Sale Order Individual Form

(A Licensed Dealing Member of the Ghana Stock Exchange)

Form Code

Client ID Number

Account details

Title

Name (1)

Title

Name (2)

Postal Address

Residential address

Nationality

Telephone

Fax

E-mail

Have on This Day/Month/Year

Deposited the under listed security(ies) for sale on these stated items.

Security	No. of Shares In Depository AC	Quantity To Be Sold	Price Range	Remarks	Action

This order is valid until: Date:

Payment Instruction

Status

(Cancelled)

Authorisation

Client Signatory (1)

Client Signatory (2)