OFFER BY BEVERAGE ASSOCIATES HOLDING LTD. ("BAH") FOR THE SECURITIES OF QUILMES INDUSTRIAL ("QUINSA"), SOCIÉTÉ ANONYME (THE "COMPANY") FORM OF WITHDRAWAL REQUEST1 TO WITHDRAW THE COMPANY SHARES TENDERED IN THE OFFER MADE BY BAH
Exhibit
99(a)(1)(iv)
OFFER
BY BEVERAGE ASSOCIATES HOLDING LTD. ("BAH")
FOR
THE SECURITIES OF QUILMES INDUSTRIAL ("QUINSA"), SOCIÉTÉ ANONYME (THE
"COMPANY")
______________________________________
FORM
OF WITHDRAWAL REQUEST1
______________________________________
TO
WITHDRAW THE COMPANY SHARES TENDERED IN THE OFFER MADE BY
BAH
The
undersigned hereby represents that the undersigned has tendered the Company
shares in the Offer made by BAH and wishes to withdraw all or part of such
tenders as indicated below.
The
undersigned further represents that the undersigned is aware of the terms
and
conditions of the Offer made by BAH for the Company shares and/or ADSs
as
described in the Offer Document, which was approved
by the CSSF on January 25, 2007 (the
“Offer Document”). All
capitalised terms used but not defined herein are defined in the Offer
Document.
THIS
FORM OF WITHDRAWAL REQUEST MUST BE FILED
ON
OR BEFORE 5:00 P.M. NEW YORK CITY TIME
(WHICH
IS 11:00 P.M. LUXEMBOURG TIME), ON FEBRUARY 28, 2007
(SUBJECT
TO POSSIBLE EXTENSION AS PUBLISHED BY THE OFFEROR)
Name
of Holder of the
Company shares:
Address
(include postal code):
Hereby:
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o
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instructs
and gives full power of attorney to the financial intermediary
with which
the tendered shares of the Company were deposited before their
tender in
the Offer:
to
withdraw their following tenders in the Offer and to credit the
withdrawn
shares back to my securities account.
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o
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withdraws
their following tenders in the Offer (in the case the Company
shares were
registered directly in the Company’s share register before their tender in
the Offer)
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(Please
tick the box corresponding to the option chosen.)
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Date(s)
of such tender(s)
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___________________
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Date:
Signature
of Holder:
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_______________________________
1
To
be completed in
duplicate in the case of shares where the holder is directly registered
in the
shareholders register with one copy to be sent to Quinsa and the other
to be
sent to the Share Transfer Agent.
With
respect to the Company shares directly registered on the Company share
register,
this form of withdrawal request must be sent to the Company, as share registrar,
and the Share Transfer Agent
at:
THE
COMPANY
Quilmes
Industrial (Quinsa) Société Anonyme,
FAO
Xxxxxxx Xxxxxxxx,
00,
Xxxxx
Xxx
L-1660
Luxembourg;
Fax:
+
000 00 0000
The
Share Tender Agent for the Offer is:
THE
BANK OF NEW YORK, LONDON
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By Mail:
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By
Hand or Overnight Delivery:
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The
Bank of New York
Xxx
Xxxxxx Xxxxxx
Xxxxxx
X00 0XX
Attn:
Xxxx Xxxxxx/Xxxxxx Xxxxx
Phone
x00 000 000 0000/x00 000 000 0000
Fax:
x00 000 000 0000
In
Luxembourg please contact:
The
Bank of New York (Luxembourg) S.A.
Aerogolf
Center
0X,
Xxxxxxxxx
X-0000
Senningerberg
Luxembourg
Attn:
Xxxxx Xxx/Xxx Xxxxxx
Phone:
x000 00 00 00 0000 / x000 00 00 00 0000
Fax:
x000 00 00 00 0000
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The
Bank of New York
One
Canada Xxxxxx
Xxxxxx
X00 0XX
Attn:
Xxxx Xxxxxx/Xxxxxx Xxxxx
Phone
x00 000 000 0000/x00 000 000 0000
Fax:
x00 000 000 0000
In
Luxembourg please contact:
The
Bank of New York (Luxembourg) S.A.
Aerogolf
Center
0X,
Xxxxxxxxx
X-0000
Senningerberg
Luxembourg
Attn:
Xxxxx Xxx/Xxx Xxxxxx
Phone:
x000 00 00 00 0000 / x000 00 00 00 0000
Fax:
x000 00 00 00 0000
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