Equiniti Dividend Re-Investment Plan Application Form - Mitchells & Butlers

ADVERTISEMENT

DIVIDEND RE-INVESTMENT PLAN
APPLICATION FORM
Section 1 YOUR DETAILS
Full name of First Named Holder
Company to which this plan applies
Mitchells & Butlers Plc
1.
Joint Holder(s) – Maximum four (4) holders
Shareholder reference (8 or 11 digits)
(Note 1)
2.
This application only applies to the holding above.
3.
Separate applications must be completed for additional
holdings held in the above Company.
4.
Full Address of First Named Holder
Shares to which this plan applies
13
ORDINARY SHARES OF 8
/
PENCE
24
HELD IN CERTIFICATED FORM
Contact Telephone Number
Country
(including any local dialling options)
(Note 2)
Post Code
IMPORTANT
Non CREST holders only (CREST holders need to elect through CREST).
In order to participate in the Plan, in respect of a particular dividend, this form must be correctly completed and received
at least fifteen (15) working days prior to the next dividend payment date.
Section 2 DECLARATION: All shareholders must sign and print their full names
Declaration: A copy of the Terms and Conditions referred to herein have been issued to you/made available on
or as detailed in the accompanying literature. These form the basis on which our services
will be provided to you. For your own benefit you should read these Terms carefully before signing the application. If you do
not understand any point please contact us on the number indicated in the Guidance Notes.
To: Equiniti Financial Services Limited (Equiniti)
By signing this form I/we apply to join the Dividend Re-Investment Plan (the Plan) for each future dividend paid on the fully
paid up shares shown above in Section 1 held by myself/ourselves to which the Plan is applied.
I/We appoint Equiniti as my/our agent to arrange the purchase of fully paid up shares of the Company shown above in
Section 1 in accordance with the Terms and Conditions of the Plan. This request will remain in force until revoked in writing
by me/us, or otherwise cancelled in accordance with the Terms and Conditions of the Plan.
To: Mitchells & Butlers Plc
I/we the undersigned instruct Mitchells & Butlers Plc to pay my/our dividend in respect of all the shares applying to the Plan
to Equiniti.
(Note 3)
Signature 1
Signature 2
Print Full Name
Print Full Name
Signature 3
Signature 4
Print Full Name
Print Full Name
Today’s Date
(Note 4)
If signing as Power of Attorney or other authority please print your full name
(Note 5)
Bodies corporate must execute under their common seal or in accordance with section 44 of the Companies Act 2006.
Equiniti may send you notices about products and services we think that you may be interested in. If you do not
wish to receive these communications, please tick this box.
(Note 6)
September 2015

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go
Page of 2