Dangote Refinery IPO

Investor Application Form

Dangote Petroleum Refinery and Petrochemicals FZE — Offer for Subscription

This form is for Qualified Investors and Eligible African Investors only. The minimum application is 10 Offer Shares. All fields marked * are required. Applications are final.

Qualified Investor Category *

I am an Eligible African Investor

Applicant Type *

Individual Corporate Joint

Participation Details *

Number of Shares Applied For (min. 10, multiples of 10)

Amount Payable (₦) — calculated automatically

Investor Details

Title

Surname (as reflected on CSCS statement) *

First Name *

Other Names

Full Postal Address *

City/Town

State

Country

Phone Number *

Tax Identification Number (TIN) *

Date of Birth *

E-mail Address *

CHN Number *

CSCS Number *

Naira Bank Account Details (for e-Payments) *

Bank Name *

Account Number *

BVN *

Payment *

Pay into

See the Receiving Agents listed in the Prospectus (pages 190–191)

Amount Paid (₦) — as shown on your payment receipt/alert *

Evidence of Payment * (JPG, PNG or PDF, max 5MB)

Declarations *

By ticking below, I/We declare that:

I/We have read the Prospectus issued by the Issuing Houses on behalf of Dangote Petroleum Refinery and Petrochemicals Free Zone Enterprise.
I/We agree to be bound by the terms and conditions of the Offer.
I/We note that allotment will only be made electronically to the CSCS accounts of allottees.
I/We note that the Issuer and the Issuing Houses are entitled in their absolute discretion to accept or reject this application.
I/We agree to accept the same or any smaller number of Offer Shares in respect of which allotment may be made upon the terms of the Prospectus.
I/We note that in the event of oversubscription, Offer Shares may be allotted on a scaled-back basis in accordance with the Basis of Allotment approved by the SEC.

I/We agree to all of the above declarations.

Review & Submit

Please confirm your details below before submitting. Applications are final and there is no right of withdrawal.

Category & Participation

Applicant Type
Shares Applied
Amount Payable

Investor Details

Name
Address
Phone
Email
CHN Number
CSCS Number

Bank Details

Bank Name
Account Number
BVN

Payment

Amount Paid

Investor Application Form

Qualified Investor Category *

Applicant Type *

Participation Details *

Investor Details

Joint Applicant Details

Corporate Details

Naira Bank Account Details (for e-Payments) *

Payment *

Declarations *

Review & Submit