extracts Plc. First Name Other Names (for individual Shareholders only) PANAfrican Capital Plc. Secure Electronic Tech. Plc. Shareholder s CHN (If Known) Postal Address C Spring Life Assurance Plc Swap Tech. & Telecoms Plc. United Mortgage Plc. City State Country Mobile (GSM) Phone Number Land Phone Number/GSM Address Previous Postal Address (If any) Company Seal/Incorporation Number (Corporate Shareholder) Shareholder s Signature or Thumbprint Shareholder s Signature\Joint This form must be signed by ALL, the registered holders, executor(s) or Administrator(s) DISCLAIMER "In no event shall PAC REGISTRARS be liable for any damages, losses or liabilities including without limitation, direct or indirect, special, incidental, consequential damages, losses or liabilities, in connection with your use of this form or your inability to use the information, materials, or in connection with any failure, error, omission, defect, delay in operation or transmission, or system failure, even if you advice us of the possibility of such damages, losses of expenses, whether express or implied in respect of such information." PAC REGISTRARS LTD. No. 122 Bode Thomas Road, Surulere, Lagos P.M.B. 3456, Surulere, Lagos. TEL: , info@pacregistrars.com WEBSITE:

16 (To be stamped by bankers) Please write your name at the back of your passport photograph E-MANDATE ACTIVATION FORM Please complete all sections of this form to make it eligible for processing The Registrar, UNITED SECURITIES LIMITED RC , Amodu Ojikutu Street, Off Bishop Oluwole Street, Victoria Island, P.M.B Lagos, Nigeria. I\We hereby request that henceforth, all my\our Dividend Payment(s) due to me\us from my\our holdings in all the companies ticked at the right hand column be credited directly to my \ our bank detailed below: Kindly tick & quote your shareholder account no in the box below Tick Name of Company Access Bank PLC Afrinvest WA Ltd AIICO Insurance PLC AIICO Money Market Fund Shareholder Number BSS Industries Ltd Caverton Offshore Support group Dangote Cement PLC Surname / Company s Name First Name Other Names Address: First Securities Discount House Food Emporium Int`l Limited Gombe State Government IHS Nigeria PLC City State Country MCNichols Consolidated PLC NDEP PLC NIPCO PLC Red Star Express PLC Skye Fixed Income Fund Three Point Industries Ltd Company Seal (If applicable) Trust Bond Mortgage Bank PLC Joint\Company s Signatories WAPIC Insurance PLC For inquiries, please call or send to customerscare@unitedsecuritieslimited.com UNITED SECURITIES LIMITED Website: ; info@unitedsecuritieslimited.com or the completed update form can also be submitted through any Access Bank PLC nearest to you. Website: UNITED SECURITIES LIMITED hereby ; disclaims info@unitedsecuritieslimited.com liability or responsibility for errors/omissions/misstatements the completed update form can also in be any submitted document through transmitted any Access electronically Bank Plc nearest to you. UNITED SECURITIES LIMITED hereby disclaims liability or responsibility for errors/omissions/misstatements in any document transmitted electronically

17 Please complete all section of this form to make it eligible for processing The Registrar, Unity Registrars Limited 25 Ogunlana Drive, Surulere,Lagos Lagos State. I\We hereby request that henceforth, all my\our Dividend Payment(s) due to me\us from my\our holdings in all the companies ticked at the right hand column be credited directly to my \ our bank detailed below: Surname / Company s Name First Name Other Names Address : City State Country TICK NAME OF COMPANY SHAREHOLDERS ACCOUNT NO AFROIL PLC BGL PLC CARANDA MANAGEMENT SERV. LTD DVCF OIL & GAS FUND DVCF OIL & GAS PLC LOTUS CAPITAL HALAL FUND NORTHLINK BROKERS PLC PELICAN PRINTS LIMITED ROKANA PLC UNITY BANK PLC UNITY REGISTRARS LTD UNITYKAPITAL ASSURANCE PLC Company Seal (If applicable) Joint\Company s Signatories UNITY REGISTRARS LIMITED Website: info@unityregistrarsng.com

18 (To be Stamped by Bankers) Please write your name at the back of your passport photograph e-dividend MANDATE FORM VERITAS REGISTRARS (formerly Zenith Registrars) RC: Please note that INSTRUCTION Please complete all sections of this form to make it eligible for processing : TICK NAME OF COMPANY DANGOTE SUGAR REFINERY PLC SHAREHOLDER S ACCOUNT No. The Registrar Veritas Registrars Limited 89, Ajose Adeogun Street Victoria Island Lagos. FORTE OIL PLC GUINNESS NIG. PLC I/We hereby request that henceforth, all my/our dividend payment(s) due to me/us from my/our holdings in all the companies ticked at the right hand column be credited directly to my/our bank detailed below: MAY & BAKER NIG. PLC ZENITH BANK PLC OSUN STATE BOND S1 OSUN STATE BOND S2 FLOUR MILLS BOND SHAREHOLDER ACCOUNT INFORMATION Surname/Company Name First Name Other Names Address: City State Country Previous Address (if any) CHN(if any) Address Shareholder s Signature or Thumbprint Shareholder s Signature or Thumbprint Company Seal/Incorporation No. (Corporate Shareholder) VERITAS REGISTRARS LIMITED. Plot 89A, Ajose Adeogun Street, P.O. Box 75315, Victoria Island, Lagos Telephone: (01) , ; Fax:(01) enquiry@veritasregistrars.com