Network Capital Limited — E-Dividend Mandate

Network Capital Limited

SEC Regulated · NGX Trading Licence Holder · 13 Maitama Sule Street, Ikoyi, Lagos · 0706 200 2333

SECNGX CSCSNASD

E-Dividend Mandate

Authorisation for electronic dividend credit directly to a registered bank account

Client Identification

Full Name / Company Name*

Full name is required.

CSCS Account Number*

Enter a valid CSCS account number.

CHN / Clearing House Number

Enter a valid CHN, or leave blank if unavailable.

Telephone Number*

Enter a valid 11-digit Nigerian number.

Email Address*

Enter a valid email address.

Request Date*

🔒

Securities Details

Company / Issuer Name*

Share Registrar — optional

Number of Units Held — optional

Bank Verification Number (BVN) — optional

Dividend Bank Account

Dividends will be credited electronically to the bank account below. Ensure the account name matches your brokerage records exactly.

Bank Name*

Account Number (NUBAN)*

Account Name*

Authorisation

Client Full Name*

Signatory name is required.

Signature Date*

🔒

Sign here using mouse or finger

A signature is required — sign above or upload a specimen.

Declaration and Privacy Policy

Declaration

I/We confirm that the information supplied in this form is true, complete, and authorised by the account holder(s). I/We authorise Network Capital Limited to verify and process this request in line with applicable SEC, NGX, CSCS, AML/CFT, and data protection requirements.

Privacy notice: Network Capital Limited will process information supplied for client account maintenance, regulatory compliance, transaction processing, dispute resolution, and record keeping. Personal data should only be submitted by the account holder or an authorised representative.

I acknowledge that I have read and understood the NETCAP Privacy Policy applicable to this instruction.

You must acknowledge the Privacy Policy.

You must read and accept the declaration.

For Official Use Only — Not to Be Completed by the Applicant

Received By

Date Received

Reviewed By

Approved By / Authorised Signatory

Remarks / Action Taken

Relationship OfficerSignature & Date

Compliance OfficerSignature & Date

Authorised OfficerSignature & Date