Affix

Current
Passport
Please write your name at the
back of your passport
photograph

SHARE ONLINE
APPLICATION FORM

PLEASE COMPLETE IN CAPITAL LETTERS

Date: / /

TITLE: SURNAME:

OTHER NAMES:

RESIDENTIAL ADDRESS (Line 1):

(Line 2):

CITY: STATE:

NATIONALITY:

ACTIVE GSM NO.:

E-MAIL.:

BVN:

STOCKBROKER:

CLEARING HOUSE NO.:

Securities Listing (Please tick as applicable)

ARDOVA DANGOTE SUGAR GUINNESS MAY & BAKER ZENITH BANK

By signing this form, I/we hereby consent that Veritas Registrars Limited can collect and process my/our personal data for the purpose of
managing my/our records in the companies for which Veritas Registrars Limited act as Registrars. I/we also confirm that I/we have read
and accept the extent to which data can be collected and processed as contained in http://veritasregistrars.com/privatepolicy.aspx)

Shareholder’s Signature

For Official Use Only

Please send all enquiries to:

The Registrar, Veritas Registrars Limited
Head Office: Plot 89A, Ajose Adeogun Street, P.O. Box 75315, Victoria Island, Lagos, Nigeria.
Telephone: +234 (1) 2784167, 2784168, 2784169, 2784170; 0704 499 7048 (Text Messages only)
E-mail: enquiry@veritasregistrars.com; customercare@veritasregistrars.com; Website: www.veritasregistrars.com