Rights Issue Please enable JavaScript in your browser to complete this form.Security *Select SecurityLINKAGE ASSURANCELASACOGuinea InsuranceCSCS A/c No *CHN No *LayoutNumber of Shares (Full Acceptance) *Amount payable (₦1.32 per/Share) *Participation Type *Participation TypeFull Acceptance/Request for additional ordinary sharesRenunciation or Partial AcceptanceLayout (Fidson)Number of Shares (Full Acceptance) *Amount payable (₦1.32 Share) *Layout IMGNumber of Shares (Full Acceptance) *Amount payable (N2/Share) *Layout (Ellah Lakes Plc )Number of Shares (Full Acceptance) *Amount payable (₦1.10/Share) *Layout (Presco)Number of Shares (Full Acceptance) *Amount payable (₦1,420/Share) *LayoutAdditional units appliedAdditional amount payable (₦1.32 per/Share) Layout FidsonAdditional units appliedAdditional amount payable (₦2/Share)Layout IMGAdditional units applied Additional amount payable (N22.0/Share) Layout (Ellah Lakes Plc )Additional units appliedAdditional amount payable (₦1.10/Share) Layout (Presco)Additional units appliedAdditional amount payable (₦1,420/Share)LayoutNumber of Shares AcceptedAdditional amount payable (₦1.05 per/Share)Number of Shares RenouncedLayout FidsonNumber of Shares AcceptedAdditional amount payable (₦1.32/Share)Number of Shares RenouncedLayout IMGNumber of Shares Accepted Additional amount payable (N22.0/Share) Number of Shares Renounced Layout (Ellah Lakes Plc )Number of Shares Accepted Additional amount payable (₦1.10/Share) Number of Shares Renounced Layout (Presco )Number of Shares AcceptedAdditional amount payable (₦1,420/Share)Number of Shares RenouncedCustomer TypeInidividualJointCorporateInvestor DetailsTitle *MrMrsMissMasterDrProfChief/SirSurnameFirst NameOther NamesLayoutEmail *Phone *Date of Birth *Residential Address *NIN *TIN *Mother's Maiden Name *LayoutState *Country *Joint Applicant DetailsTitle *MrMrsMissMasterDrProfChief/SirSurnameFirst NameOther NamesOccupation *Mobile Number *Email *BVN *Residential Address *Next Of Kin *Company NameType of BusinessR/C No.AddressEmail *Phone NumberContact Person *Bank Account InformationAccount Name *Account Number *Bank NameBVN *Form Upload (kindly upload files max 3MB in size)Form Upload * Click or drag a file to this area to upload. Evidence of Payment(1014048866 - Meristem Stockbrokers Limited- Zenith Bank) * Click or drag a file to this area to upload. EmailSubmit
