E-Dividend Mandate Activation Form of First Registrars

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E-Dividend Mandate Activation Form of First Registrars

Affix E-DIVIDEND Current Passport (To be stamped by Bankers) E-DIVIDEND ACTIVATION FORM Write your name at the back of your passport photograph SHAREHOLER’S TICK NAMES OF COMPANY ACCOUNT NUMBER ABC TRANSPORT PLC ACAP CANARY GROWTH FUND AFRICAN DEVELOPMENT BANK BOND Instruction Only Clearing Banks are acceptable AFRICAN PAINTS PLC ASSET & RESOURCE MANAGEMENT COMPANY Please complete all section of this form to make it eligible for processing LTD(FUND) and return to the address below ARM AGGRESSIVE GROWTH FUND ARM ETHICAL FUND The Registrar, ASO-SAVINGS AND LOANS PLC First Registrars & Investor Services Ltd. AUSTIN LAZ AND COMPANY PLC 2 , A b e b e V i l l a g e R o a d , I g a n m u BANK PHB PLC (NOW KEYSTONE BANK LIMITED) P. M. B. 12692 Lagos. Nigeria. BAYELSA STATE GOVERNMENT BOND BCN PLC-MARKETING COMPANY I\We hereby request that henceforth, all my\our dividend Payment(s) due to BOC GASES NIGERIA PLC CADBURY NIGERIA PLC me\us from my\our holdings in all the companies ticked at the right hand CHAMS PLC column be credited directly to my \ our bank detailed below: COSTAIN WEST AFRICA PLC CORE INVESTMENT SCHEME (COINS) CORE VALUE ACCOUNT (COVA) Bank Verification Number CR SERVICES (CREDIT BUREAU) PLC CROSS RIVERS STATE GOVT BOND DAAR COMMUNICATIONS PLC Bank Name DEAP CAPITAL MANAGEMENT & TRUST PLC DELTA STATE GOVT BOND Bank Branch DV BALANCED FUND EDO STATE GOVT BOND Bank Address FAMAD NIGERIA PLC FBN FIXED INCOME FUND FBN HOLDINGS PLC FBN HERITAGE FUND FBN MONEY MARKET FUND Bank Account Number FBN NIGERIA EUROBOND (USD) FUND FBN NIGERIA SMART BETA FUND FIDELITY BANK PLC Account Opening Date FIDELITY BANK PLC BOND FORTIS MICROFINANCE BANK PLC Account Type (Tick) Current Savings FRIESLANDCAMPINA WAMCO NIGERIA PLC HONEYWELL FLOUR MILLS PLC INDORAMA ELEME PETROCHEMICALS COMPANY Shareholder Account Information STAFF COOP SOCIETY LTD JULI PLC Surname First Name Other Names LAGOS STATE BOND 167.5 BILLION 2ND DEBT ISSUANCE PROGRAMME N80 BILLION 4% (SERIES 1 BOND) LAGOS STATE BOND 167.5 BILLION 2ND DEBT ISSUANCE PROGRAMME N87.5 BILLION 13.5% Address : (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 City State Country OYO STATE GOVT BOND PARTNERSHIP INVESTMENT CO.PLC PRESCO PLC PRESTIGE ASSURANCE PLC Previous Address (If any) PZ-CUSSONS NIGERIA PLC RAK UNITY PETROLEUM PLC REDEEMED GLOBAL MEDIA COMPANY SIM CAPITAL ALLIANCE VALUE FUND STACO INSURANCE PLC CHN (If any) STANBIC IBTC BANK PLC FLOATING RATE& FIXED RATE SUBORDINATED UNSECURED NOTES BOND TRANCHE A & B STANBIC IBTC BOND FUND STANBIC IBTC ETF 30 FUND Mobile Telephone 1 Mobile Telephone 2 STANBIC IBTC ETF 40 FUND STANBIC IBTC BALANCED FUND STANBIC IBTC DOLLAR FUND STANBIC IBTC ETHICAL FUND STANBIC IBTC GUARANTEED INCOME FUND Email Address STANBIC IBTC HOLDINGS PLC STANBIC IBTC MONEY MARKET FUND STANBIC IBTC NIGERIAN EQUITY FUND STANDARD ALLIANCE INSURANCE PLC STARCOMMS PLC Signature(s) Company’s Seal UBA FIXED RATE SUBORDINATED UNSECURED NOTES BOND UNION DIAGNOSTIC AND CLINICAL SERVICES PLC UPDC REITS Joint\Company’s Signatories VANTAGE BALANCED FUND (INCOME & ACCUMULATED) VANTAGE GUARANTEED INCOME FUND WEST AFRICAN ALUMINIUM PRODUCTS (WAAP) ZAMFARA STATE BOND First Registrars & Investor Services Limited ...connecting you to your wealth. website:www.firstregistrarsnigeria.com; E-mail: [email protected] .

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