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zanmecantile

PURCHASE ORDER FORM

SUBJECT TO RULES AND PRACTICES OF THE DSE
APPLICATION DETAILS
BANK ACCOUNT DETAILS
SECURITIES TO BE PURCHASED
Security Quantity Quantity in Words Max Price Per Share Limit Order Date
DECLARATION

"I/We hereby authorize ZAN Securities Ltd to purchase the above securities on my/our behalf in accordance with DSE rules and regulations."

FOR OFFICIAL USE ONLY