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Shares under PCD / Broker Account
PCD
Stockholder's Full Name (required)
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Stockholder's Contact Number (required)
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Stockholder's Email Address (required)
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Stockholder's Government ID (Passport, Driver's License, Unified Multipurpose ID)
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Name of Broker (required)
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Broker's Email Address (required)
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Broker's Contact Number (required)
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Broker's Certification with Number of Shares (required)
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I attest to the truth and veracity of the information provided above. I hereby appoint the Chairman of the Board to act as my proxy and vote accordingly in all matters to be discussed in the Annual Stockholders’ Meeting in the event I am not able to cast my vote.
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