Exhibit 99.5
FORM OF BENEFICIAL OWNER ELECTION FORM
I (we) acknowledge receipt of your letter and the enclosed materials relating to the offering of rights (the “Class C Rights”) to purchase Class C common shares, par value $0.01 per share (the “Class C Common Shares”), of Liberty Latin America Ltd. (the “Company”).
In Part I of this form, I (we) instruct you whether to exercise, sell or transfer the Class C Rights distributed pursuant to the terms and subject to the conditions set forth in the prospectus dated September 10, 2020.
PART I
BOX 1. | ☐ | Please do not exercise Class C Rights. | ||||
BOX 2. | ☐ | Please exercise Class C Rights as set forth below: |
Number of Class C Rights | Subscription Price | Payment | ||||||||||||||||
Basic Subscription Privilege: | x | $ | 7.14 | = | $ | (Line 1) | ||||||||||||
Oversubscription Privilege: | x | $ | 7.14 | = | $ | (Line 2) | ||||||||||||
By exercising the oversubscription privilege (the “Oversubscription Privilege”) with respect to my (our) Class C Rights, I (we) hereby represent and certify that I (we) have fully exercised my (our) basic subscription privilege (the “Basic Subscription Privilege”) received in respect of Class C common shares held in the below described capacity.
Total Payment Required = $______________
(Sum of Lines 1 and 2 must equal total of amounts in Boxes 3 and 4)
BOX 3. | ☐ | Payment in the following amount is enclosed: ______________ | ||||
BOX 4. | ☐ | Please deduct payment from the following account maintained by you as follows: |
Type of Account | Account No: | |||||||
Amount to be deducted: $___________________ | Signature: | |||||||
Date: ______________, 2020 | Signature: | |||||||
(If held jointly) |
BOX 5. | ☐ | Please sell __________________of my Class C Rights. | ||
BOX 6. | ☐ | Please have Computershare N.A. effect my specific instructions that I have attached hereto and for which I have had an Eligible Institution guarantee my signature. |
Signature(s): | ||
Signature(s): | ||
(If held jointly) |
Please type or print name(s) below: | ||
Signature(s) Guaranteed by: | ||
Eligible Institution | ||
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