e-dividend mandate diamond registrars
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Diamond Registrars Limited | 59 Ogunlana Drive | Surulere | Lagos | Nigeria Tel:01-2710574 ;e-mail:[email protected]
www.diamond-registrars.com
E-Dividend Mandate Form
SHAREHOLDER REQUEST Please take this as authority to credit my under-mentioned account(s) with any dividend payment(s) due on my shareholdings, which are stated below from the date hereof:
Names (in full) Shareholder Account Number(s)
Contact address City State
Bank Name and Branch Bank Account Number
Mobile phone number E-mail address
Shareholders Signature Date
Bank Authorized signatory Bank stamp /seal Bank Authorized Signatory
Completed forms should be returned to Diamond Registrars Limited 59, Ogunlana Drive, Surulere, Lagos. For further information call us on 01-2710574 or email [email protected].
To implement this for your holdings in other companies we manage, kindly tick as appropriate
C&I Leasing Plc Linkage Assurance Plc Vital Products Plc Nigeria Wire Industries Plc Diamond Bank Plc
For Administrative Use Only: Date received________________
Action taken_________________________________________________________________________
_____________________________________________________ Date________________
Action taken_________________________________________________________________________
_____________________________________________________ Date_______________
[Attach additional documentation, if applicable.]