Affix Current Passport (To be stamped by bankers) E-DIVIDEND MANDATE ACTIVATION FORM DIAMOND SHAREHOLDER MANDATE FO RM Please write your name at the back of your passport photograph

Kindly quote your shareholder account no in the box below Instruction Only Clearing are acceptable

Please complete all sections of this form to make it eligible for processing Name of Company Shareholder Number and return to the address below The Registrar, PLC UNITED SECURITIES LIMITED RC 126257 9, Amodu Ojikutu Street, Off Bishop Oluwole Street, Victo ria Island, P.M.B 12753 , . 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 Verification Number (BVN)

Bank Name Bank Account Nu mb er

Account Opening Date

Shareholder Account Information

Surname / Company’s Name First Name Other Names

Address (Previous & New )

Gender ( Male/Female ) City State Country

Previous Address (If any)

CHN (If any)

Mobile Telephone 1 Mobile Telephone 2

Email Address

Signature(s) Company Seal (If applicable)

Joint \Company’s Signatories

For inquiries, please call 01-2714566-7 or send e-mail to [email protected]

Website: www.unitedsecuritieslimited.com ; E-mail: [email protected] or the completed update form can also be submitted through any Access Bank PLC nearest to you. UNITED SECURITIES LIMITED Website:“UNITED www.unitedsecuritieslimited.com SECURITIES LIMITED hereby ; E-mail: disclaims [email protected] liability or responsibility for errors/omissions/misstaor the completed update formtements can also in beany 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”