To:

FGN Roads Sukuk Company 1 PLC., No:

Debt Management Office, Official use only
Abuja

SUBSCRIPTION FOR SUKUK ISSUED ON BEHALF OF FEDERAL GOVERNMENT OF NIGERIA

Applications must be made in accordance with the instructions set out on the back of this Application Form. Care must be taken to follow these instructions as
applications that do not comply with the instructions may be rejected. Please consult your Financial or Legal Adviser for guidance before completing this Form.

In response to the advertisement in both print and electronic media, I/we hereby offer my/our subscription for FGN Sukuk

Date D D M M Y Y Y Y E-allotment Details – Depository A/C

Guide to Applications
: S/4 CSCS
A Minimum Value: N10,000.00 Value of Sukuk Applied for N
Multiples thereafter: N1,000.00

B Amount in Words: ……………………………………………………………………………………

PLEASE TICK BOX AS APPROPRIATE

C
Individual Joint Applicant Religious Group Other Non-Qualified Institutional Investor

1. Individual Applicants (to be completed in block letters) 3. Non-Qualified Institutional Investors (to be completed in block letters)
Full Name (Surname first).........................................................................................................
Company’s Name: ..............................................................................................................
………………………………………………………………………………………….………...…......
Type of Business: .......................................................R/C No: ........................................
(State titles if any e.g. Mr., Mrs., Miss., Alh., Haj., Mal)
2. Joint Applicants (to be completed in block letters) Address:............................................................................................:................................

Full Name (Surname first)................................................................................. E-mail Address: ................................................................................................................

………………………………………………………………………………….....… Contact Person: ...............................................................................................................
(State titles if any e.g. Mr., Mrs., Miss., Alh., Haj., Mal) Phone No:
.

Occupation: .................................................................................................................
Bank Name: .....................................................................................................................
Bank Account Number:……………………Bank Verification Number (BVN):……….……..
.

Phone No:
(For profit/rental payment purpose)
Address:......................................................................................................….………………
Name of Signatory 1:………………….. Designation: ………………..…………
….............................................................................................................................................
Passport/Driving License/National ID No: ................................................................................Usual Signature: ………………………………………… Date:……………………………...…
Date of Birth: ..................................... Mother’s Maiden Name: ...........................................
E-mail Address: ...................................................................................................................Name of Signatory 2:……………….. Designation: ………………………………
Next of Kin: ................................................................................................................................
Usual Signature: ……….……………………………… Date:……………………….….…...…
Name of Bank: ..............................................................................................................................
Residency classification of Applicant (tick the Appropriate box)
Bank Account Number: Resident Non-Resident

Bank Verification Number (BVN) : Country/State: .........................../.........................................

(Residency classification of Applicant must be indicated)
(For profit/rental payment purpose) Usual Signature: ..............................................Date: ............................................
Residency classification of Applicant (tick the Appropriate box)
Resident Non-Resident

Country/State: .........................../.........................................
(Residency classification of Applicant must be indicated)

Usual Signature: ..............................................Date: ............................................ E Issuing House

D Receiving Bank Greenwich Merchant Bank Limited

(Where Investors will pay into)

JaizSignature:
Usual Bank PLC .................................................. Date: ....................................................

Residency classification Vetiva Capital Management Limited

Lotus Bank Limited of Applicant (tick the Appropriate box)
Resident Non-Resident
(Residency classification
Stanbic IBTC Bank PLC of Applicant must be indicated)
Stanbic IBTC Capital Limited
Sterling Bank PLC

TAJ Bank Limited

Amount Allotted N…………………………………………

F Thumb print of illiterate applicant

Witness:
PRINT HERE
THUMB
AFFIX

I,…………………………………………have given detailed explanation to this applicant in the language understood by him/her and
consequently the applicant has a clear understanding of the transaction he/she has entered into.
Signature: ……………………………………………………………… Date: …………………………………..…………
 INSTRUCTIONS FOR COMPLETING THE APPLICATION FORM

1. Non-Qualified Institutional Investors are institutions that do not fall into any of the following categories; Banks,
Co-operative Societies, Fund Managers, Pension Fund Administrators, Insurance Companies, Government
Agencies, Staff Schemes, Non-Bank Financial Institutions, Trustees, Custodians, Investment/Unit Trust,
Stockbrokers and Market Makers

2. Applications must be made only on the official form as prescribed by the FGN Roads Sukuk Company 1 PLC.

3. Applications must be for a minimum of N10,000.00 and thereafter, in multiples of N1,000.00. The value of the
Sukuk applied for should be entered in the appropriate box.

4. The Application Form, when completed, should be lodged with the Issuing Houses. Applications must be
accompanied by full payment for the amount applied for, which must be paid to the Issuing House at the time of
submission. Payment may be in any form acceptable to the Issuing House.

5. Payment narrations must include the individuals first name and BVN number.

6. Applicants should note that No Charges or Fees would be paid by investors.

7. For the purpose of this application, residency classification refers to the country where the Applicant(s)
permanently resides as at the time of filling the Application Form, Applicant(s) must indicate his/their residency
classification in the appropriate box provided.

8. For joint applications, information on the Applicants should be provided in the appropriate boxes. However,
all correspondence will be addressed to the first named Applicant.

9. An application from a group of individuals should be made in the names of those individuals with no mention of
the names of the group.

10. An application from a corporation must bear the corporate body’s seal and be signed in accordance with the
company’s signature mandate by duly authorized officials. A corporate stamp may be used where the corporate
seal is not available.

11. Applicants should indicate their preference in where their Bond should be deposited by either indicating their S/4
and CSCS numbers for depository accounts or tick in either of the boxes for investors without Accounts.

12. An application by an illiterate person should bear his right thumb print on the Subscription Form a n d be witnessed
by an official of the Issuing House or Bank at which the application is lodged, who must first have explained
the meaning and effect of the application to the illiterate person in his own language. The witness should indicate
his name and signature in the appropriate box.

13. The applicant should not print his signature. If he is unable to sign in the normal manner he should be treated for
the purpose of this offer as an illiterate and his right thumb should be clearly impressed on the Subscription Form.

14. Applicants who are submitting forms to the Issuing Houses shall make payment to the following accounts:

Bank Name Account Name Account Number

Jaiz Bank PLC 0012112663

Lotus Bank Limited 1600001956

FGN SUKUK VI PROCEEDS
Stanbic IBTC Bank PLC 0050631974
ACCOUNT
Sterling Bank PLC 0094845469

TAJ Bank Limited 0005264099