WSFx SMART CURRENCY CARD

Issuance Fee

Reload Fee

Cross Currency Fee (Mark-up Fee)

Cash Advance / Cash Disbursement

Fee

INR 150/- INR 100/- 3% of Transaction Amount

2% of Transaction Amount

Wallet to Wallet Transfer Fee*

2% of Transaction Amount

USD 5.00 or equivalent for every 180 days of inactivity

Inactivity Fee

SCHEDULE OF CHARGES AND DAILY USAGE LIMITS*: For Latest Schedule of Charges & Spending limits please visit URL: https://wsfx.in/SmartCurrencyCard

GUARANTEED CONVENIENCE SECURE Chip based Card for higher security Real time Email and SMS alerts Insurance coverage on Card Temporary Card lock feature

One Card, multiple currencies 24x7 access to your funds Online account management Longer validity Toll-free international

Lost Card Replacement Fee

International Locations** – USD 20.00;

Indian locations – USD 2.00

Currency USD GBP EUR CAD AUD SGD AED JPY

Balance Enquiry Fee at ATM 0.50 0.50 0.50 0.75 0.75 0.75 2.00 60.00

ATM Cash Withdrawal Fee 2.00 1.50 1.75 2.50 2.50 2.75 7.25 225.00

ATM Cash Withdrawal Limit Per Day 1,500 1,000 1,000 1,500 2,000 1,500 5,000 150,000

POS / Ecom / Cash Advance / Cash @ POS limit Per day 7,500 5,500 6,500 9,500 10,000 10,000 25,000 850,000

Currency SAR THB NZD ZAR HKD CHF INR

Balance Enquiry Fee at ATM 0.75 7.00 4.00 0.50

ATM Cash Withdrawal Fee 2.75 28.00 15.00 2.00

ATM Cash Withdrawal Limit Per Day 1,500 12,500 7,500 1,000

POS / Ecom / Cash Advance / Cash @ POS limit Per day 10,500 1,00,000 55,000 7,500

1.75 16.00

7.50 65.00

5,000 45,000

25,000 250,000

8.00

20.00

10,000

20,000

Statement Fee: NIL, Charge-back Fee: NIL, New ATM PIN: NILAll fees and charges mentioned above are exclusive of taxes. In case on insufficient balance on particular wallet, fee along with taxes will be debited from the highest order wallet with sufficient balance.*Wallet to Wallet transfer from your FC wallet to your INR wallet will have a transfer fee of 1% of the transaction amount** Actual International Courier charges will be applied.

Daily limits set on your WSCC is the higher limit, however foreign ATM's may have their own per transaction limit depending upon their service providing bank or regulatory authorities. You are requested to check the same in the ATM premise before usage. In such cases, the lower limits will apply. Additional fees for ATM transactions may be levied by the bank owning the overseas ATM used for transaction.QUICK TIPS FOR USING YOUR WSFx SMART CURRENCY CARD BETTER: REMOTE RELOAD: Enjoy your overseas trip even when running short of balances, just leave a signed authority letter along with the duly filled and signed reload form

with your close relative. BALANCE ENQUIRY AND VIEW STATEMENT: Check currency wise available balance and view statement for past transactions online TEMPORARY LOCK/UNLOCK: During your trip or upon return to India you can lock your card temporarily and unlock it anytime SMS/E-MAIL ALERT FACILITY ON INDIAN MOBILE NUMBER: Real time SMS/Email alerts will be sent on your registered Indian Mobile Number, if the same is not

updated in our records you are advised to call WSFx Customer Care for updation of the same PRE-AUTHORIZATION DURING CHECK-IN IN HOTELS OR RENTING CAR/BIKE: Hotels/Car Rentals before check-in/renting services etc. take a pre-auth on your card.

A Pre-Authorization is essentially blocking of certain amount on your card. At the time of checking out of the hotel/settling the bill, you should:- Ask the executive to settle the final bill against the pre-auth that was taken- Ask the executive to cancel the pre-auth (credit back the amount) that was taken and settle the bill by taking an authorization for the actual bill amount- In case the pre-auth that was taken remains unclaimed by merchant up to 30 days then it would be automatically credited back to the Card account on the 31st day. Card Issuer is not responsible for any additional funds debited or charges levied on your Card by Hotel or merchant. We recommend you to not use your WSFx Smart Currency Card for pre-authorization.

Round the clock support for your queries:Contact Center Number - 080-45651100 ; Contact Center Email ID- wsfxsmartcard@yesbank.in

CUSTOMER COPY CUM APPLICATION ACKNOWLEDGEMENT (PLEASE HAND IT OVER TO THE CUSTOMER)Making life easier when you’re traveling abroad, with WSFx Smart Currency Card (WSCC). It's the safe and secure alternative to pockets full of cash or traveller’s cheques when you're away. Use your WSFx Smart Currency Card, pre-loaded with foreign currency just like another credit/debit card for in-store purchases, online transactions or to withdraw money from ATM's affiliated by VISA-card while away. The card automatically chooses the currency wallet as per the local currency of transaction from the multiple available wallets on the Card. Load the currencies you want, lock in your exchange rate for peace of mind and save on exchange rate fluctuations.

INSURANCE BENEFIT: Lost Card Liability & Counterfeit Card Liability Insurance up to INR 3,00,000/-

DYNAMIC CURRENCY CONVERSIONDYNAMIC CURRENCY CONVERSION::In In certain certain countries, countries, the the acquiring acquiring banks banks may may choose choose to to activate activate the the feature feature of of "Dynamic "Dynamic Currency Currency Conversion" Conversion" on on their their ATMATM''s s and and POS POS Machine Machine network.network. As As per per this this facility, facility, the the ATM/POS ATM/POS machine machine identifies identifies the the WSFx WSFx Smart Smart Currency Currency card card as as a a card card issued issued from from a a foreign foreign country country and and prompts prompts the the customer customer toto transact transact in in their their “home “home currency”. currency”. Your Your WSFx WSFx Smart Smart Currency Currency Card Card does does not not have have the the Dynamic Dynamic Currency Currency Conversion Conversion enabled enabled andand the transaction the transaction will get rejectedwill get rejected if if you choose “home currency” saving conversion charges for you.you choose “home currency” saving conversion charges for you.Card Card Issuer Issuer will will not not be be responsible responsible for for any any "Dynamic"Dynamic Currency Currency Conversion" Conversion" related related charges charges and and will will not not be be able able to to refund refund any any such such charges charges in in case case theythey are levied on account of wrong usage of the WSCC.are levied on account of wrong usage of the WSCC. **Govt Taxes as applicable will beGovt Taxes as applicable will be charged charged additionallyadditionally

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PERSONAL DETAILS

PAN No.:*(As per PAN)

PAN belogs to:* Self Father Mother

Passport No.*

Date of Birth*

UID (Aadhaar)

Gender:*

Minor:* (upto 10 years or below) Yes No Marital Status:* Single Married

M F T

Date of Issue* Expiry Date* Place of Issue*

E-mail ID.*Your WSFx Smart Currency Card Statement will be sent on the above e-mail id

D D M M Y Y Y Y

D D M M Y Y Y Y D D M M Y Y Y Y

Office Name & Address:

City*

City

STD Code Landline No.

Landmark

Landmark

Pin Code*

Pin Code

Mobile No.*State*

State

WSFx SMART CURRENCY CARD APPLICATION FORM

All fields marked "*" are MANDATORYPromo Code:

Residential Address (Current / Permanent):*

Country Name 2

10th or below 10+2 or below Graduate Postgraduate & above Other (Please Specify) ________Resident Indian NRI Foreign National Person of Indian origin (PIO) Overseas Citizenship of India (OCI)

Name*(As per PAN)

Title* Mr Ms Mrs Dr. First Name Middle Name Last Name

(If selected Father/Mother Please fill below field as per PAN Only)

Father's Name:(As per PAN)Mother's Name:(As per PAN)

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What is your Education qualification*?

What is your Nationality?*

What Is Your Country of Citizenship?*

Country Name 1

STD Code Landline No.

Tick( )here to enable/disable International Transactions* Enable

Mobile No.

Disable

Affix a recent passport size photograph of the applicant

Affix a recent passport size photograph of the guardian

(Applicable for minor applicants below the age of 10 years)

CUSTOMER INFORMATION

Public Sector or Business or Govt. Sect Govt. SectorGovt. Sect yed Self-EmplSelf-EmployedSelf-Emplooyed StudentOccupation* Private Sector Annual Salary Income (`lakhs)* <1 >1-5 > 5-10 >10-15 >15-25 >25-50 >50Salaried* Y N If Yes*, Employer Name ________________________________ Job Role ______________________ Designation _____________________

.

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TRAVEL DETAILS*

Date of Travel* D D M

Travel Type* Business Leisure (Personal Trip)

Air-Ticket or Visa Passport Copy

Education (Studies Abroad)

Pan Card# Travel Documents submitted - (Self attested Photocopies)*

Date of Return*

Country of Travel* Country 1 Country 2

No of Days Travel*

Others_____________________________

Others (Please specify) _____________ _

Y YM Y Y D M Y YD M Y Y

Country 3

#In case of Minor applicants below the age of 10 years, submission of Guardian's PAN Card / ID proof is mandatory.

Loading Details Cheque/DD (Card activation subject to availability of clear funds after clearing)

Funding Amount in INR* (in words) _________________________________________________________________________________________________________

Cheque/DD Amount ______________ Instrument No. _______________________ Drawn on (Bank Name) _________________ Instrument Date _________________ Branch Name ________________________Fund Transfer RTGS/NEFT UTR No.: ____________________________ Bank Name: _______________________________

EUR ________ GBP ________USD _______ SGD _______ AUD _______ JPY ________ AED _______ CAD ________ THB _________ SAR _______

Self Family Member (Please enclose Letter of authority from Cardholder (in case of third party)

Load Currency & Amount*

Source of Funds* Salary Other (please specify) ________________

NZD ______ ZAR________ CHF________

HKD________

Business Income Rent Income Education Loan^

PAYMENT MODE* (All fields are mandatory)

Relation* with person funding the Card:*

(4) Son’s wife(1) Father (incl stepfather)(6) Sister (incl stepsister)

(2) Mother (including stepmother)(7) Daughter

(3) Son (Incl stepson)(8) Daughter’s husband (9) Husband

(5) Brother (incl stepbrother)(10) Wife

(11) Member of Hindu Undivided Family (HUF) I hereby accept the below mentioned terms and conditions:Declaration:

Name: __________________________________________________ Date: ___________________ Place: ________________________

P 1_____________________________________________________________________________________________________

Signature of the Card Holder (To be signed by Natural Guardian/Parent in case of Minor Applicant)

1. I hereby apply for the issuance of a WSFx Smart Currency Card to me, and declare that the information included in the application is true and correct, and that I am eligible to apply for an internationally valid Card. I accept that the card issuer is entitled in its absolute discretion to accept or reject this application, without assigning any reason whatsoever. If this application is accepted, I will be bound by the Terms and Conditions governing the WSFx Smart Currency Card, as may be in force from time to time and use of the Card shall be deemed to be acceptance of those Terms and Conditions. 2. I authorize the Card Issuer and / or its associates to verify any information or otherwise at my office / residence or to contact me, my employer / banker / credit bureau / RBI or any other source to obtain or provide any information that may be required for maintaining any account in good standing. 3. I understand and acknowledge that local laws and Reserve Bank of India rules and regulations lay down norms and limits for the purchase and use of foreign exchange. 4. I undertake that the usage of the WSFx Smart Currency Card by me will be in accordance with the Exchange Control Regulations of the Reserve Bank of India and the applicable laws in-force from time to time, in particular and without limitation, to the Foreign Exchange Management Act, 1999. In the event of any failure on my part to comply with the Rules and Regulations or in the event of any information supplied by me being incorrect or inaccurate, I agree that I will be solely liable for any / all penalties and / or action under local laws and / or regulations as may be in force, governing the purchase and use of the WSFx Smart Currency Card. 5. I agree and acknowledge that Card Issuer will act on requests made by any persons for reload of the WSFx Smart Currency Card issued to me. 6. In case of WSFx Smart Currency Card issued to me at the requests of m y employer, I hereby authorize the Card Issuer to act on the requests made by my employer for reload, cancellation and refund of the WSFx Smart Currency Card. 7. I understand and take responsibility to surrender any unutilized balances of value greater than $ 2,000 (or equivalent) on the Card within 180 days from completion of my travel as per the FEMA guidelines.8. I acknowledge that I carry the risks of reloading a wrong Card number by communicating a wrong Card number to the Card Issuer. I understand that the Card Issuer cannot be held responsible for the same.9. I agree and acknowledge that the fees are non-refundable.10. I understand that ATM's / EDC terminals are machines and errors could occur while in operation. I agree to indemnify the Card Issuer for any such machine / mechanical errors / failures.11. I understand that the Alert facility offered by the Card Issuer will enable me to receive customized Alert messages through the Short Messaging Service ("SMS") over my mobile phone, as chosen by me, with respect to events and transactions on my Card.12. I have read and understood the Terms and Conditions relating to the Alerts service being offered by the Card Issuer. If this Application Form is accepted I shall be bound by the said Terms and Conditions as in force, and as may be amended by the Card Issuer and use of Alert facility will be deemed to be acceptance of those Terms and Conditions.13. I certify that the details furnished in this Application Form are correct and I give my consent to receive such information under this Alert Facility. I shall advise the Card Issuer immediately in the agreed manner as acceptable to WSFx, in case of any change in any of the above details & information given in this Registration Form.14. I agree to provide any further information and necessary documentation or any additional KYC required and demanded by the Card Issuer, from time to time with respect to the regulatory and statutory guidelines.15. I acknowledge having received a sealed WSFx Smart Currency Card kit.16. I hereby agree that the Smart Currency Card will not be funded by the Card Issuer in the event there is any breach of the limits as prescribed under FEMA, and as applicable to me or if there is any discrepancy/breach of the KYC requirements and I shall not hold the Card Issuer liable for non-funding due to the reasons mentioned aforesaid.17.The Cardholder hereby unconditionally and irrevocably authorizes the Bank to block/ cancel or terminate the Card, in the event, details of the Cardholder or any of the transaction on the Card comes under the category of any of the prudent list of the Bank/RBI or any other statutory authority or the Cardholder’s validation fails against NSDL. Further, the Cardholder hereby agrees and confirm that upon cancellation/ termination of the Card, the Cardholder shall approach the Bank for refund of the balance, if any, on the Card as per the refund process of the Bank applicable on the Card

#PAN to be obtained from the person whose a/c is being debited for loading /reloading the Card. In case of Minor applicants below the age of 10 years, Guardian's PAN is to be submitted.

(3) the one is related to the other in the manner indicated below:

^ If Education loan has been selected above as the Source of Funds, then please provide Loan disbursement letter provided by NBFC/Bank, Education loan sanctioned letter with student and parent's name who is the co-borrower, and Bank statement showing the source of funds as un-utilized disbursed Education loan by a financial institution of India.

A person shall be deemed to be a relative of another, if and only if, (1) they are members or a Hindu Undivided Family (HUF) or (2) they are husband and wife or

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FORM DA1-NOMINATION DETAIL (Applicable for individuals/sole proprietors)

Relationship with depositor, if any..........................................................Age.....................If minor, nominee’s date of birth (DDMMYYYY)

Please select any one I wish to nominate I do not wish to nominate "Nomination under section 45ZA of the Banking Regulation Act, 1949 and Rule 2(1) of the Banking Companies (Nomination) Rules, 1985 in respect of bank deposits" I/We (Name (S) and address (es) -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Nominate the following person to whom in the event of my/my minor ’s death the amount of the deposit in the account, particulars whereof are given below, may bereturned by the Card Issuer. Deposit/Account NATURE ADDITIONAL DETAILS, IF ANY NOMINEE NAME (Nomination should be only in favour of an individual) ---------------------------------------------------------------------------------------------------------------------------

"*As the nominee is a minor on this date, I/we appoint Shri / Smt. / Kum. (name) .............................................................................................................. (age)...................... (Address)....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... to receive the amount of the deposit in the account on behalf of the nominee in the event of my/minor’s death during the minority of the nominee. Agree / do not agree for the name of my nominee to be displayed on the Fixed Deposit Advice/ Statement of Accounts and/or other documents/ letters.

Name: __________________________________________________ Date: ___________________ Place: ________________________

_________________________________________________________________________**Signature of Applicant (Guardian's Signature if applicant is a minor)

P____2

*Strike out if nominee is not a minor** Where deposit is made/account is held in the name of minor, the nomination should be signed by a person lawfully entitled to act on behalf of the minor.

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Declaration for purchase of foreign exchange under the Liberalised Remittance Scheme of USD 2,50,000

Details of the remittances made/transactions effected under the Scheme in the current financial year (April___- March___)

Sr.No

Sr.No Whether under LRS (Yes/No) Purpose Code Description

As per the Annex

Date Amount Name and Address of AD branch/FFMC through which tansaction has been effected

1. I /We hereby declare that the transaction details of which are mentioned above does not involve, and is not designed for the purpose of any contravention or evasion of the provisions of the aforesaid Act, or of any rule, regulation, notification, direction or order made there under.

2. I/We also understand that if I /we refuse to comply with any such requirement or make only unsatisfactory compliance therewith, the Bank shall refuse, in writing, to understand the transaction and shall, if it has reason to believe that any contravention/evasion is contemplated by me/ us, report the matter to RBI.

3. I/We also hereby agree and undertake to give such information/documents as will reasonable satisfy you about this transaction, in terms of the above declaration.

Declaration under Liberalized Remittance Scheme for Resident Individuals:

Declaration-cum-undertakingunder Sec 10(5), Chapter III of FEMA 1999:

DeclarationI/We_________________________________________________________________________ (Name) hereby declare that.Declaration under FEMA 1999 as per Form A2:I / We hereby declare that-

(1) The total amount of foreign exchange purchased from or remitted through, all sources in India, during this financial year including this application is within USD 2,50,000 (USD Two Lakh Fifty thousand only) the annual limit prescribed by Reserve Bank of India for the said purpose#

(2) Foreign exchange purchased from me is for the purpose indicated in section Details of Travel. *(Strike out whichever is not applicable)(3) I/We have not done LRS transaction from other Bank/ Forex issuing authorized agency or breached the ₹ 7 lakhs limit for the fiscal year earlier with other Bank/Forex issuing

authorized agency.

1. I/We hereby declare that the total amount of foreign exchange purchased form or remitted through, all sources in India during the financial year including this application is within the overall limit of the Liberalized Remittance Scheme prescribed by the Reserve Bank of India and certify that source of funds for making the said remittance belongs to me and the foreign exchange will not be used for prohibited purposes.2. I am person resident in India. I am not a Foreign National/NRI/PIO.3. The remittance would be utilized for permitted Capital & Current Account transactions only.4. I have not availed any loan/credit/borrowing for remitting under Liberalized Remittance Scheme for Capital Account transactions5. The remittance is not being requested for any transaction not permissible under FEMA and those in the nature of remittance for margins or margin calls to overseas exchange/ overseas country party are not allowed under the Scheme.6. The Scheme is not available for capital account remittances to countries identified by Financial Action Task Force (FATF) as non-co-operative countries and territories as available on FATF website www.fatf-gafi.org or as notified by the Reserve Bank.7. The remittance is not being sent for purchase of FCCBs issued by Indian companies in the overseas secondary market.8. The remittance is not being sent for trading in foreign exchange abroad.9. I/We undertake to make all Capital A/c transactions under LRS from YES BANK only.

(I) Resident Individuals as per enclosed list. The remittance made is within the limits prescribed by the Reserve Bank of India for the resident individuals under the Liberalized Remittance Scheme

Declaration from Tour Operators:I/We confirm that the remittance is being made for travel arrangements of

(ii) Foreign tourists as per enclosed list. The amount of remittance does not exceed the amount of foreign exchange remitted to India by the foreign tourists.

1. General Declaration2. The Purpose and transaction details as mentioned above are true to the best of my knowledge.3. I/We shall be responsible and liable for any incorrect details provided by me/us.4. The remittance is not being requested for any purpose specifically prohibited under Schedule I or any item restricted under Schedule II of Foreign Exchange Management

(Current Account Transaction) Rules, 2000.5. The remittance is not being sent directly or indirectly to Nepal and Bhutan. The remittance is not being sent directly or indirectly to those individuals and entities identified as

posing significant risk of committing acts terrorism as advised separately by the RBI to the banks.6. The transaction mentioned above does not involve, and is not designed for any purpose for which the drawl of foreign exchange is prohibited under Rule 3 of the Foreign

Exchange Management (Current Account Transactions) Rules, 2000, read with Schedule I there of viz:a. Remittance out of lottery winnings.b. Remittance of income from racing/riding. etc. or any other hobbyc. Remittance for purchase of lottery tickets, banned/proscribed magazines, football pools, sweepstakes, schemes involving money circulation, securing prize money/ awards, etc.d. Payment of commission on exports made towards equity investment in Joints Ventures/Wholly Owned Subsidiaries abroad of Indian companies.e. Remittance of dividends by any company, to which the requirement of dividend balancing is applicable.f. Payment of commission on exports under the Rupee State Credit Route, except commission up to 10% of invoice value of exports of tea and tobacco.g. Payment related to "Callback Services" of telephones.h. Remittance of interest income on funds held in the Non-Resident Special Rupee Account Scheme.i. Travel to Nepal and/or Bhutan

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*Where the applicant is minor, the application should be countersigned by minor's nautal guardian

7. I/We agree that submission of request does not necessarily imply processing of the transaction. YES BANK has full rights to reject the transaction based on regulatory and internal guideline

8. I/We agree that in the event the transaction could not be executed/debited to my/our account, after submitting the request for processing to the bank on account of insufficien/unclear balance at the time of execution of the transaction in my/our account, YES BANK shall not be responsible for not being able to process the transaction. Any exchange losses incurred in this connection, due to reversal of the fore deal, can be charged to my / our YES BANK account.

9. I/We agree that in the event the transaction is canceled or revoked by me/us after submitting the request for processing to the bank, any exchange losses incurred in this connection, can be charges to my/ our YES BANK account.

10. I/We further agree that once the funds remitted by me/us have been transmitted by YES BANK to the correspondent and/or beneficiary bank, YES BANK shall not be responsible for any delays in the disbursement of such funds, including the withholding of such funds by the correspondent and/or beneficiary bank.

11. I/We agree that once the funds remitted by me/us have been transmitted by YES BANK intermediary bank charges may be levied by correspondent and/or beneficiary banks, which may vary from bank to bank.

12. I/We agree that in the event the transaction being rejected by the beneficiary bank, because of incorrect information submitted by me, any charges levied by the beneficiary bank or exchange losses incurred in this connection can be charged to my YES BANK account.

13. I/We further declare that the undersigned has the authority to give this application, declaration and undertaking on behalf of the firm/company. (Applicable when the application/declaration/undertaking is signed on behalf of the firm/compa

P 3________________________________________________________________________________________________

**Signature of Applicant (Guardian's Signature if applicant is a minor)

Name: __________________________________________________ Date: ___________________ Place: ________________________

Payment Purposes

Purpose Code

S0301

S0303

S0304

S0305

S0306

S1307

Description

Business travel

Travel for pilgrimage

Travel for medical treatment

Travel for education (including fees, hoster expenses etc.)

Other travel (including holiday trips and payments for settling international credit cards transactions)

Outflows on account of migrant transfers including personal

City Of Birth Nationality

Residence Address for Tax Purpose (üTick against one which is applicable)

Same as the address mentioned in Application Form / provided for Bank Record

Country Of Birth

Other (Provide detailed address below)Mailing Address Permanent Address

Type of the provided address (ü Tick against one which is applicable)Residential Business Registered Office

If Others provide your Residence Address for Tax Purpose in detail here

Pin CodeStateCountry

City

FATCA-CRS Declaration For INDIVIDUALS* (To be filed Mandatory)

Section B: Document submitted as proof of identify of the individual (tick against one which is applicable and provide Identification Number)

Section A : Personal Details

I am a tax resident of India and not resident of any other country If Tax Resident of other country then fill below

itle itle Title Mritle . First Name Middle Name Last Name

Name

Please Tick the applicable tax resident declaration: (Any One)

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Identification Number

Section C: TAX Residence Declaration

Section D: Certification, terms & conditions and instructions

Tax Identification Number (TIN) Country

Identification Type (TIN or Other, please specify)

Passport Driving License Aadhar Card

Pan Card NREGA JOB CARD Others

Document Type Voters ID Govt. ID Card

Name: __________________________________________________ Date: ___________________ Place: ________________________

Terms and Conditions: The Central Board of Direct Taxes has notified on August 7, 2015, Rules 1114F to 114H, as part of the Income Tax Rules, 1962, which Rules require Indian Financial Institutions such as the Bank to seek additional personal tax and beneficial owner information and certain certification and documentation form all our account holders. In relevant cases, Information will have to be reported to tax authorities/ appointed agencies/ withholding agents for the purpose of ensuring appropriate withholding from the account or any proceeds in relation thereto. Should there be any change in any information provided by you, please ensure you advise us promptly i.e. within 30 days If you have any question about tax residency, please contact your Tax Advisor. If you are a US citizen or resident or green Cardholder, please include United Stated inthe foreign country information field along with your US Tax Identification Number. It is mandatory to supply a TIN or functional equivalent of the country in which youare tax resident issues such identifiers. If no TIN is yet available or has not yet been issued, please provide an explanation and attach this to the Form.

P____4____________________________________________________________________________________________**Signature of Applicant (Guardian's Signature if applicant is a minor)

FOR BRANCH/OFFICE USE ONLY

Branch Stamp : __________________________

Employee Code:

Sign & Date: __________________________________

Sign & Date: __________________________________

This is to certify that the remittance is not being made by/to ineligible entities and that the remittance is in conformity with the instructions issued by the Reserve Bank from time to time under the Scheme.

Employee Code:

Sell Rate Date D D M M Y Y Y Y

Branch Code

WSCC Reference No. Funded

Amount

Branch Name

SSC Code (Sourcing RM code)

Document Checked by

Document Approved by

Maker Name: Checker Name:

________________________

________________________

________________________________

9 digit reference no. (Kit no.)