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Safaricom Opt in Form

A form to.help in registration

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billtravis1998
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We take content rights seriously. If you suspect this is your content, claim it here.
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50 views

Safaricom Opt in Form

A form to.help in registration

Uploaded by

billtravis1998
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Safaricom Limited

Safaricom House
P. O. Box 66827-00800 Nairobi Kenya
Landline: +254 (0) 722 00 4524/4746

OPT-IN DIVIDEND PAYMENT FORM


Name of shareholder ……
As it appears on your CDSC account or share certificate

ID /Passport number………………………………………………………………………………………………………………

CDS Account Number…………………………………………………………………………………………………………..


As it appears on you CDSC account number or share certificate

Member Account Number…………………………………………………………………………………………………….


As it appears on your CDSC Account or Share certificate

Kindly fill in your preferred options Option 1 ~ mobile money transfer via M-pesa*

Option 2 ~ Electronic Funds Transfer (EFT) for

Member’s without a CDS Account

1. Registered Mobile phone number for mobile money transfer via M-


pesa option (please indicate in the space provided below)

M~pesa registered mobile number

I certify that the above information is true to my knowledge

Signature……………………………………………..date………………………………………………..

* M-pesa terms and conditions shall apply.


OPT-IN DIVIDEND PAYMENT
Kindly update us with the following details for our records

Postal Address……………………………………………………………………..Code………………………………

Town…………………………………………………………..Country……………………………………………………

Email Address……………………………………………………………….Mobile No ………………………………

2. For Electronic Funds Transfer Option, Please fill the section below:
Account Name……………………………………………………………………………………………………………..

Account Number…………………………………………………………………………………………………………

Name of Bank & Branch………………………………………………………………………………………………

Bank code……………………………………………………………………………………………………………………

Branch code………………………………………………………………………………………………………………..

Swift code…………………………………………………………………………………………................................

I herby authorize Safaricom Limited to pay my dividends by electronic funds transfer to my


Bank account details.

Individual /Joint Shareholders

…………………………………………………………………Name

…………………………………………………………………Signature 1

…………………………………………………………………Name

…………………………………………………………………Signature 2

Corporate Shareholders
Compan
………………………………………………………………….Director y
seal
…………………………………………………………………..Director /Company Secretary

Notes:

1. Please attach a copy of you ID/Passport. For Corporate entities, please also attach the
certificate of incorporation and a certified Declaration confirming the indemnities of the
signatories on this mandate.
2. If you have a CDS Account, please amend your Bank Mandate details with your stock broker.
3. Please fill in this form and return it to “Image Registrars Limited, 5th Floor, Barclays Plaza,
Loita Street. P.O Box 9287 -00100 Nairobi.”
4. Kindly note that the electronic details will be used for payment of outstanding and future
dividends.

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