SIP ENROLLMENT DETAILS

APP No.:

MFD /RIA INFORMATION

Name & ARN Code Sub Agent ARN Code Sub Agent Code /Bank Branch Code/ Internal Code *Employee Unique Identification Number RIA Code++

ARN-(ARN stamp here) ARN-

*Please sign alongside in case the EUIN is left blank/not provided. I/We hereby confirm that the EUIN box has been intentionally left blank by me/us as this transaction is executed without any interaction or advice by the
employee/relationship manager/sales person of the above distributor/sub broker or not with standing the advice of in-appropriateness, if any, provided by the employee/relationship manager/sales person of the
distributor/sub broker.

SIGN First / Sole Applicant / Guardian / Second Applicant / Third Applicant /

HERE Authorised Signatory Authorised Signatory Authorised Signatory
Upfront commission shall be paid directly by the investor to the AMFI registered distributor based on the investor's assessment of various factors including the service rendered by the distributor.
APPLICANT DETAILS FOLIO NO.
Name of Sole/1st holder Mr./Ms./M/s PAN No / PEKRN. M A N D A T O R Y KYC

Name of 2nd holder Mr./Ms. PAN No / PEKRN. M A N D A T O R Y KYC

Name of 3rd holder Mr./Ms. PAN No / PEKRN. M A N D A T O R Y KYC

INITIAL INVESTMENT DETAILS

Cheque/ DD No. Cheque / DD Date DD Charge `
Net Amount ` Bank Name: Branch City:
UNITHOLDING OPTION - Demat Mode Physical Mode (Ref. Instruction No. 24) Demat Account details are compulsory if demat mode is opted.
National Securities Depository Limited (NSDL) Central Depository Securities Limited (CDSL)
I N
DP ID No. Beneficiary Account No. Target ID No.

Enclosures (Please tick any one box) : Client Master List (CML) Transaction cum Holding Statement Cancelled Delivery Instruction Slip (DIS)
SIP DETAILS (Refer Instruction No. 14. If the investor wishes to invest in Direct Plan please mention Direct Plan against the scheme name. Please refer respective SID/KIM for product labeling)
Frequency SIP Step-Up Facility (Optional) (Refer Instruction No. 26)
Scheme / Plan / Option (Please any one) Enrollment Period SIP Date Amount Amount Frequency Count
Daily$$ Weekly$$ From MM Y Y Y Y D D
Half-yearly Increase SIP amount
Monthly (Default) M M Y Y Y Y ` `
To
$ (Any date from 1 to 28
st th
time(s)
of a given month)## (in figures) (Multiples of ` 100 only )
**
Yearly (Default)
Plan: Direct Regular Quarterly Yearly OR Default Date (31/12/2050) (Default 1 time)
** In case of Nippon India Tax Saver Fund, Nippon India Retirement fund - Income Generation Plan & Nippon India Retirement fund- Wealth Creation Plan, the Step up minimum Amount should be ` 500 and in multiples of ` 500/-.
$ "END DATE” is mandatory and should be less than or equal to 30 years from the application date. $$ Daily & Weekly SIP Frequencies are applicable for normal SIP and not for Flex SIP & Pause Facility. ##For weekly frequency, only 1st, 8th, 15th & 22nd date
are eligible of every month.

DECLARATION: I/We Would like to invest in above mentioned scheme subject to terms of the statement of Additional Information (SAI), Scheme Information Document (SID), Key Information Memorandum (KIM) and

OTBM + SIP Form / 1st Oct 2023 / Ver 4.0

subsequent amendments thereto. I/We have read, understood (before filling application form) and is/are bound by the details of the SAI, SID & KIM including details relating to various services. By filling up this form I
understand that the amount towards my lumpsum / systematic investment plan (SIP) transaction will be debited from bank account details provided in my One Time Bank Mandate Form. I/We have not received
nor been induced by any rebate or gifts, directly or indirectly, in making this investment. I /We declare that the amount invested in the Scheme is through legitimate sources only and is not designed for the purpose of
contravention or evasion of any Act / Regulations / Rules / Notifications /Directions or any other Applicable Laws enacted by the Government of India or any Statutory Authority. I accept and agree to be bound by the
said Terms and Conditions including those excluding/ limiting the Nippon Life India Asset Management Limited (NAM India) liability. I understand that the NAM India may, at its absolute discretion, discontinue any of
the services completely or partially without any prior notice to me. I agree NAM India can debit from my folio for the service charges as applicable from time to time. The ARN holder has disclosed to me/us all the
commissions (in the form of trail commission or any other mode), payable to him for the different competing Schemes of various Mutual Funds from amongst which the Scheme is being recommended to me/us. I
hereby declare that the above information is given by the undersigned and particulars given by me/us are correct and complete. Further, I agree that the transaction charge (if applicable) shall be deducted from
the subscription amount and the said charges shall be paid to the distributors.
I confirm that I am resident of India. I/We confirm that I am/We are Non-Resident of Indian Nationality/Origin and I/We hereby confirm that the funds for subscription have been remitted from abroad through
normal banking channels or from funds in my/our Non-Resident External /Ordinary Account/FCNR Account. I/We undertake that all additional purchases made under this folio will also be from funds received from
abroad through approved banking channels or from funds in my/ our NRE/FCNR Account.
++ I/We, have invested in the Scheme(s) of your Mutual Fund under Direct Plan. I/We hereby give you my/our consent to share/provide the transactions data feed/ portfolio holdings/ NAV etc. in respect of my/our
investments under Direct Plan of all Schemes Managed by you, to the above mentioned Mutual Fund Distributor / SEBI-Registered Investment Adviser. I hereby authorize the representatives of Nippon Life India
Asset Management Limited and its Associates to contact me through any mode of communication. This will override registry on DND / DNDC , as the case may be.

SIGNATURE
By signing this SIP enrolment form I/We understand that the amount will be debited from the Bank account mentioned in One Time Bank Mandate / Invest Easy - Individuals Mandate Form.

SIGN First / Sole Applicant / Guardian / Second Applicant / Third Applicant /

HERE Authorised Signatory Authorised Signatory Authorised Signatory
Investors are requested to note that the amount mentioned in One Time Bank Mandate should be the maximum amount that you would like to invest in schemes of NIMF on any transaction day.

ONE TIME BANK MANDATE

(NACH / Direct Debit Mandate Form)
(Applicable for Lumpsum Additional Purchases as well as SIP Registration)
UMRN (FForr Office
O e Us
Use On
nly) Date: D D M M Y Y Y Y
Sponsor Bank Code (For Office Use Only) Create x Modify x Cancel

Utility Code (For Office Use Only) I/We hereby authorize Nippon India Mutual Fund
to debit (tick ) SB / CA / CC / SB-NRE / SB-NRO / Other Bank a/c number (Destination Bank Account Number)

With Bank (Name of Destination Bank) IFSC / MICR

an amount of Rupees (Amount in word) ` (Amount in figure)

DEBIT TYPE x Fixed Amount Maximum Amount FREQUENCY: x Monthly x Quarterly x Half Yearly x Yearly as & when presented

Reference 1 (Folio No.) Reference 2

1. I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank. 2. This is to confirm that
the declaration has been carefully read, understood & made by me/us. I am authorising the user entity/Corporate to debit my account, based on the instructions as agreed and
signed by me. 3. I have understood that I am authorized to cancel/amend this mandate by appropriately communicating the cancellation / amendment request to the user entity
/ corporate or the bank where I have authorized the debit.

From : D D M M Y Y Y Y

To:*** 3 Signature of Account Holder Signature of Account Holder Signature of Account Holder
D 1D 1
M 2
M 2
Y 0 5 Y0
Y Y

Phone No: Name as in Bank Record Name as in Bank Record Name as in Bank Record
1 2 3
***As per NPCI Circular dated 18th Aug’2023, mandate can be for maximum duration of 30 years from the date of application.
 INSTRUCTIONS cum TERMS AND CONDITIONS
(1) Auto Debit facility is offered only to the investors maintaining their bank accounts with Bank of Baroda / Bank of India / HDFC Bank / (18) No entry load will be charged with effect from August 1, 2009. Exit Load as applicable in the respective Scheme at the time of
ICICI Bank / AXIS Bank / State Bank of India / Union Bank Of India / Allahabad Bank / Punjab National Bank / Central Bank of India / enrolment of SIP will be applicable.
Bank of Maharashtra. The above list is subject to change from time to time. "National Automated Clearing House (NACH)" is Direct (19) In order to transact through Call Center, SMS, online mode whether through NIMF website or any other application using the
Electronic Debit mode implemented by National Payments Corporation of India (NPCI), list of banks is available on NPCI website internet and /or through Mobile or any other device, the investor needs to have the IPIN, issued by NAM India. By filling this form the
www.npci.org.in. The said list is subject to modifications. The investor agrees to abide by the terms and conditions of NACH Debit / investor will be issued IPIN by default in case he has not opted for the same earlier. This IPIN can also be used by the investor to
Auto Debit facility of Reserve Bank of India / Banks. If any city / bank is removed from the above mentioned list NAM India at its sole Transact Online. If only the email id of the investor is registered with NAM India / NIMF, investor can execute Transaction through
discretion may accept Post Dated Cheques (PDC's) from the investors for the balance period.. Call Center, Transaction through mobile WAP (Web Access Portal) Site, Transaction through NIMF website. If only the mobile
(2) Nippon India Mutual Fund (NIMF) / NAM India, its registrars and other service providers shall not be held responsible or will not be number of the investor is registered with NAM India/NIMF, investor can execute transaction only through SMS. For further details
liable for any damages and will not compensate for any loss, damage etc. incurred to the investor. The investor assumes the investors arerequested to refer SAI.
entire risk of using this facility and takes full responsibility. Investor will not hold NIMF / NAM India, its registrars and other service (20) Kindly note that in case of a folio with joint Unitholders, having mode of operations as "either or survivor" or "anyone or survivor any
providers responsible if the transaction is delayed or not effected or the investor bank account is debited in advance or after the one of the Investor(s) can transact through SMS, provided that such instruction is received vide an SMS from the mobile number
specific SIP date due to various clearing cycles of NACH Debit / Auto Debit / local holidays. registered with NAM India with respect to the concerned folio.
(3) Investors are required to submit One Time Bank Mandate Form and SIP Enrollment Form along with a photo copy/cancelled (21) Permanent Account Number (PAN): SEBI has made it mandatory for all applicants (in the case of application in joint names, each
cheque of Debit Bank Account (as mentioned on the One Time Bank Mandate Form) atleast 25th calendar days before the first SIP of the applicants) to mention his/her permanent account number (PAN) irrespective of the amount of purchase. Where the
Installment date for NACH Debit & Auto Debit Clearing. In case One time Bank Mandate form is already registered in the folio then applicant is a minor, and does not possess his / her own PAN, he / she shall quote the PAN of his/ her father or mother or the
the subsequent SIP registration request provided in the same folio will be processed with in 12 calendar days. guardian, signing on behalf of the minor, as the case may be. In order to verify that the PAN of the applicants (in case of application
in joint names, each of the applicants), the applicants shall attach along with the purchase application, a photocopy of the PAN
(4) An investor can opt for Daily, Weekly, Monthly, Quarterly and Yearly frequency for SIP. In case the investor has not specified the card duly self-certified along with the original PAN Card. The original PAN Card will be returned immediately across the counter
frequency then by default the frequency will be treated as Monthly. If an investor does not mention SIP start date appropriately, the after verification. Micro SIP & Investors residing in the state of Sikkim are exempted from the mandatory requirement of PAN proof
SIP will by default start from the next month after meeting the minimum registration requirement of 25th calendar days or 12 submission however they are required to mandatorily submit KYC Acknowledgement copy. Applications not complying with the
calendar days as applicable ( Refer point 3). above requirement may not be accepted/processed. Additionally, in the event of any Application Form being subsequently
SIP start date should be within 6 months from the date of submission of SIP application for all frequencies. In case the SIP start date rejected for mismatch / non-verification of applicant's PAN details with the details on the website of the Income Tax Department,
is more than 6 months from the date of submission, such SIP application shall be liable for rejection. If an investor does not mention the investment transaction will be cancelled and the amount may be redeemed at the applicable NAV, subject to payment of exit
SIP end date appropriately the tenure of SIP shall be considered same as OTBM end date. load, if any. Please contact any of the Investor Service Centres/Distributors or visit our website https://mf.nipponindiaim.com for
further details.
(5) An investor shall have the option of choosing for 1 or more than 1 SIP in the same scheme same plan and in the same month. The
investor can choose the SIP Dates from 1st to 28th of any given month for SIP registered through One Time Bank Mandate. Only for (22) Prevention of Money Laundering and Know Your Client (KYC): SEBI has prescribed uniform uniform KYC compliance procedure
Daily SIP frequency in case of mandates received with dates between 29th to 31st of a month, the SIP would commence from 1st of for all the investors dealing with them. SEBI also issued KYC Registration Agency ( "KRA") Regulations 2011 and the guidelines in
the subsequent month. For Daily SIP frequency option SIP will be executed on Daily basis and for Weekly SIP frequency Option SIP pursuance of the said Regulations and for In-Person Verification ("IPV"). All investors (individual and non- individual) are required
will be executed on 1st, 8th, 15th and 22nd of every month. More than one SIP for the same debit date shall be acceptable. If an to be KYC compliant. However, applicants should note that minors cannot apply for KYC and any investment in the name of
investor does not mention SIP Date in the application form or multiple SIP dates are mentioned in the SIP Mandate or the SIP Date is minors should be through a Guardian, who should be KYC compliant for the purpose of investing with a Mutual Fund. Should the
unclear in the application form / SIP Mandate, the default SIP date shall be treated as 10th as per the frequency defined by the applicant desire to change KYC related information, POS will extend the services of effecting such changes. In case of an existing
investor. In case the criteria are not met the SIP would start on the same date from the next month. Investors should check the investor of NIMF who is already KYC Compliant under the erstwhile centralized KYC with CVL (CVLMF) then there will be no effect on
same at the Designated Investor Service Centre of Nippon India Mutual Fund before investing. Units will not be created in cases of subsequent Purchase/Additional Purchase (or ongoing SIPs/STPs, etc) in the existing folios/accounts which are KYC compliant.
Non Transaction Day / Holiday in case of Daily SIP. Daily SIP Frequency would not be available in case of Daily IDCW Plans of the Existing Folio holder can also open a new folio with Nippon India Mutual Fund with the erstwhile centralized KYC.
Schemes. (i) In case of an existing investor of Nippon India Mutual Fund and who is not KYC Compliant as per our records, the investor will
have to submit the standard KYC Application forms available in the website www.cvlkra.com along with supporting
(6) For details about the Scheme and its facility please refer the SID, SAI & KIM of the respective schemes / Addendum issued from
documents at any of the SEBI registered intermediaries at the time of purchase / additional purchase / new registration of
time to time carefully before investing.
SIP/STP etc. In Person Verification (IPV) will be mandatory at the time of KYC Submission.
(7) In case of three consecutive failures due to insufficient balance in bank account while processing request for SIP, NAM India shall (ii) Investors who have complied with KYC process before December 31, 2011 (KYC status with CVL-KRA as "MF - VERIFIED BY
reserve the right to terminate the SIP without any written request from the investor. In the meantime, if any debits for subsequent
CVLMF") and not invested in the schemes of Nippon India Mutual Fund i.e not opened a folio earlier, and wishes to invest on
installments is effected by banker, then Units would get created for the same.
or after December 01, 2012, such investors will be required to submit| 'missing/not available' KYC information and complete
(8) SIP Amount: the IPV requirements.
SIP Frequency SIP Period Minimum Amount Updation of 'missing / not available' KYC information along with IPV is currently a one-time requirement and needs to be
Minimum 3 months 100 per Instalment and in multiples of Rs.1 thereafter completed with any one of the mutual funds i.e. need not be done with all the mutual funds where investors have existing
Daily investments. The said form is available on NIMF's website i.e. https://mf.nipponindiaim.com or on the website of Association of
Minimum 1 month 500 per Instalment and in multiples of Rs.1 thereafter
Mutual Funds in India i.e. www.amfiindia.com or on the website of any authorised KRA's. Once the same is done then the KYC status
Minimum 1 year 100 per Instalment and in multiples of Rs.1 thereafter at CVL-KRA will change to 'Verified by CVL KRA' after due verification. In such a scenario, where the KYC status changes to 'Verified
Weekly
Minimum 3 months 500 per Instalment and in multiples of Rs.1 thereafter by CVL KRA', investors need not submit the 'missing/not available' KYC information to mutual funds again.
(9) In case an investor wishes to change the bank account details for the existing SIP registered through Auto debit / NACH Debit (23) Communication for the investors: In accordance with SEBI Circular No. Cir/ IMD/ DF/16/ 2011 dated September 8, 2011 and SEBI
mode, then he has to provide Change of bank details for One Time Bank Mandate. The existing SIP registration will not get Circular no. CIR/MRD/DP/31/2014 dated November 12, 2014 the investor whose transaction has been accepted by the NAM
cancelled. The investor has to submit the Change of bank details for One Time Bank Mandate atleast 21 business days prior to the India/NIMF shall receive a confirmation by way of email and/or SMS within 5 Business Days from the date of receipt of transaction
next SIP Debit date. request, same will be sent to the Unit holders registered e-mail address and/or mobile number.
(10) In case the Investor wishes to cancel the One Time Bank Mandate / SIP , Investor will have to submit an One Time Bank Mandate Thereafter, a Consolidated Account Statement ("CAS") shall be issued in line with the following procedure:
Cancellation Form or SIP cancellation form , at least 10 business days prior to next SIP due date. 1. Consolidation of account statement shall be done on the basis of PAN. In case of multiple holding, it shall be PAN of the first
(11) Investors may note that all the transactions executed through Invest Easy such as "Online Transactions" (whether on our website or holder and pattern of holding.
through any other application using the internet) "Transactions through call center", "Transactions through SMS", "Transactions 2. The CAS shall be generated on a monthly basis and shall be issued on or before 10th of the immediately succeeding month
through Mobile Phone" or any other facility as offered by NIMF from time to time using the IPIN / One Time Password (OTP) will be to the unit holder(s) in whose folio(s) transaction(s) has/have taken place during the month.
considered as transaction through the mentioned broker (ARN) mentioned on this "SIP Enrollment Details" Form. 3. In case there is no transaction in any of the mutual fund folios then CAS detailing holding of investments across all schemes
(12) The Broker Code given in this mandate will be applicable for all the transactions done through Invest Easy mode. In case there is a of all Mutual Funds will be issued on half yearly basis [at the end of every six months (i.e. September/ March)]
change of Broker Code then the investor are requested to cancel the existing mandate and register a fresh mandate with us. 4. Investors having MF investments and holding securities in Demat account shall receive a Consolidated Account Statement
containing details of transactions across all Mutual Fund schemes and securities from the Depository by email / physical
(13) For Direct Investment Please Mention "Direct in the Column "Name & Broker Code/ARN.
mode.
(14) Investors are required to clearly indicate the plans/options in the application form of the scheme. Investor may note that following 5. Investors having MF investments and not having Demat account shall receive a Consolidated Account Statement from the
shall be applicable for default plan MF Industry containing details of transactions across all Mutual Fund schemes byemail /physical mode. The word
Broker Code mentioned Plan mentioned by Default Plan to 'transaction' shall include purchase, redemption, switch, Payout of Income Distribution cum capital withdrawal option,
Sr Reinvestment of Income Distribution cum capital withdrawal optio, systematic investment plan, systematic withdrawal
by the investor the investor be captured

OTBM + SIP Form / 1st Oct 2023 / Ver 4.0

plan and systematic transfer plan transactions. CAS shall not be received by the Unit holders for the folio(s) wherein the
1 Not mentioned Not mentioned Direct Plan PAN details are not updated. The Unit holders are therefore requested to ensure that the folio(s) are updated with their PAN.
For Micro SIP and Sikkim based investors whose PAN details are not mandatorily required to be updated Account
2 Not mentioned Direct Plan Direct Plan Statement will be dispatched by NAM India/NIMF for each calendar month on or before 10th of the immediately succeeding
3 Not mentioned Regular Plan/Other than Direct Plan Direct Plan month.
In case of a specific request received from the Unit holders, NAM India / NIMF will provide the account statement to the investors
4 Mentioned Direct Plan Direct Plan
within 5 Business Days from the receipt of such request.
5 Direct Not mentioned Direct Plan (24) Units held in the dematerialized form: Unitholders can have a option to hold the units in dematerialized form in terms of the
6 Direct Regular Plan/Other than Direct Plan Direct Plan guidelines / procedural requirements as laid by the Depositories (NSDL/CDSL) / Stock Exchanges (NSE / BSE). Please ensure that
the sequence of names as mentioned in the application form matches with that of the account held with any one of the
7 Mentioned Regular Plan/Other than Direct Plan Regular Plan/Other than Direct Plan Depository Participant.
8 Mentioned Not mentioned Regular Plan/Other than Direct Plan (25) Employee Unique Identification Number (EUIN) would assist in tackling the problem of mis-selling even if the employee /
relationship manager/sales person leave the employment of the distributor.
In cases of wrong/ invalid/ incomplete ARN codes mentioned on the application form, the application shall be processed under
(26) Nippon India STEP-UP Facility: Under this facility the Investor can increase the SIP installment (excluding MICRO SIP) at
Regular Plan. The AMC shall contact and obtain the correct ARN code within 30 calendar days of the receipt of the application form
pre-defined intervals by a fixed amount. This facility is available for all categories of investors. For availing the said facilities,
from the investor/distributor. In case, the correct code is not received within 30 calendar days, the AMC shall reprocess the
investors are required to note the following:
transaction under Direct Plan from the date of application without any exit load. Similarly, in the absence of clear indication as to
the choice of option (Growth or Payout of Income Distribution cum capital withdrawal option), by default, the units will be allotted 1. Investor willing to register STEP-UP should provide the STEP-UP details along with the SIP enrolment details and is also required to
under the Growth Option of the default /selected plan of the scheme. fill up " One Time Bank Mandate Form" from which the amount shall be debited. Investors who are currently registered under Invest
Easy - Individuals facility may avail this facility without registering the One Time Bank Mandate. 2. The minimum amount for
(15) Applications should be submitted at any of the Designated Investor Service Centre (DISCs) of NAM India or KFin Technologies Nippon India STEP-UP facility is `100/- and in multiples of `100/- [except for Nippon India Tax Saver (ELSS) Fund, Nippon India
Limited (Formerly KFin Technologies Private Limited). Retirement fund - Income Generation Plan & Nippon India Retirement fund- Wealth Creation Plan for which the minimum amount
(16) Existing unit holders should note that unit holders' details and mode of holding (single, jointly, anyone or survivor) will be as per the shall be `500/- and in multiple of `500/-. 3. Daily, Weekly and Monthly SIP offers STEP-UP frequency at half yearly and yearly
existing Account. intervals. Quarterly and Yearly SIP offers STEP-UP frequency at yearly interval only. In case STEP-UP frequency is not indicated, it will
be considered as Yearly by Default. 4. There should be clear indication about STEP-UP Count i.e. the number of times the SIP
(17) NAM India reserves the right to reject any application without assigning any reason thereof. NAM India in consultation with Trustees Installment amount should be increased. In case STEP-UP amount is mentioned and STEP-UP count is not indicated, it will be
reserves the right to withdraw these offerings, modify the procedure, frequency, dates, load structure in accordance with the SEBI considered as 1 (One) by Default. 5. The date for Nippon India STEP-UP Facility will correspond to the registered SIP. The enrolment
Regulations and any such change will be applicable only to units transacted pursuant to such change on a prospective basis. period specified in the Nippon India STEP-UP form should be less than or equal to the enrolment period mentioned in the SIP. 6. In
case of any deviation in period, the tenure of the SIP shall be considered.

*I/We hereby declare that the particulars given on this mandate are correct and complete. If the transaction is delayed or not effected at all for reasons of incomplete or
incorrect information, I/We would not hold Nippon India Mutual Fund, their representatives, service providers, participating banks & other user institutions responsible. I/We
have read the Terms & Conditions and agree to discharge the responsibility expected of me/us as a participant/s under the scheme. I/We authorize use of above mentioned
contact details for the purpose of this specific mandate instruction processing. I/We hereby confirm adherence to terms on this mandate. I hereby authorize the
representatives of Nippon Life India Asset Management Limited and its Associates to contact me through any mode of communication.This will override registry on DND /
DNDC , as the case may be.

Authorisation to Bank: I/We wish to inform you that I/we have registered with Nippon India Mutual Fund for NACH / Direct Debit through their authorised Service Provider(s)
and representative for my/our payment to the above mentioned beneficiary by debit to my/our above mentioned bank account. For this purpose I/We hereby approve to
raise a debit to my/our above mentioned account with your branch. I/We hereby authorize you to honor all such requests received through to debit my/our account with the
amount requested, for due remittance of the proceeds to the beneficiary.

FOR OFFICE USE ONLY (Not to be filled in by Investor)

Affix Barcode Date and Time Stamp No.