.
All
to:
All correspondence
correspondence to:
Computershare
PLC,
ComputershareInvestor
Investor Services
Services PLC,
PO Box , The Pavilions,
The Pavilions, Bridgwater Road,
Bridgwater Road, Bristol XXXX XXX
BS99XXXX
6ZZ
Telephone Bristol
XXX XXX
Telephone
0870
702
0000
Facsimile XXX XXX XXXX
TextPhone users please
call 0870
702 6120
0005
Facsimile
0870 703
DX:0870
78139
TextPhone users please call
702Bristol
0005
www.computershare.com
DX: 78139 Bristol
www.computershare.com
Shareholder Reference Number
*
*
*
*
Dividend Mandate Form
Kindly Note: This form is issued only to the addressee(s) and is specific to the unique designated account printed hereon. This personalised
form is not transferable between different (i) account holders; or (ii) uniquely designated accounts. The Company and Computershare Investor
Services PLC accept no liability for any instruction that does not comply with these conditions.
Please use a black pen. Print in
CAPITAL letters inside the boxes
as shown in this example.
FOLD
........
HERE
A.
A B C
1 2 3
X
Bank or Building Society Details
FOLD
........
HERE
Complete this form if you wish to have your dividends paid directly into a Bank or Building Society.
Sort Code
Account Number
Bank or Building Society Reference or Roll Number (if applicable)
Bank or Building Society ....................................................................................................................................................................................................................................................................
.............................................................................................................................................................................................................................................................................................................
Address of Branch ..............................................................................................................................................................................................................................................................................
.............................................................................................................................................................................................................................................................................................................
B.
Signature(s)
For details of who needs to sign this form, please see the notes on how to complete this form.
Signature 1 (Please sign in the box below)
Signature 3 (Please sign in the box below)
Signature 2 (Please sign in the box below)
Signature 4 (Please sign in the box below)
Date
DD / MM / YY
In the event that we need to contact you regarding the processing of this form, please supply one of the following:Daytime Telephone Number
E-mail Address (if available)
Please note that these contact details will not be recorded by Computershare Investor Services PLC for any future use.
9 04 71
HL 1
C OM P A N Y
ADOBEDMFv5
.
How to complete this form
Please use a black pen. Print in
CAPITAL letters inside the boxes
as shown in this example.
A.
A B C
1 2 3
X
Bank or Building Society Details
Complete this section if you want future dividends or interest from the company shown to be paid directly to a bank or building society.
Payment in accordance with these instructions will discharge the company and registrar from any further liability.
Computershare Investor Services PLC cannot accept responsibility in the event that the Sort Code or Account Number quoted by you is
incorrect. If you do not complete this section or the form is incomplete, unsigned or invalid in any other way, you will continue to receive
payments by cheque. Neither the company nor the registrar will be responsible for delays in crediting payments to your nominated account as
a result of transaction procedures or errors by any financial institution.
1 The submission of this form will NOT override any existing SCRIP Dividend mandate or Dividend Reinvestment Plan mandate, which must
2 be cancelled in writing before new instructions can be applied.
B. Signature(s)
You must sign this form as follows in the spaces provided:Joint Holding:
The signatures of all joint holders, executors or administrators are required. If the holder is under 18, a parent or
legal guardian must sign and state their capacity.
Power of Attorney:
To sign under Power of Attorney, you must have already lodged an original or certified copy of the Power of Attorney
with the registrar. If you have not previously lodged this document for notation, please attach it to this form when
you return it.
Please note that Computershare Investor Services PLC requires a photocopy Power of Attorney to be certified under
the Powers of Attorney Act 1971. It must be certified in ink on every page by the donor, or by a solicitor or
stockbroker, to state that it is a true and complete copy of the original. Computershare Investor Services PLC
cannot accept a photocopy that has not been certified in ink on every page.
Companies:
The form should be signed by two authorised signatories of the Company, whose representative capacities (e.g.
Director and Company Secretary) must be stated. Alternatively, Computershare Investor Services PLC will accept
just one authorised signature; however, the signatory’s capacity must be stated and the form must be impressed
with the Company Seal.
Please return this form to: Computershare
1 Computershare
Investor
Services
Box 82,Bristol
The Pavilions,
Investor
Services
PLC,PLC,
The P.O.
Pavilions,
BS99 6ZZBridgwater Road, Bristol BS99 7NH
2
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Computershare
Investor
Services
PLC isPLC,
Registered
in England
& Wales,
NoCompany
3498808,No.
Registered
Office,
The Pavilions,
Bridgwater
Road,
Bristol Road,
BS13 8AE
This form is issued
by Computershare
Investor
Services
Registered
in England
& Wales,
3498808,
Registered
Office: The
Pavilions,
Bridgwater
Bristol BS13 8AE.
Investor Services
PLC is authorised
and regulated
by theOffice:
Financial
Services
Computershare Investor Services PLC is Computershare
authorised and regulated
by the Financial
Services Authority,
Registered
25 The
NorthAuthority
Colonnade, Canary Wharf, London E14 5HS.
ADOBEDMFv5