Individual Stockholder Registration Form Full Name* First Name * Middle Name * Last Name * Valid Government ID * Upload More informationFiles must be less than 2 MB. Allowed file types: jpg jpeg png pdf doc docx odt ppt pptx. Email * Phone * Total Number of Shares * Shares Type * Stock Certificate Number/s (if certificated shares) Certification from broker (if uncertificated shares) Stock Certificate Number/s (if certificated shares) * Certification from broker (if uncertificated shares) * Attach Certificate * Upload More informationFiles must be less than 2 MB. Allowed file types: jpg jpeg png pdf doc docx odt ppt pptx. Are you going to assign a proxy for the meeting? * Yes No Proxy Form Proxy's Full Name * Proxy's First Name * Proxy's Middle Name * Proxy's Last Name * Proxy's Email * Proxy's Contact Number * Proxy's Valid Government ID * Upload More informationFiles must be less than 2 MB. Allowed file types: jpg jpeg png pdf doc docx odt ppt pptx. Submit