Registration Form • Feb 6, 2013
Registration Form
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Severn Trent Plc PO Box 5309 Coventry CV3 9FH
Tel 024 7771 5000 www.severntrent.com
THIS DOCUMENT IS IMPORTANT AND REQUIRES YOUR IMMEDIATE ATTENTION: If you are in any doubt as to the action you should take, you should consult your stockbroker, bank manager, solicitor, accountant or other independent professional advisor authorised under the Financial Services and Markets Act 2000 if you are in the United Kingdom or, if not, from another appropriately authorised independent financial adviser.
Dear Shareholder,
The Company's shareholders have previously passed a resolution enabling us to take advantage of provisions in the Companies Act 2006 that allow us to communicate with our shareholders electronically. This allows us to make documentation available to our shareholders on the Company's website (www.severntrent.com).
We are writing to you as you have either previously indicated that you would like to receive shareholder documentation in paper copy form, or you are a new shareholder who has not yet made any election as to how you would like to receive documentation from the Company.
There are a number of advantages for you and us in using electronic communications:
To ensure that we can benefit from these advantages, we periodically consult with shareholders to check how they wish to continue to receive shareholder documentation from us. You therefore have the options overleaf available to you.
PTO
| Shareholder Reference Number | |
|---|---|
| Product ID | 0815-097-S |
To continue to receive documention in paper format, please tick this box and return this Response Form to Equiniti by 08 March 2013 using the envelope provided.
You do not need to return this Response Form if you wish to view and download documentation from www.severntrent.com
If you wish to view shareholder communications online and be advised by email when such communications have been placed on our website, you should register at www.shareview.co.uk
We will publish shareholder documents on our website and will notify you by post when a new document is made available. We will continue to send any Notice of Meeting and a personalised Proxy Form to you in paper format by post. If you choose this option then you do not need to take any further action.
If you wish to continue to receive shareholder information in paper form by post, you should complete the Response Form overleaf and return this to our Registrar, Equiniti, by 08 March 2013 using the prepaid envelope provided.
Please note that if you do not return your Response Form or register at www.shareview.co.uk by 08 March 2013 you will be deemed to have elected to receive paper copy notification documents whenever documentation is available on the Company's website, as in option 2 above.
You can of course change your mind at any time and elect to receive paper form documentation by contacting Equiniti using the prepaid envelope provided or contact details stated on the prepaid envelope. Notwithstanding any election, the Company may, at any time and at its discretion, choose to send or supply any notification, documents or information to some or all shareholders in paper form.
Yours sincerely
Bronagh Kennedy General Counsel and Company Secretary
* Calls to this 0871 telephone number are charged at 8p per minute from a BT landline. Other providers' costs may vary. Lines are open 8.30am to 5.30pm Monday to Friday, excluding UK bank holidays.
Registered in England & Wales Registration No. 2366619 Registered Office: Severn Trent Centre, 2 St John's Street, Coventry CV1 2LZ
Return your form by 14 March 2013 to participate
If you are in any doubt as to the action you should take, you should consult your stockbroker, bank manager, solicitor, accountant or other independent professional advisor authorised under the Financial Services and Markets Act 2000.
I am writing to tell you about a service which we are pleased to offer to our UK resident shareholders for a limited period. This easy to use service, which we have arranged with Equiniti Financial Services Limited (Equiniti), is now available to shareholders who wish to sell or buy shares or donate their sale proceeds to charity by post. Please read the Useful Information overleaf and Equiniti's Terms and Conditions for more details.
As a Severn Trent employee you will be aware that we actively encourage employee share ownership in Severn Trent Plc in order that you have the opportunity to benefit from your contribution to the continuing improvement of our business. This share dealing service does not constitute a change in philosophy but allows employees to benefit from a service being offered to shareholders generally.
Of course, this is not a recommendation to take any action, and if you do not wish to sell or buy shares then you don't need to return the enclosed form.
Please note that if you wish to buy or sell shares then you must comply with the Severn Trent Share Dealing Policy.
Option 1: Sell all your shares – Just sign the enclosed form and post it back to Equiniti with your certificate(s) in the envelope provided and Equiniti will do the rest. It costs just £1.30 per share, up to a maximum of £50, to sell. Equiniti will post your cheque to you within two working days of the sale of your shares. Even if you can't find your certificate(s), you may still be able to sell your shares. Turn to the Useful Information overleaf for more details.
Option 2: Buy more shares – Just complete and sign the form enclosed and return it with your cheque in the envelope provided. It costs £50 per purchase regardless of the amount invested, plus stamp duty reserve tax.
Option 3: Give to charity – A free service enabling you to sell your shares and donate the proceeds to the charity ShareGift. Just write SHAREGIFT in the Give to charity box on the form, then sign and return it.
If you would like to take advantage of any of these options, your completed form and any accompanying documentation must be received by Equiniti no later than Thursday 14 March 2013. There's more information about each of these options in the Useful Information overleaf.
Alternatively, if you prefer to deal online, please visit www.shareview.co.uk/dealing. To deal by phone, please call 08456 037 037. This telephone number is to give an instruction to sell or buy shares only. If you wish to contact Equiniti with an enquiry, please turn to the Useful Information overleaf for the Equiniti Helpline number. Please note that different charges and terms and conditions apply to the online and phone share dealing services. Full details of these can be found at www.shareview.co.uk/dealing.
The value of shares and any income from them can fluctuate and you may get back less than you invested.
Yours sincerely
Bronagh Kennedy General Counsel and Company Secretary
Registered in England & Wales Registration No. 2366619 Registered Office: Severn Trent Centre, 2 St John's Street, Coventry CV1 2LZ
You may still be able to sell your shares. If you have invalid/missing share certificate(s) worth less than £5,000 in value, please see 'Lost or Invalid Share Certificate(s)' below. If your invalid/missing share certificate(s) are worth more than £5,000 then you will need to contact the Equiniti Helpline on 0871 384 2967* for further advice before you can sell your shares using this service.
Selling – £1.30 for each share you sell with a maximum charge of £50. If you are missing share certificate(s) for more than 15 shares but less than £5,000 in value, you do not enclose all your share certificates or you enclose invalid share certificates, an additional charge of £20 will be deducted from your sale proceeds. There is no sale or lost certificate charge if you donate your share sale proceeds to ShareGift. Buying – a flat fee of £50 will be charged regardless of the amount invested. In addition, stamp duty reserve tax is also payable on purchases currently at the rate of 0.5% of the transaction value.
7. What do I need to do to update my details on the register? If your details need to be updated on the register before the sale or purchase of shares, please enclose the relevant documentation (see 'Do your account details need updating?' below). An administration charge of £20 will be payable for all register updates required. If you take advantage of either or both the lost share certificate and register update services, only one charge of £20 will be payable.The register updates possible are shown below.
This Declaration and Undertaking applies only to shareholders who have not enclosed valid or sufficient share certificates with their form.
If you are missing valid certificate(s) for 15 shares or fewer there won't be a lost certificate charge. If the missing or invalid certificate(s) is/are for more than 15 shares but less than £5,000 in value, a lost certificate charge of £20 will be deducted from your sale proceeds.
To Severn Trent Plc, Equiniti Financial Services Limited and Equiniti Limited, Registrar of Severn Trent Plc:
In consideration of your registering a transfer relating to the sale of shares through this service without production of the relevant valid share certificate(s) which has/have been lost, stolen or destroyed, I/we jointly and severally agree:
If your details need to be updated on the register before the sale or purchase of shares, please enclose the relevant documentation.
Any other changes will still be actioned but may result in a delay in the sale or purchase of shares.
Arrangements have been made for shareholders, if they wish, to donate all the proceeds from the sale of their shares to ShareGift, the share donation charity (registered charity no 1052686). Equiniti Financial Services Limited have agreed to make no charges for selling your shares if you choose to donate the proceeds to ShareGift through this service.
ShareGift is particularly designed so that smaller holdings of shares that may otherwise be uneconomic to sell, can be used for charitable purposes. All share sale proceeds donated through this service are pooled by ShareGift and will be used at the close of the service to make donations to Severn Trent's nominated charity, WaterAid; registered Charity No.288701 (England and Wales) and SCO039479 (Scotland).
ShareGift has already donated millions of pounds to hundreds of different charities, supporting a broad range of local, national and international work. The charities which benefit are chosen by ShareGift's trustees, guided by suggestions received from donors.
If you donate your share sale proceeds to ShareGift, you will receive a sale advice providing details of your donation and an explanation of how to suggest a charity for ShareGift's future donations.
Complete Option 2 and sign the form and return it with your cheque made payable to Equiniti Financial Services Limited in the envelope provided. Cheques must be drawn on a UK Bank or Building Society account in the name of the shareholder. We cannot accept third party cheques.
Shares will be bought within five working days following receipt of your cheque and instruction to ensure cleared funds are available to purchase shares. A purchase advice will be sent to you two working days after your shares have been bought.
You can invest from £500 to £10,000 in Severn Trent Plc shares, including charges.
Please note that the share price may alter significantly from the date that you decide to deal to the time when the shares are either sold or bought.
The last date for instruction forms to reach us is Thursday 14 March 2013. The last dealing date for sales will be Friday 15 March 2013 and the last dealing date for purchases will be Friday 22 March 2013.
*Calls to this number are charged at 8p per minute from a BT landline. Other providers' costs may vary. Lines are open 8.30am to 5.30pm, Monday to Friday.
An administration charge of £20 will be payable for any register updates required. By signing the form you are agreeing to this charge.
If you take advantage of either this service, the Lost or Invalid Share Certificate service or both only one charge of £20 will be payable.
* If this documentation has been addressed to 'The Personal Representatives of' this indicates that we have been previously made aware that the shareholder has passed away. However, in order to formally record the death and to enable use of this service, we require sight of the Grant of Representation.
Further information about ShareGift and the charities it has supported may be obtained from the website www.sharegift.org or by contacting ShareGift at 17 Carlton House Terrace, London, SW1Y 5AH United Kingdom.
If you are a UK tax payer you can increase the value of your gift to charity by up to 25% at no extra cost to yourself by authorising ShareGift to reclaim tax from HM Revenue & Customs through Gift Aid.
To qualify for Gift Aid the amount you pay in Income Tax and/or Capital Gains Tax for each tax year (6 April one year to 5 April the next) must be at least equal to the amount of tax that ShareGift will reclaim on your gifts for that tax year.
Higher rate tax payers can claim tax relief at the difference between basic rate tax and higher rate tax.
Gift Aid is not available to the Personal Representatives of deceased shareholders.
| Number of shares you hold | Shareholder reference no. |
|---|---|
| Example price per share | |
| Estimated value of your shares |
The above share price and estimated value are based on a recent closing price for each Severn Trent Plc ordinary share on the London Stock Exchange. This is therefore only an example and if you should choose to sell your shares in Severn Trent Plc, the value of your shares may be higher or lower depending upon the actual price on the day they are sold. If you are selling shares, Equiniti Financial Services Limited will deduct any applicable charges from the sale proceeds.
If you wish to sell all your Severn Trent Plc shares as shown above, just sign this form in the box below and return it with your certificate(s) in the envelope provided. Only share certificates in the name of Severn Trent Plc dated 9 October 2006 or later are valid. It costs £1.30 per share up to a maximum of £50 to sell.
I/We appoint Equiniti Financial Services Limited as agent to arrange to sell the number of Severn Trent Plc shares shown in the box above in accordance with the terms and conditions of the service which I/we have read and retained.
I/We declare that I/we have the right to sell these shares, free from any liens, charges and any other third party rights.
I/We authorise Equiniti Financial Services Limited to execute a transfer to give effect to the sale of my/our shares.
If in the event that I/we cannot find my/our share certificate(s) or only have invalid certificate(s) to enclose with my/our form, by signing this form I am/we are agreeing to the Declaration and Undertaking for Lost or Invalid Share Certificate(s). lf my/our details need updating, I/we agree to the registration update charge of £20.
Enter the amount of money you wish to invest and sign below. (Minimum £500, maximum £10,000)
A flat fee of £50 will be charged regardless of the amount invested. In addition, stamp duty reserve tax is also payable on purchases currently at the rate of 0.5% of the transaction value. These fees will be deducted from the amount you invest.
Please attach your cheque made payable to Equiniti Financial Services Limited.
Cheques must be drawn on a UK Bank or Building Society account in the name of the shareholder. We cannot accept third party cheques.
£
I/We appoint Equiniti Financial Services Limited as agent to arrange to buy Severn Trent Plc shares in accordance with the terms and conditions of the service. The shares will be purchased in the name(s) shown above. I/We authorise any person nominated by Equiniti Financial Services Limited to send a share certificate to the first named holder, by post at my/our own risk. lf my/our details need updating, I/we agree to the registration update charge of £20.
or otherwise in accordance with applicable statutory requirements.
To use our free service and donate all your sale proceeds to ShareGift, please write SHAREGIFT in the box below.
Gift Aid: If you are a UK taxpayer and also wish ShareGift to increase the value of your donation at no extra cost to yourself by reclaiming tax, please mark an X in this box. Please refer to the notes in the Donations to ShareGift section.
Date
Telephone
To sell, buy or give to charity please sign below. By signing and returning this form you are confirming you want to participate. Please note: Money laundering checks may delay your instruction, issue of sale proceeds or the issue of share certificates. Please enter your date(s) of birth when you sign below. This may assist with any money laundering checks required. If additional information is necessary, we will contact you.
If you are happy with your current shareholding no further action is required and you should not return this form. Return your completed forms in the enclosed reply paid envelope by Thursday 14 March 2013 to: Equiniti, Aspect House, Spencer Road, Lancing, West Sussex, BN99 6JA, United Kingdom.
Signature:
If you are signing under a Power of Attorney or other authority, please also print your name here
| Signature: Date of Birth: |
|---|
| Date of Birth: |
|---|
| Signature: |
Signature: Date of Birth:
| Signature: | |
|---|---|
| Date of Birth: |
For more information please read the Useful Information on the reverse of the letter or call the Helpline on 0871 384 2967. Calls to this number are charged at 8p per minute from a BT landline. Other providers' costs may vary. Lines are open 8.30am to 5.30pm, Monday to Friday. A corporate body should execute this instruction under its common seal
Return your form by 14 March 2013 to participate
If you are in any doubt as to the action you should take, you should consult your stockbroker, bank manager, solicitor, accountant or other independent professional advisor authorised under the Financial Services and Markets Act 2000.
Dear Shareholder,
I am writing to tell you about a service which we are pleased to offer to our UK resident shareholders for a limited period. This easy to use service, which we have arranged with Equiniti Financial Services Limited (Equiniti), is now available to shareholders who wish to sell or buy shares or donate their sale proceeds to charity by post. Please read the Useful Information overleaf and Equiniti's Terms and Conditions for more details.
Option 1: Sell all your shares – Just sign the enclosed form and post it back to Equiniti with your certificate(s) in the envelope provided and Equiniti will do the rest. It costs just £1.30 per share, up to a maximum of £50, to sell. Equiniti will post your cheque to you within two working days of the sale of your shares. Even if you can't find your certificate(s), you may still be able to sell your shares. Turn to the Useful Information overleaf for more details.
Option 2: Buy more shares – Just complete and sign the form enclosed and return it with your cheque in the envelope provided. It costs £50 per purchase regardless of the amount invested, plus stamp duty reserve tax.
Option 3: Give to charity – A free service enabling you to sell your shares and donate the proceeds to the charity ShareGift. Just write SHAREGIFT in the Give to charity box on the form, then sign and return it.
Of course, this is not a recommendation to take any action, and if you do not wish to sell or buy shares then you don't need to return the enclosed form.
If you would like to take advantage of any of these options, your completed form and any accompanying documentation must be received by Equiniti no later than Thursday 14 March 2013. There's more information about each of these options in the Useful Information overleaf.
Alternatively, if you prefer to deal online, please visit www.shareview.co.uk/dealing. To deal by phone, please call 08456 037 037. This telephone number is to give an instruction to sell or buy shares only. If you wish to contact Equiniti with an enquiry, please turn to the Useful Information overleaf for the Equiniti Helpline number. Please note that different charges and terms and conditions apply to the online and phone share dealing services. Full details of these can be found at www.shareview.co.uk/dealing.
The value of shares and any income from them can fluctuate and you may get back less than you invested.
Yours sincerely
Bronagh Kennedy General Counsel and Company Secretary
SDF SHARE DEALING FORM
Registered in England & Wales Registration No. 2366619 Registered Office: Severn Trent Centre, 2 St John's Street, Coventry CV1 2LZ
You may still be able to sell your shares. If you have invalid/missing share certificate(s) worth less than £5,000 in value, please see 'Lost or Invalid Share Certificate(s)' below. If your invalid/missing share certificate(s) are worth more than £5,000 then you will need to contact the Equiniti Helpline on 0871 384 2967* for further advice before you can sell your shares using this service.
Selling – £1.30 for each share you sell with a maximum charge of £50. If you are missing share certificate(s) for more than 15 shares but less than £5,000 in value, you do not enclose all your share certificates or you enclose invalid share certificates, an additional charge of £20 will be deducted from your sale proceeds. There is no sale or lost certificate charge if you donate your share sale proceeds to ShareGift. Buying – a flat fee of £50 will be charged regardless of the amount invested. In addition, stamp duty reserve tax is also payable on purchases currently at the rate of 0.5% of the transaction value.
7. What do I need to do to update my details on the register? If your details need to be updated on the register before the sale or purchase of shares, please enclose the relevant documentation (see 'Do your account details need updating?' below). An administration charge of £20 will be payable for all register updates required. If you take advantage of either or both the lost share certificate and register update services, only one charge of £20 will be payable.The register updates possible are shown below.
This Declaration and Undertaking applies only to shareholders who have not enclosed valid or sufficient share certificates with their form.
If you are missing valid certificate(s) for 15 shares or fewer there won't be a lost certificate charge. If the missing or invalid certificate(s) is/are for more than 15 shares but less than £5,000 in value, a lost certificate charge of £20 will be deducted from your sale proceeds.
To Severn Trent Plc, Equiniti Financial Services Limited and Equiniti Limited, Registrar of Severn Trent Plc:
In consideration of your registering a transfer relating to the sale of shares through this service without production of the relevant valid share certificate(s) which has/have been lost, stolen or destroyed, I/we jointly and severally agree:
If your details need to be updated on the register before the sale or purchase of shares, please enclose the relevant documentation.
Any other changes will still be actioned but may result in a delay in the sale or purchase of shares.
Arrangements have been made for shareholders, if they wish, to donate all the proceeds from the sale of their shares to ShareGift, the share donation charity (registered charity no 1052686). Equiniti Financial Services Limited have agreed to make no charges for selling your shares if you choose to donate the proceeds to ShareGift through this service.
ShareGift is particularly designed so that smaller holdings of shares that may otherwise be uneconomic to sell, can be used for charitable purposes. All share sale proceeds donated through this service are pooled by ShareGift and will be used at the close of the service to make donations to Severn Trent's nominated charity, WaterAid; registered Charity No.288701 (England and Wales) and SCO039479 (Scotland).
ShareGift has already donated millions of pounds to hundreds of different charities, supporting a broad range of local, national and international work. The charities which benefit are chosen by ShareGift's trustees, guided by suggestions received from donors.
If you donate your share sale proceeds to ShareGift, you will receive a sale advice providing details of your donation and an explanation of how to suggest a charity for ShareGift's future donations.
8. When will my shares be sold? Dealing normally happens daily for forms received up to the close of business the previous business day.
9. If I am selling shares, when will I receive my sale proceeds? A sale advice and cheque for your sale proceeds will be posted to you two working days after your shares have been sold.
Complete Option 2 and sign the form and return it with your cheque made payable to Equiniti Financial Services Limited in the envelope provided. Cheques must be drawn on a UK Bank or Building Society account in the name of the shareholder. We cannot accept third party cheques.
Shares will be bought within five working days following receipt of your cheque and instruction to ensure cleared funds are available to purchase shares. A purchase advice will be sent to you two working days after your shares have been bought.
You can invest from £500 to £10,000 in Severn Trent Plc shares, including charges.
Recent prices can be found in the share listings of most national newspapers or at Severn Trent Plc's website at www.severntrent.com. Please note that the share price may alter significantly from the date that you decide to deal to the time when the shares are either sold or bought.
The last date for instruction forms to reach us is Thursday 14 March 2013. The last dealing date for sales will be Friday 15 March 2013 and the last dealing date for purchases will be Friday 22 March 2013.
*Calls to this number are charged at 8p per minute from a BT landline. Other providers' costs may vary. Lines are open 8.30am to 5.30pm, Monday to Friday.
An administration charge of £20 will be payable for any register updates required. By signing the form you are agreeing to this charge. If you take advantage of either this service, the Lost or Invalid Share Certificate service or both only one charge of £20 will be payable.
* If this documentation has been addressed to 'The Personal Representatives of' this indicates that we have been previously made aware that the shareholder has passed away. However, in order to formally record the death and to enable use of this service, we require sight of the Grant of Representation.
Further information about ShareGift and the charities it has supported may be obtained from the website www.sharegift.org or by contacting ShareGift at 17 Carlton House Terrace, London, SW1Y 5AH United Kingdom.
If you are a UK tax payer you can increase the value of your gift to charity by up to 25% at no extra cost to yourself by authorising ShareGift to reclaim tax from HM Revenue & Customs through Gift Aid.
To qualify for Gift Aid the amount you pay in Income Tax and/or Capital Gains Tax for each tax year (6 April one year to 5 April the next) must be at least equal to the amount of tax that ShareGift will reclaim on your gifts for that tax year.
Higher rate tax payers can claim tax relief at the difference between basic rate tax and higher rate tax.
Gift Aid is not available to the Personal Representatives of deceased shareholders.
| Number of shares you hold | Shareholder reference no. |
|---|---|
| Example price per share | |
| Estimated value of your shares |
The above share price and estimated value are based on a recent closing price for each Severn Trent Plc ordinary share on the London Stock Exchange. This is therefore only an example and if you should choose to sell your shares in Severn Trent Plc, the value of your shares may be higher or lower depending upon the actual price on the day they are sold. If you are selling shares, Equiniti Financial Services Limited will deduct any applicable charges from the sale proceeds.
If you wish to sell all your Severn Trent Plc shares as shown above, just sign this form in the box below and return it with your certificate(s) in the envelope provided. Only share certificates in the name of Severn Trent Plc dated 9 October 2006 or later are valid. It costs £1.30 per share up to a maximum of £50 to sell.
I/We appoint Equiniti Financial Services Limited as agent to arrange to sell the number of Severn Trent Plc shares shown in the box above in accordance with the terms and conditions of the service which I/we have read and retained.
I/We declare that I/we have the right to sell these shares, free from any liens, charges and any other third party rights.
I/We authorise Equiniti Financial Services Limited to execute a transfer to give effect to the sale of my/our shares.
If in the event that I/we cannot find my/our share certificate(s) or only have invalid certificate(s) to enclose with my/our form, by signing this form I am/we are agreeing to the Declaration and Undertaking for Lost or Invalid Share Certificate(s). lf my/our details need updating, I/we agree to the registration update charge of £20.
Enter the amount of money you wish to invest and sign below. (Minimum £500, maximum £10,000)
A flat fee of £50 will be charged regardless of the amount invested. In addition, stamp duty reserve tax is also payable on purchases currently at the rate of 0.5% of the transaction value. These fees will be deducted from the amount you invest.
Please attach your cheque made payable to Equiniti Financial Services Limited.
Cheques must be drawn on a UK Bank or Building Society account in the name of the shareholder. We cannot accept third party cheques.
£
I/We appoint Equiniti Financial Services Limited as agent to arrange to buy Severn Trent Plc shares in accordance with the terms and conditions of the service. The shares will be purchased in the name(s) shown above. I/We authorise any person nominated by Equiniti Financial Services Limited to send a share certificate to the first named holder, by post at my/our own risk. lf my/our details need updating, I/we agree to the registration update charge of £20.
To use our free service and donate all your sale proceeds to ShareGift, please write SHAREGIFT in the box below.
Gift Aid: If you are a UK taxpayer and also wish ShareGift to increase the value of your donation at no extra cost to yourself by reclaiming tax, please mark an X in this box. Please refer to the notes in the Donations to ShareGift section.
Date
Telephone
To sell, buy or give to charity please sign below. By signing and returning this form you are confirming you want to participate. Please note: Money laundering checks may delay your instruction, issue of sale proceeds or the issue of share certificates. Please enter your date(s) of birth when you sign below. This may assist with any money laundering checks required. If additional information is necessary, we will contact you.
For more information please read the Useful Information on the reverse of the letter or call the Helpline on 0871 384 2967. Calls to this number are charged at 8p per minute from a BT landline. Other providers' costs may vary. Lines are open 8.30am to 5.30pm, Monday to Friday. A corporate body should execute this instruction under its common seal
If you are happy with your current shareholding no further action is required and you should not return this form. Return your completed forms in the enclosed reply paid envelope by Thursday 14 March 2013 to: Equiniti, Aspect House, Spencer Road, Lancing, West Sussex, BN99 6JA, United Kingdom.
Signature:
If you are signing under a Power of Attorney or other authority, please also print your name here
| Signature: |
|---|
| Date of Birth: |
| Date of Birth: |
|---|
| Signature: |
Date of Birth:
Signature: Date of Birth:
or otherwise in accordance with applicable statutory requirements.
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