Name of Company in which Shares are held. The company name ...

6
SG151 12OYGA D04 Kindly Note: This form is issued only to the addressee(s) and is specific to the unique designated account printed hereon. This personalised form is not transferable between different (i) account holders; or (ii) uniquely designated accounts. The Company and Computershare Investor Services PLC accept no liability for any instruction that does not comply with these conditions. C2 9 0 9 Request for Designation or Re-designation of Account Account Designation (if any) Company Code (if known) Shareholder Reference Number (SRN) Your SRN starts with ‘C’ ‘I’ or ‘G’ followed by 10 digits Name of Company in which Shares are held. The company name must be specified. Name and Address of first named shareholder and names of all other shareholders Full Names & Personal Details of all Registered Holders, Executors or Administrators required: - If the above Shareholder Reference Number (SRN) starts with ‘I’, please complete the full personal details below using the enclosed User Guide for information. For other SRNs, only the full names are required. Title Forename(s) in full Surname Name (1) Nationality National ID Type Date of Birth National ID or LEI Name (2) Nationality National ID Type Date of Birth National ID or LEI Name (3) Nationality National ID Type Date of Birth National ID or LEI Computershare Investor Services PLC, Registered in England & Wales, Company No. 3498808, Registered Office: The Pavilions, Bridgwater Road, Bristol BS13 8AE. Computershare Investor Services PLC is authorised and regulated by the Financial Services Authority, Registered Office: 25 The North Colonnade, Canary Wharf, London E14 5HS.

Transcript of Name of Company in which Shares are held. The company name ...

Page 1: Name of Company in which Shares are held. The company name ...

SG15112OYGA D04

Kindly Note: This form is issued only to the addressee(s) and is specifi c to the unique designated account printed hereon. This personalised form is not transferable between different (i) account holders; or (ii) uniquely designated accounts. The Company and Computershare Investor Services PLC accept no liability for any instruction that does not comply with these conditions.

C 2 90 9

Request for Designation or Re-designation of Account

Account Designation (if any) Company Code (if known)

Shareholder Reference Number (SRN)

Your SRN starts with ‘C’ ‘I’ or ‘G’ followed by 10 digits

Name of Company in which Shares are held. The company name must be specifi ed.

Name and Address of fi rst named shareholder and names of all other shareholders

Full Names & Personal Details of all Registered Holders, Executors or Administrators required: -If the above Shareholder Reference Number (SRN) starts with ‘I’, please complete the full personal details below using the enclosed User Guide for information. For other SRNs, only the full names are required. Title Forename(s) in full Surname

Name (1) Nationality National ID Type Date of Birth

National ID or LEI

Name (2) Nationality National ID Type Date of Birth

National ID or LEI

Name (3) Nationality National ID Type Date of Birth

National ID or LEI

Computershare Investor Services PLC, Registered in England & Wales, Company No. 3498808, Registered Offi ce: The Pavilions, Bridgwater Road, Bristol BS13 8AE. Computershare Investor Services PLC is authorised and regulated by the Financial Services Authority, Registered Offi ce: 25 The North Colonnade, Canary Wharf, London E14 5HS.

Page 2: Name of Company in which Shares are held. The company name ...

12OYGA D04

Name (4)

Nationality National ID Type Date of Birth

National ID or LEI

Designation (if any)

Previous House Number Previous Post Code

Previous AddressDetails

Name and address of person lodging this form, to whom the new certifi cate will be sent

Description of Security Amount of Shares or Stock in wordsAmount of Shares or Stock in fi gures

I/We the undersigned, request the amount of shares shown above to be: -

(a) Designated as shown in the New Designation box, or

New Designation (b) Re-designated as shown in the New Designation box, or

(c) The existing designation to be cancelled. Cancel Designation (Please write ‘cancelled’ in the Cancel Designation box).

Please turn the page and complete all the sections overleaf. Both pages must be completed before your request be processed.

Computershare Investor Services PLC, Registered in England & Wales, Company No. 3498808, Registered Offi ce: The Pavilions, Bridgwater Road, Bristol BS13 8AE. Computershare Investor Services PLC is authorised and regulated by the Financial Services Authority, Registered Offi ce: 25 The North Colonnade, Canary Wharf, London E14 5HS.

Page 3: Name of Company in which Shares are held. The company name ...

12OYGA D04

Furthermore, I/we hereby certify that no benefi cial ownership in the shareholding/stock passes by virtue of this designation/redesignation.

Signature(s) of all holders. (The signatories of corporate bodies should sign and state their representative capacity).

(1) Capacity

(2) Capacity

(3) Capacity

(4) Capacity

Date / / All share certifi cate(s) will need to be returned for amendment together with this form and our administration fee of £43.50.

Page 4: Name of Company in which Shares are held. The company name ...

12OYGA D04

Page 5: Name of Company in which Shares are held. The company name ...

12OYGA D04

CERTAINTY

INGENUITY

ADVANTAGE

Per

sona

l Det

ails

Use

r G

uide

Th

e ac

com

pany

ing

form

will

hav

e th

e 4

boxe

s be

low

whi

ch r

elat

e to

the

info

rmat

ion

in t

he t

able

s on

pag

e 2

of t

his

Use

r G

uide

. The

exa

mpl

e be

low

sho

ws

whi

ch in

form

atio

n go

es in

whi

ch b

ox o

n th

e fo

rm.

If y

ou d

o n

ot p

rovi

de t

he

deta

ils r

equi

red

we

may

not

be

able

to

carr

y ou

t yo

ur

tran

sact

ion

req

uest

as

regu

lati

on r

equ

ires

us

to c

olle

ct t

hem

.

EX

AM

PLE

ON

LY!

Ple

ase

see

the

tabl

es o

ver

the

page

to

fin

d th

e de

tails

th

at a

pply

to

you

r n

atio

nal

ity:

Wha

t if

I h

ave

Mul

tipl

e N

atio

nalit

ies?

If

you

hav

e M

ultip

le N

atio

nalit

ies,

ple

ase

refe

r to

the

rul

es b

elow

M

ult

iple

Nat

ion

alit

ies

and

only

one

is E

uro

pean

– P

leas

e pr

ovid

e de

tails

for

the

Eur

opea

nna

tiona

lity.

Mu

ltip

le E

urop

ean

Nat

ion

alit

ies

– Pl

ease

pro

vide

det

ails

for

whi

chev

er c

ount

ry c

omes

firs

ton

the

‘Eur

opea

n Co

untr

ies’

tab

le.

For

exa

mpl

e, if

you

are

a n

atio

nal o

f Spa

in a

nd E

ston

ia,

you

shou

ld s

uppl

y th

e N

atio

nalit

y Co

untr

y Co

de f

or E

ston

ia b

ecau

se it

app

ears

bef

ore

Spai

n in

the

list.

Mu

ltip

le n

on-E

uro

pean

Nat

ion

alit

ies

- Pl

ease

pro

vide

det

ails

for

whi

chev

er c

ount

ry c

omes

first

on

the

‘Non

-Eur

opea

n Co

untr

ies’

tab

le. F

or e

xam

ple,

if y

ou a

re a

nat

iona

l of

Aust

ralia

and

Arub

a, y

ou s

houl

d su

pply

the

Nat

iona

lity

Coun

try

Code

for

Aus

tral

ia b

ecau

se it

app

ears

bef

ore

Arub

a in

the

list

.

Reg

ulat

ion

requ

ires

us t

o co

llect

the

hig

hest

prio

rity

ID t

ype

that

you

pos

sess

. The

rel

evan

t N

atio

nal I

Ds

and

rela

ted

prio

rity

for

your

cou

ntry

are

sho

wn

in t

he a

ppro

pria

te t

able

on

the

next

pag

e.

If y

ou p

rovi

de a

n ID

whi

ch is

not

the

hig

hest

prio

rity

ID li

sted

, the

n yo

u ar

e ce

rtify

ing

that

you

are

sup

plyi

ng

the

high

est

prio

rity

ID in

you

r po

sses

sion

.

For

som

e co

untr

ies

we

are

allo

wed

to

crea

te a

‘Com

pute

rsha

re G

ener

ated

’ ID

. If

you

requ

ire u

s to

gen

erat

e an

ID

for

you

plea

se le

ave

the

‘Nat

iona

l ID

’ box

bla

nk a

nd fi

ll in

the

oth

er 3

box

es.

For

corp

orat

e bo

dies

, su

ch a

s so

licito

rs, b

anks

and

bui

ldin

g so

ciet

ies,

we

only

req

uire

the

Leg

al E

ntity

Id

entif

ier

(LEI

.) T

he o

ther

box

es m

ay r

emai

n bl

ank.

If

you

are

unsu

re if

you

're e

ligib

le for

an

LEI

or r

equi

re

mor

e in

form

atio

n on

app

lyin

g fo

r on

e, p

leas

e vi

sit

ww

w.g

leif.

org

This

is t

he

uniq

ue 3

di

git

Nat

iona

lity

Code

Ente

r th

e ap

prop

riate

N

atio

nal I

D T

ype

code

:

NID

N –

Nat

iona

l ID

CCPT

– P

assp

ort

No.

CON

CAT

–Co

mpu

ters

hare

Gen

erat

ed I

D

Ente

r yo

ur d

ate

of b

irth

in

DD

/MM

/YYY

Y fo

rmat

G B

R N

J

54

99

91

RN

ID

N25

05

1984

Why

do

I ne

ed t

o pr

ovid

e th

ese

deta

ils?

Und

er t

he M

arke

ts in

Fin

anci

al I

nstr

umen

ts R

egul

atio

ns w

e ne

ed t

o re

port

the

det

ails

of

any

one

wis

hing

to

sell

shar

es o

r ot

her

secu

ritie

s.

Who

nee

ds t

o pr

ovid

e th

eir

deta

ils?

We

DO

nee

d de

tails

for

: Al

l ind

ivid

uals

on

the

acco

unt

incl

udin

g: >

Joi

nt H

olde

rs;

> D

ecea

sed

Hol

ders

;>

Anyo

ne in

stru

ctin

g un

der

a Po

wer

of

Atto

rney

We

DO

NO

T ne

ed d

etai

ls fo

r:

Exec

utor

s of

a d

ecea

sed

esta

te;

Any

Atto

rney

s no

t re

ques

ting

the

sale

Page 6: Name of Company in which Shares are held. The company name ...

12OYGA D04

CERTAINTY

INGENUITY

ADVANTAGE

Coun

try

Nam

eCo

deCo

untr

y Na

me

Code

Coun

try

Nam

eCo

deCo

untr

y Na

me

Code

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Thai

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et N

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ich

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Com

oros

(th

e) -

KM

Mon

golia

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ru -

PE

San

Mar

ino

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an (

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ince

of C

hina

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TW

Sval

bard

and

Jan

May

en -

SJ

Trin

idad

and

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ago

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Afgh

anis

tan

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Braz

il -

BRDj

ibou

ti -

DJEq

uato

rial G

uine

a -

GQKi

ribat

i - K

IM

yanm

ar -

MM

Pana

ma

- PA

Sier

ra L

eone

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L

New

Zea

land

- N

ZSa

int H

elen

a, A

scen

sion

and

Tr

ista

n da

Cun

ha -

SH

Turk

ey -

TR

Unite

d Ar

ab E

mira

tes

(the

) -

AEBo

naire

, Sin

t Eus

tatiu

s an

d Sa

ba -

BQ

Chris

tmas

Isla

nd -

CX

Guad

elou

pe -

GP

Cam

bodi

a -

KHM

ali -

ML

Om

an -

OM

Ando

rra

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Boliv

ia (

Plur

inat

iona

l Sta

te o

f) -

BO

Cura

çao

- CW

Guin

ea -

GN

Kyrg

yzst

an -

KG

Mac

edon

ia (

the

form

er Y

ugos

lav

Repu

blic

of)

- M

K