E-Dividend Mandate Activation Form

Instruction
Please complete all sections of this form to make it eligible for processing. I / We hereby request that henceforth, all my / our Dividend Payment(s) due to me/us from my / our holdings on your records be credited directly to my / our bank details below:

Passport Photograph*

Accepted file types: jpg, jpeg, png, gif.

NAME OF COMPANY*

Please tick the applicable company

FLOURMILLS OF NIGERIA PLC (FMN)
NIGERIAN BAG MANUFACTURING COMPANY (BAGCO)
NORTHERN FLOURMILLS OF NIGERIA LIMITED (NNFM)
FMN BOND 1
FMN BOND 2
FMN BOND 3
FMN BOND 4

Account Type*

Bank Account Name*

Bank Account Number*

Bank Name*

Bank Verification Number (BVN)

Account Opening Date*

SHAREHOLDER ACCOUNT INFORMATION

Surname/Company Name*

Address Line 1

Address Line 2

Address Country

Address State

Address City

Previous Address(if any)

Clearing House Number(CHN)

Mobile Phone 1*

Mobile Phone 2*

Email Address

Signature

Consent Clause*

I consent to the collection, processing, use and transfer of my personal data, including transfer to third parties (within or outside Nigeria), for the purpose of this inquiry and any other related data processing activities which may arise therefrom. I affirm that I am aware and take cognizance of my rights under the relevant Data Protection Laws in Nigeria and other terms detailed in the Data Privacy Policy of the Company.

I Agree

SHAREHOLDER ACCOUNT INFORMATION

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E-Dividend Mandate Activation Form

SHAREHOLDER ACCOUNT INFORMATION

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