Appendix I: Form for Exercise of Preemptive Rights

Transcription

1 Appendix I: Form for Exercise of Preemptive Rights This form MUST be signed by the shareholder(s) in the presence of a Representative or of The Bank of Nevis, Licensed ECSE Representative/Principal or notarized by a Justice of the Peace or Notary Public. The following must also be submitted or originals presented at the point of application, copies must be notarized by a Justice of the Peace or Notary Public: Copies of 2 Government Issued Picture IDs All applications must be submitted along with payments made at The Bank of Nevis Limited on or before 2.00 p.m. on 31 st March, 2017 at the following address: The Bank of Nevis Building Main Street, Charlestown Nevis, West Indies Payments are to be made in full on application. Shareholders residing outside of St. Kitts & Nevis must mail documents as per the above address and can make payments via wire transfer. Wiring instructions for the associated currencies are listed at the end of this form. Shareholders residing outside of St. Kitts & Nevis can send scanned copies of the completed forms for review to the following address pending receipt of the original, notarized copy: investments@thebankofnevis.com Full name of security: Full description of security: THE BANK OF NEVIS LIMITED ORDINARY SHARES No. of BON Ordinary Shares Currently Held: No. of shares in words No. of shares in figures Total number of BON Shares applied for via Preemptive Rights: No. of shares in words No. of shares in figures The BON Ordinary Shares which are the subject of this acceptance are registered in the name(s) of: (1) Primary Holder: Full Name/ Company Name

2 (2) Joint Holder(s) (if any): Full Name(s) (3) Joint Holder(s) (if any): Full Name(s) 2

3 I/We confirm that I/we have read and understood and hereby agree to be bound by the terms and conditions contained in the Prospectus. I/We request that the consideration due to me/us be delivered to me/ us as follows: ECCSR Registry Account number: Primary Signature/ Authorised Signatories: Joint Holder(s) (if any) Signature/Corporate Seal of Joint Holder Name of Joint Holder (Type or Print) Signature/Corporate Seal of Joint Holder Name of Joint Holder (Type or Print) In the Presence of (BON Official, Justice of the Peace, Notary Public): Witness Signature/Corporate Seal: Witness Name: (Type or Print): 3

4 Please see wire instructions for the Rights Issue below. Kindly observe field numbers for accurate processing. UNITED STATES- US$ WIRES UNITED KINGDOM GBP WIRES US$ WIRES United Kingdom United Kingdom Sort Code: Sort Code: IBAN: GB63LOYD IBAN: GB48LOYD The Bank of Nevis Ltd A/c#: A/c#: FINAL CREDIT TO(59) BON Rights Issue AC # Remittance Info (70) (Full Name & Number of Shares) EASTERN CARIBBEAN -EC$ WIRES Eastern Caribbean Central Bank Basseterre, St. Kitts SWIFT Code: ECCBKNSK A/c#: US$ WIRES United Kingdom Sort Code: IBAN: GB48LOYD The Bank of Nevis Ltd A/c#: CANADA - CAD$ WIRES Royal Bank of Canada 55 Wellington St. W 14th Floor Toronto, Ontario Canada, M5V 3K7 SWIFT Code: ROYCCAT2 A/c#: EURO WIRES United Kingdom Sort Code: IBAN: GB70LOYD A/c#:

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