Certificated Multiple Stockholders or Joint Owners

Multiple

Full Names of Stockholders (required) *

Contact Numbers of Stockholders (required) *

Email Address of Authorized Stockholder (required) *

Contact Number of Authorized Stockholder (required) *

Stock Certificate Number

Government IDs (Passport, Driver's License, Unified Multipurpose ID) *

Maximum upload size: 516MB

Letter Appointing Authorized Stockholder *

Maximum upload size: 516MB

We attest to the truth and veracity of the information provided above. We hereby appoint the Chairman of the Board to act as our proxy and vote accordingly in all matters to be discussed in the Annual Stockholders’ Meeting in the event we are not able to cast our vote.