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    Reissue Request Form: Company Shares Held in Account Name Account Number Name of Bank

    Uploaded by

    Rohit Verma
    This document is a request form for a shareholder to reissue unclaimed dividend cheque(s). It contains the shareholder's details such as name, address, and shareholding information. It requests the company to reissue stale or unclaimed dividend cheques, noting a reissue fee will be deducted. It certifies the shareholder has not received the original cheques and will return any located cheques. Bank details are also provided to deposit future dividends directly. The shareholder authorizes the company to act on the instructions to reissue cheques and deposit future dividends in the nominated bank account.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Reissue Request Form: Company Shares Held in Account Name Account Number Name of Bank

    Uploaded by

    Rohit Verma
    144 views1 page
    This document is a request form for a shareholder to reissue unclaimed dividend cheque(s). It contains the shareholder's details such as name, address, and shareholding information. It requests the company to reissue stale or unclaimed dividend cheques, noting a reissue fee will be deducted. It certifies the shareholder has not received the original cheques and will return any located cheques. Bank details are also provided to deposit future dividends directly. The shareholder authorizes the company to act on the instructions to reissue cheques and deposit future dividends in the nominated bank account.

    Original Title

    Re-Issue-Request-Form-Updated

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    This document is a request form for a shareholder to reissue unclaimed dividend cheque(s). It contains the shareholder's details such as name, address, and shareholding information. It requests the company to reissue stale or unclaimed dividend cheques, noting a reissue fee will be deducted. It certifies the shareholder has not received the original cheques and will return any located cheques. Bank details are also provided to deposit future dividends directly. The shareholder authorizes the company to act on the instructions to reissue cheques and deposit future dividends in the nominated bank account.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    144 views1 page

    Reissue Request Form: Company Shares Held in Account Name Account Number Name of Bank

    Uploaded by

    Rohit Verma
    This document is a request form for a shareholder to reissue unclaimed dividend cheque(s). It contains the shareholder's details such as name, address, and shareholding information. It requests the company to reissue stale or unclaimed dividend cheques, noting a reissue fee will be deducted. It certifies the shareholder has not received the original cheques and will return any located cheques. Bank details are also provided to deposit future dividends directly. The shareholder authorizes the company to act on the instructions to reissue cheques and deposit future dividends in the nominated bank account.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    REISSUE REQUEST FORM

    To:
    The Share Registry,
    _______ _____________ (Company Name)

    RE: Request for Re-issue of Unclaimed Dividend Cheque(s)

    I/We _______________________________ (name of shareholder) of _________________________


    (address) being the registered holder of _______ (number of shares) in ______________ (company
    name), hereby request you to reissue the unclaimed dividend cheque(s) which have become stale or
    has not been claimed by me for other reasons. I/We also understand that there is a reissue fee which
    will be deducted from the cheque(s) itself.

    IN CONSIDERATION OF your Share Registry re-issuing the dividend cheque(s) as aforesaid, I/We
    HEREBY CERTIFY that I have received the cheque(s) indicated above I request the cheque(s) be issued
    to me at the above address. I understand that should I receive/locate the original cheque, I will return
    it to the Central Share Registry Limited Office.

    Section A – SHAREHOLDER DETAILS


    SIN #: __________
    Previous Address (if changed): _________________________________________________________
    E-mail: _________________________________
    Phone Contact: (H) ____________ (B) ______________ (M) _____________ (F) __________

    Section B – BANK DETAILS


    Should you require the cheques to be directly deposited into your nominated bank, please fill in the
    table below:
    Company Shares
    Account Name Account Number Name of Bank
    Held in

    Please deposit all future dividends into the bank account as indicated above.

    Section C – DECLARATION
    I/We authorize you to act in accordance with my/our instructions set out above. I/We acknowledge
    that these instructions supersede and have priority over all previous instructions relating to payments
    of dividends to which I/We am/are entitled to be paid.
    1. Individual/Joint or Group Shareholders:

    ________________ _______________ _______________


    Shareholder 1 Shareholder 2 Shareholder 3
    2. Company/Partnership and Trust Shareholders:

    ___________________ ___________________ _________________


    Authorized Signatory 1 Authorized Signatory 2 Company Seal
    ----------------------------------------------------- FOR OFFICIAL USE----------------------------------------------------------------
    Photo Id Received Shareholding Confirmation (Share Certificate/Dividend-
    Prepared By: _____________________ Interest Advice/Correspondence/Tax Slip/Buy-Sell Order
    Form)
    Date Received: ______________________ Date Cheque(s) Printed: ______________________
    Date Cheque(s) Posted: ______________________

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