2) Do you, as an individual invest in the shares for which the proxy voting process is made available and you want to participate in the voting process?

yes          no

3) Do you represent a stockbroking company, company or institution or nominee company?

yes          no

2) Do you represent a stockbroking company, company or institution or nominee company?

yes          no

3) Are you authorised to submit vote instructions on behalf of the stockbroking company, company, institution or nominee company?

4) Are you authorised to submit vote instructions on behalf of the stockbroking company, company, institution or nominee company?

yes          no

*First name:

*Company/institution/nominee company:

*Surname:

*ID number:

*Date of Birth: