Microsoft Word - Del Monte Notice & POC.v1.doc
STATEMENT OF OWNERSHIP
Please complete the Statement of Ownership form below if you were a record holder or beneficial owner of Sino Agro Food Company (“SIAF”) common stock on THE DATE OF RECORD, September 28, 2012 (regardless of the date of purchase of SIAF common stock).
This Statement of Ownership form must contain the name, address, and taxpayer identification number of the beneficial owner(s). The taxpayer identification number (TIN), consisting of a valid Social Security number (SSN) for individuals or employer identification number (EIN) for business entities, trusts, estates, etc., and telephone number of the beneficial owner(s) may be used in verifying ownership; this information is required. Non-USA residents can submit a copy of their passport’s identification page in lieu of TIN.
You must also provide the quantity of shares and the stock certificate numbers (if shares were held in certificate form; if shares were held through a brokerage account certificate, numbers would not be needed). You must sign the Statement of Ownership form in the space provided in order to deposit a valid claim. Please also provide your brokerage statement for September 2012 or a letter from your bank, broker, or other nominee indicating the quantity of shares held as of September 28, 2012, if you did not hold shares in certificate form. If you held shares in certificate form, please provide confirmation from the transfer agent of record.
Statement of Ownership forms must be postmarked no later than December 31, 2012, and mailed to:
REMINDER CHECKLIST
THE BUSINESS ADVOCATE, INC.
ATTN: SINO AGRO FOOD PROCESSING AGENT
PO BOX 333
ETNA, OHIO 43018-0333
USA
1. Please sign the certification below. If this Statement of Ownership form is being submitted on behalf of joint owners, then both must sign.
2. Remember to attach only copies of acceptable supporting documentation.
3. Do not send original stock certificates as documentation. These items cannot be returned to you by the Company.
4. Keep copies of the completed Statement of Ownership form and documentation for your own records.
5. If confirmation of receipt is desired, please send your Statement of Ownership Certified Mail, Return Receipt requested.
6. If your address changes in the future, please mail the Processing Agent notification of your new address. If you change your name, please inform the Processing Agent.
PART I—OWNER INFORMATION
Last Name (Owner First Name (Owner)
Last Name (Beneficial Owner If Different From Owner) First Name (Beneficial Owner)
Last Name (Co–Beneficial Owner) First Name (Co–Beneficial Owner)
Company/Other Entity (If Owner Is Not an Individual) Contact Person (If Owner Is Not an Individual)
Address Line 1
Address Line 2 (If Applicable)
City State Zip Code
-
Foreign Province Foreign Zip Code Foreign Country
○ Check Here to Use Alternate Address for Distribution (Optional)
Distribution Address Line 1
Distribution Address Line 2 (If Applicable)
City State Zip Code
-
Foreign Province Foreign Zip Code Foreign Country
Telephone Number (Day) Telephone Number (Night)
( ) - ( ) -
Beneficial Owner’s Employer Identification Number or Social Security Number
- - -
Email Address [An email address is not required, but if you provide it, you authorize the Processing Agent to use it in providing you with information relevant to this dividend.]
PART II—HOLDINGS ON SEPTEMBER 28, 2012
HOLDINGS ON SEPTEMBER 28, 2012
State the number of shares of SIAF common stock of record held on September 28, 2012. Documentation includes THE ENTIRE BROKERAGE STATEMENT(s) for September, 2012 or proof of stock certificate (see below for more details if your shares were held in certificate form).
Proof enclosed
○ Y ○ N
STOCK CERTIFICATE NUMBERS (If applicable)
List below the stock certificate numbers for all SIAF common stock held on September 28, 2012, for all shares NOT HELD IN A BROKERAGE ACCOUNT. Be sure to attach documentation of ownership from the Transfer Agent, Broadridge Corporate Issuer Solutions, Inc., e-mail: shareholder@; phone: 877-830-4936; mail: PO BOX 1342, Brentwood, NY, 11717.
Proof of surrender enclosed?
○ Y ○ N
CERTIFICATE 1:
CERTIFICATE 2:
CERTIFICATE 3:
IF YOU REQUIRE ADDITIONAL SPACE, ATTACH EXTRA SCHEDULES IN THE SAME FORMAT AS ABOVE. PRINT THE BENEFICIAL OWNER’S FULL NAME AND TAXPAYER IDENTIFICATION NUMBER ON EACH ADDITIONAL PAGE.
YOU MUST SIGN THE STATEMENT OF OWNERSHIP
I (we) certify that I am (we are) NOT subject to backup withholding under the provisions of Section 3406(a)(1)(c) of the Internal Revenue Code. ○ Y ○ N
NOTE: The Internal Revenue Service does not require your consent to any provision other than the certification required to avoid backup withholding.
UNDER THE PENALTIES OF PERJURY, I (WE) CERTIFY THAT ALL OF THE INFORMATION PROVIDED BY ME (US) ON THIS FORM IS TRUE, CORRECT, AND COMPLETE AND THAT THE DOCUMENTS SUBMITTED HEREWITH ARE TRUE AND CORRECT COPIES OF WHAT THEY PURPORT TO BE.
________________________________________________ ________________________ ____________________________________________
Signature of OWNER Date Print name of OWNER
________________________________________________ ________________________ ____________________________________________
Signature of JOINT OWNER Date Print name of Joint Owner
________________________________________________
Capacity of Person(s) Signing, e.g., beneficial owner(s), executor, administrator, trustee, etc.
THIS STATEMENT OF OWNERSHIP MUST BE MAILED TO THE PROCESSING AGENT POSTMARKED BY DECEMBER 31, 2012.
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