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Shareholders Application Form

Sale of Ordinary Shares at Kshs. 25.00 per share payable in full on application.

Number of Shares applied for:

Amount due on application: Kshs

Insert Corporate Name and other particulars as they appear in the Share Certificate.

Full name of Company/Institution:

P.O. Box

Town/City:

Phone:

A Corporate body must complete the space below under the hand of a duly authorised officer who should state his/her capacity.

Name

Designation

Nomination of Beneficiaries to the Shareholder Medical Benefits Scheme
	Name of Beneficiary	Relationship	Date Of Birth	ID No (if applicable)
1
2
3
4
5
6

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