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(to be stamped by your banker) E-DIVIDEND MANDATE ACTIVATION FORM

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. CLIENTELE A/C No.

The Registrar 1. AFRICA PRUDENTIAL REGISTRARS PLC

Africa Prudential Registrars Plc 2. ABBEY MORTGAGE BANK PLC
220B, Ikorodu Road, Palmgrove, Lagos. 3. AFRILAND PROPERTIES PLC
4. A & G INSURANCE PLC
5. MIXTA REAL ESTATE PLC (formerlyARM Properties Plc)
I/We hereby request that henceforth, all my/our Dividend Payment(s) due to me\us from 6. A.R.M LIFE PLC
my/our holdings in all the companies ticked at the right hand column be credited directly to 7. ADAMAWA STATE GOVERNMENT BOND
my /our bank detailed below:
8. BECO PETROLEUM PRODUCTS PLC
9. BUA GROUP
Bank Verification Number (BVN): 10. BENUE STATE GOVERNMENT BOND
11. CAP PLC
12. CAPPA AND D'ALBERTO PLC
Bank Name:
13. CEMENT COY OF NORTHERN NIG. PLC
14. CSCS PLC
Bank Account Number: 15. CHAMPION BREWERIES PLC
16. COMPUTER WAREHOUSE GROUP
D D M M Y Y Y Y 17. EBONYI STATE GOVERNMENT BOND
Account Opening Date:
18. GOLDEN CAPITAL PLC
19. INFINITY TRUST MORTGAGE BANK PLC
SHAREHOLDER ACCOUNT INFORMATION 20. INTERNATIONAL BREWERIES PLC
21. INVESTMENT & ALLIED ASSURANCE PLC
Surname/Companys Name First Name Other Name
22. JAIZ BANK PLC
23. KADUNA STATE GOVERNMENT BOND
24. NEM INSURANCE PLC
Address 25. NEXANS KABLEMETAL NIG. PLC
26. OMOLUABI SAVINGS AND LOANS PLC
27. PERSONAL TRUST & SAVINGS LTD
City State Country 28. P.S MANDRIDES PLC
29. PORTLAND PAINTS & PRODUCTS NIG. PLC
30. PREMIER BREWERIES PLC
Previous Address (if any) 31. RESORT SAVINGS & LOANS PLC
32. ROADS NIGERIA PLC
33. SCOA NIGERIA PLC
34. TRANSCORP HOTELS PLC
Clearing House Number (CHN) (if any) Name of Stockbroking Firm 35. TRANSCORP PLC
C 36. TOWER BOND
37. THE LA CASERA CORPORATE BOND
Mobile Telephone 1 Mobile Telephone 2 38. UACN Plc
39. UBA BALANCED FUND
40. UBA BOND FUND
E-mail Address 41. UBA CAPITAL PLC
42. UBA EQUITY FUND
43. UBA MONEY MARKET FUND
44. UNITED BANK FOR AFRICA PLC
Company Seal (if applicable) 45. UNIC PLC
46. UAC PROPERTY DEVELOPMENT COMPANY PLC
Signature: Signature:
47. UTC NIGERIA PLC
Joint/Companys Signatories
48. WEST AFRICAN GLASS IND PLC

DISCLAIMER
"In no event shall Africa Prudential 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."

Africa Prudential Registrars Plc @APRPlc