Exchange Traded Fund

SUBSCRIPTION FOR (Kindly Tick): *

Date

Meristem Value ETF

Number of Units Applied For

Value of units applied for/Amount Paid:

Meristem Value ETF

Meristem Growth ETF

Number of Unites Applied For

Value of units applied for/Amount Paid:

Meristem Growth ETF

Name(s) *

In Block Letters

Next Of Kin

In Block Letters

Email *

Mobile Number *

Daytime Telephone Number

Name of Stockbroker

Clearing House Number (CHN)

CSCS No.

(Dividend will not be re-invested)

Name of Bank

Branch

Account Number

BVN

1st Signature

2nd Signature

Name of Authorised Signatory 1 (Corporate Only)

Name of Authorised Signatory 2 (Corporate Only)

Designation 1 (Corporate Only)

Designation 2 (Corporate Only)

Declaration *

- I am/We are 18 years of age or above
- I/We attach the amount payable in full on application for the above number of Units indicated MG ETF/MV ETF at ₦10 per unit.
- I/We agree to accept the same or any smaller number of Units in respect of which allotment may be made upon the terms of the Prospectus and subject to the Trust Deed of MG ETF/MV ETF
- I/We authorise you to send a Statement of Unit-holding and/or a cheque for any amount overpaid, by registered post to the address given below and to procure registration in my/our name as the holder(s) of such number of Units or such smaller number, as aforesaid.
- I/we hereby by declare that I/We have read a copy of the Prospectus dated 14 January 2020 issued by the Issuing Houses on behalf of MG ETF and /or MV ETF