Page 357 - ACCESS BANK ANNUAL REPORTS_eBook

Affix
Current
Passport

(To be stamped by bankers) E-DIVIDEND MANDATE ACTIVATION FORM
E-MANDATE ACTIVATION FORM

Please write your name at the

back of your passport
photograph

Kindly quote your shareholder account no in the box below
Instruction Only Clearing Banks are acceptable

Please complete all sections of this form to make it eligible for processing Name of Company Shareholder Number
and return to the address below
The Registrar,
UNITED SECURITIES LIMITED RC 126257 ACCESS BANK PLC
9, Amodu Ojikutu Street, Off Bishop Oluwole Street,
Victoria Island, P.M.B 12753 Lagos, Nigeria.
I\We hereby request that henceforth, all my\our Dividend Payment(s) due to me\us from my\our holdings in all the companies ticked at the
right-hand column be credited directly to my \ our bank detailed below:
Bank Verification Number (BVN)

Bank Name
Bank Account Number
Account Opening Date

Shareholder Account Information

Surname / Company’s Name First Name Other Names

Address (Previous & New)

Gender (Male/Female) City State Country

Previous Address (If any)

CHN (If any)

Mobile Telephone 1 Mobile Telephone 2

Email Address

Signature(s) Company Seal (If applicable)

Joint\Company’s Signatories

For inquiries, please call 01-2714566-7 or send e-mail to customerscare@unitedsecuritieslimited.com

UNITED SECURITIES LIMITED
Website: www.unitedsecuritieslimited.com ; E-mail: info@unitedsecuritieslimited.com or the completed update form can also be submitted through any Access Bank PLC nearest to you.

“UNITED SECURITIES LIMITED hereby disclaims liability or responsibility for errors/omissions/misstatements in any document transmitted electronically”
Website: www.unitedsecuritieslimited.com ; E-mail: info@unitedsecuritieslimited.com or the completed update form can also be submitted through any Access Bank Plc nearest to you.

“UNITED SECURITIES LIMITED hereby disclaims liability or responsibility for errors/omissions/misstatements in any document transmitted electronically”