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VERITAS REGISTRARS
(formerly Zenith Registrars)
RC: 510155
Plot 89A, Ajose Adeogun Street, P.O. Box 75315, Victoria Island, Lagos
Telephone: (01) 2708930-4, 2784167–8; Fax:(01)2704085
[email protected];
www.veritasregistrars.com
e-DIVIDEND MANDATE FORM FOR DANGOTE SUGAR
Affix
Passport
Photograph
(to be stamped by the Bank)
I/We hereby request that from now, all dividends due to me/us from my/our shareholding in
Dangote Sugar Refinery Plc be credited to my/our bank account named below.
/
Date: DD/MM/YYYY
/
Surname/Company’s Name
Other Names (for Individual Shareholder)
Present Postal Address
City
State
E-mail Address
Mobile (GSM) Phone Number
Clearing House Number
Bank Name
Branch Address
Bank Account Number
Bank Sort Code
Company Seal/Incorporation No. (Corporate Shareholder)
Shareholder’s Signature or Thumbprint
Shareholder’s Signature or Thumbprint
For Bank’s use only
Date account was established:
Authorized Signature and Stamp of Bankers
/
/
Authorized Signature and Stamp of Bankers