Equiniti Dividend Re-Investment Plan Application Form - Imperial Brands Page 2


You should find the answer to any queries you have, as well as a copy of the full Terms and Conditions for the Plan,
online at
However, if you would like to speak to someone then you can contact the Shareholder Services Helpline on:
UK: 0371 384 2037
International: +44 121 415 7009
A textphone service is also available on:
UK: 0371 384 2255
International: +44 121 415 7028
Lines open 8.30am to 5.30pm (UK time), Monday to Friday (excluding public holidays in England and Wales).
Alternatively you can write to us at the address below.
Once completed please send your form to:
Share Dividend Team
Aspect House
Spencer Road
West Sussex BN99 6DA
United Kingdom
Note 1: Shareholder reference (8 or 11 digits)
This can be found on your share certificate or previous tax voucher.
Note 2: Contact Telephone Number (including any local dialling options)
Please provide your contact telephone number (including any local dialling options) for any enquiries.
Note 3: Print & Sign
All shareholders must sign the declaration and print their full name. If you are a sole shareholder please only
sign and print one box.
Note 4: Dividend Election deadline
To participate in respect of a particular dividend, Equiniti must receive the fully completed form at least fifteen
(15) working days prior to the next dividend payment date.
Note 5: Power of Attorney (if applicable)
Complete your full name here if you are signing as a power of attorney.
To avoid rejection if you have not previously recorded the Power of Attorney document with us please ensure
that you send us either the original document or a photocopy with this form. If you are sending a photocopy,
please make sure every page is signed with an original signature, either by the person granting the Power or by a
solicitor or stockbroker, to confirm that it is a true and complete copy of the original.
Note 6: Marketing
If you do not want to receive any additional marketing communications from Equiniti please tick this box.
Equiniti Limited and Equiniti Financial Services Limited are part of the Equiniti Group. Their registered offices are Aspect House, Spencer Road, Lancing,
West Sussex BN99 6DA United Kingdom. Company share registration, employee scheme and pension administration services are provided through
Equiniti Limited, which is registered in England & Wales with No. 6226088. Investment and general insurance services are provided through Equiniti
Financial Services Limited, which is registered in England & Wales with No. 6208699 and is authorised and regulated by the UK Financial Conduct
Authority no. 468631.


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