DIVIDEND MANDATE FORM

Date:________________

The Share Registrar

Central Depository Company of Pakistan Limited,
CDC House, 99-B, Block-B,
S.M.C.H.S., Shahra-e-Faisal,
Karachi

Dear Sir,

I, Mr. / Ms. / Mrs. ____________________________S/o, D/o, W/o____________________________ hereby authorize

Hascol Petroleum Limited to directly credit cash dividend declared by it, if any, in the below mentioned bank account.

(i) Shareholder’s Detail

Name of the shareholder
Folio No. / CDC Participant ID Account No.
*CNIC No.
**Passport No. (in case of foreign shareholder)
***NTN (in case of corporate entity, attach copy)
Landline Phone Number
Cell Number

(ii) Shareholder’s Bank Detail

Title of the Bank Account
Bank Account Number
Bank’s Name
Branch Name and Address
Branch Code

It is stated that the above-mentioned information is correct and I shall intimate any changes in the above-mentioned
information to the Share Registrar as soon as these occur.

_____________________
Signature of Shareholder

Note: The shareholders who hold shares in physical form are requested to submit the duly filled above-mentioned
Dividend Mandate Form to Share Registrar concerned. The shareholders who hold shares in Central Depository
Company are requested to submit the duly filled above mentioned Dividend Mandate Form to their Participants
/ Investor Account Services of the Central Depository Company of Pakistan Limited.

* Please attach attested photocopy of CNIC

** Please attach attested photocopy of the Passport
*** Please attach valid photocopy of NTN Certificate