2012 Annual Report & Financial Statements - UBA Plc

E-Share Registration Form
United Bank for Africa Plc
RC: 2457
Africa Prudential Registrars Plc
RC NO: 649007
E-SHARE REGISTRATION FORM
(*
=Compulsory fields)
1. SURNAME/COMPANY NAME*
2. FIRST NAME* 3. OTHER NAMES
4. SPOUSE’S NAME
5. MOTHER’S MAIDEN NAME
6. EMAIL*
7. ALTERNATE E-MAIL
8. MOBILE NO. 9. PHONE NO. (HOME)
10. POSTAL ADDRESS
11. SEX: MALE FEMALE 12. CSCS CLEARING HOUSE NO.*
13. OCCUPATION 14. NATIONALITY
15. NEXT OF KIN
16. TEST QUESTIONS (answer one) *
I. FATHER’S MIDDLE NAME
ii. PLACE OF BIRTH
DECLARATION
“I declare that the information I have provided is true and correct.”
Signature:
for joint/corporate accounts only
DISCLAIMER
"In no event shall Africa Prudential Registrars be liable for any damages , losses or liabilities including without limitation, direct or indirect, special,
incidental, consequential damages, losses or liabilities, in connection wit your use of this form or your inability to use the information, materials, or
in connection with any failure, error, omission, defect, delay in operation or transmission, or system failure, even if you advice us of the possibility of
such damages, losses of expenses, whether express or implied in respect of such. information."
LAGOS
220B, Ikorodu Road
Palmgrove
Tel: 01-893150, 01-7450427, 01-8401153
Email: info@africaprudentialregistrars.com
Website: www.africaprudentialregistrars.com
ABUJA
11, Lafia Close,
Area 8
Garki
Tel: 09-8701645, 09-2348562
PORT-HARCOURT
Plot 137, Olu Obasanjo Road
(2nd Floor)
Tel: 08-4803171