Change of Name Form.

I\We hereby request for change of name in my/our shares’ accounts existing in all the companies ticked at the right hand of this form.

S/N NAME OF COMPANY TICK

Attached are the requested documents to enable you effect the change:

• Introduction/Consent Letter
• Sworn Court Affidavit
• Marriage Certificate (s) in the case of marriage
• Newspaper Publication
• Banker’s Confirmation of Signature
• Proof of Ownership
• Means of identification

I/We hereby declare that the information I have provided is true and correct and that I shall be held personally liable for any of my personal details.

I/We also agree and consent that Cordros Registrars Limited may collect, use, disclose, process and deal in any manner whatsoever with my/our personal, biometric and shareholding information’s out in this form and/or otherwise provided by me/us or possessed by Cordros Registrars for administration of my/our shareholding and matters related thereto.