Network Capital Limited — Change of Next of Kin

Network Capital Limited

SEC Regulated · NGX Trading Licence Holder · 13 Maitama Sule Street, Ikoyi, Lagos · 0706 200 2333

SECNGX CSCSNASD

Change of Next of Kin

Request to update registered next of kin details with Network Capital Limited

Client Identification

Full Name / Company Name*

Full name is required.

CSCS Account Number*

Enter a valid CSCS account number.

CHN / Clearing House Number

Enter a valid CHN, or leave blank if unavailable.

Telephone Number*

Enter a valid 11-digit Nigerian number.

Email Address*

Enter a valid email address.

Request Date*

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Current Next of Kin — for verification

Current Next of Kin Name*

Current Relationship*

Current Next of Kin Phone*

Current Next of Kin Email*

New Next of Kin Details

All marked fields are required. The new Next of Kin details will fully replace the current record.

New Next of Kin Full Name*

Relationship to Account Holder*

New Next of Kin Phone*

New Next of Kin Email — optional

New Next of Kin Address — optional

Authorisation

Client Full Name*

Signatory name is required.

Signature Date*

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Sign here using mouse or finger

A signature is required — sign above or upload a specimen.

Declaration and Privacy Policy

Declaration

I/We confirm that the information supplied in this form is true, complete, and authorised by the account holder(s). I/We authorise Network Capital Limited to verify and process this request in line with applicable SEC, NGX, CSCS, AML/CFT, and data protection requirements.

Privacy notice: Network Capital Limited will process information supplied for client account maintenance, regulatory compliance, transaction processing, dispute resolution, and record keeping. Personal data should only be submitted by the account holder or an authorised representative.

I acknowledge that I have read and understood the NETCAP Privacy Policy applicable to this instruction.

You must acknowledge the Privacy Policy.

You must read and accept the declaration.

For Official Use Only — Not to Be Completed by the Applicant

Received By

Date Received

Reviewed By

Approved By / Authorised Signatory

Remarks / Action Taken

Relationship OfficerSignature & Date

Compliance OfficerSignature & Date

Authorised OfficerSignature & Date