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------Official Use--------
Current Date:
Member Code:
Member Name:
Shareholder's Type:
   
------Please Supply your details--------
Shareholder's Name (Surname):
Other Names:
Mother's Maiden Name:
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WAIVER

I/We of a national of am (are) a prospective shareholder(s) in   Securities quoted on The Nigerian Stock Exchange and I (We) hereby FREELY state that being of my (our) right to be issued with a share Certificate(s) under section 146 and 147 of Companies and Allied matters Decree 1990 and the Memoranda and Articles of Association of the Listed Companies for my (our) sole benefit and private purposes to hereby waive the said right and also DECLARE that I (We) shall accept as sufficient certification of my  (our) shareholding any memorandum to that effect delivered to me  (us) by the said listed company/ companies or the MAYFIELD INVESTMENTS LIMITED acting on behalf of same as satisfaction of my (our) said right under the sections and Memoranda and Articles of association aforementioned.

Dated this  day of 20

 
   
                      
   
 
   

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