EX-99.5 11 d97410dex995.htm EX-99.5 EX-99.5

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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