DIVIDEND RE-INVESTMENT PLAN APPLICATION FORM Lloyds

DIVIDEND RE-INVESTMENT PLAN
APPLICATION FORM
Full name of First Named Holder
Section 1 YOUR DETAILS
Company to which this plan applies
Lloyds Banking Group plc
1.
Joint Holder(s) – Maximum four (4) holders
Shareholder reference (8 or 11 digits) (Note 1)
2.
This application only applies to the holding above.
Separate applications must be completed for additional
holdings held in the above Company.
3.
4.
Full Address of First Named Holder
Country
Shares to which this plan applies
ORDINARY SHARES OF 10 PENCE
HELD IN CERTIFICATED FORM
ORDINARY SHARES OF 10 PENCE
HELD IN SHAREHOLDER ACCOUNT
Contact Telephone Number
(including any local dialling options) (Note 2)
Post Code
IMPORTANT
 Non CREST holders only (CREST holders need to elect through CREST).
 In order to participate in the Plan, in respect of a particular dividend, this form must be correctly completed and received
at least twenty (20) working days prior to the next dividend payment date.
Section 2 DECLARATION: All shareholders must sign and print their full names
Declaration: A copy of the Terms and Conditions referred to herein have been issued to you/made available on
www.shareview.co.uk/info/drip or as detailed in the accompanying literature. These form the basis on which our services
will be provided to you. For your own benefit you should read these Terms carefully before signing the application. If you do
not understand any point please contact us on the number indicated in the Guidance Notes.
To: Equiniti Financial Services Limited (Equiniti)
By signing this form I/we apply to join the Dividend Re-Investment Plan (the Plan) for each future dividend paid on the fully
paid up shares shown above in Section 1 held by myself/ourselves to which the Plan is applied.
I/We appoint Equiniti as my/our agent to arrange the purchase of fully paid up shares of the Company shown above in
Section 1 in accordance with the Terms and Conditions of the Plan. This request will remain in force until revoked in writing
by me/us, or otherwise cancelled in accordance with the Terms and Conditions of the Plan.
I/we agree to direct Equiniti Financial Services Limited to participate in the Plan in respect of all of the fully paid up shares
held in the Shareholder Account on my/our behalf.
To: Lloyds Banking Group plc
I/we the undersigned instruct Lloyds Banking Group plc to pay my/our dividend in respect of all the shares applying to the
Plan to Equiniti. (Note 3)
Signature 1
Signature 2
Print Full Name
Print Full Name
Signature 3
Signature 4
Print Full Name
Print Full Name
Today’s Date (Note 4)
If signing as Power of Attorney or other authority please print your full name (Note 5)
Bodies corporate must execute under their common seal or in accordance with section 44 of the Companies Act 2006.
Equiniti may send you notices about products and services we think that you may be interested in. If you do not
wish to receive these communications, please tick this box. (Note 6)
September 2015
GUIDANCE NOTES
You should find the answer to any queries you have, as well as a copy of the full Terms and Conditions for the Plan,
online at www.shareview.co.uk/info/DRIP
However, if you would like to speak to someone then you can contact the Shareholder Services Helpline on:
UK: 0371 384 2990
International: +44 121 415 7066
A textphone service is also available on:
UK: 0371 384 2255
International: +44 121 415 7028
Lines open 8.30am to 5.30pm (UK time), Monday to Friday (excluding public holidays in England and Wales).
Alternatively you can write to us at the address below.
Once completed please send your form to:
Share Dividend Team
Equiniti
Aspect House
Spencer Road
Lancing
West Sussex BN99 6DA
United Kingdom
Note 1: Shareholder reference (8 or 11 digits)
This can be found on your share certificate, Shareholder Account Statement or previous tax voucher.
Note 2: Contact Telephone Number (including any local dialling options)
Please provide your contact telephone number (including any local dialling options) for any enquiries.
Note 3: Print & Sign
All shareholders must sign the declaration and print their full name. If you are a sole shareholder please only
sign and print one box.
Note 4: Dividend Election deadline
To participate in respect of a particular dividend, Equiniti must receive the fully completed form at least twenty
(20) working days prior to the next dividend payment date.
Note 5: Power of Attorney (if applicable)
Complete your full name here if you are signing as a power of attorney.
To avoid rejection if you have not previously recorded the Power of Attorney document with us please ensure
that you send us either the original document or a photocopy with this form. If you are sending a photocopy,
please make sure every page is signed with an original signature, either by the person granting the Power or by a
solicitor or stockbroker, to confirm that it is a true and complete copy of the original.
Note 6: Marketing
If you do not want to receive any additional marketing communications from Equiniti please tick this box.
Equiniti Limited and Equiniti Financial Services Limited are part of the Equiniti Group. Their registered offices are Aspect House, Spencer Road, Lancing,
West Sussex BN99 6DA United Kingdom. Company share registration, employee scheme and pension administration services are provided through
Equiniti Limited, which is registered in England & Wales with No. 6226088. Investment and general insurance services are provided through Equiniti
Financial Services Limited, which is registered in England & Wales with No. 6208699 and is authorised and regulated by the UK Financial Conduct
Authority no. 468631.