| Date / / |
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| Application Form for Transfer of Securities from DIFX to BSE |
| Please read all instructions carefully before filling up the form |
| A) Source Account Details in DIFX |
| DIFX BP Id* (11-digit) ..................... | |
| DIFX BP Name* ................................ | |
| DIFX BP Account No* .................... | |
| Execution Date for securities transfer* | / / (dd/mm/yyyy) |
| B) Target Account Details in BSE |
| BSE-CDS BP Id in DIFX* (11 digits) .......... | ________________________________________________ | ||
| BSE-CDS BP Name in DIFX* ...................... | ________________________________________________ | ||
| BSE-CDS Account No in DIFX* ................ | ________________________________________________ | ||
| BSE-CDS Investor Number (IN)* ............... | |||
| BSE-CDS Investor Name* ........................... | |||
| Broker's Name* .............................................. | |||
| Investor's Account Number ........................ | |||
| C) Security Details | For official use | |||||||||
| ISIN* |
Security Name & Symbol* |
Quantity (in figures)* |
Quantity (in words)* |
Instruction / Transaction No. |
| BH000A0KEZD7 |
Al Baraka Banking Group (BARKA) |
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Instructions: 1. The (*) fields are mandatory. 2. Please fill all the details in CAPITAL LETTERS. 3. Disclaimer Clause – Incorrect or Incomplete Instructions are liable to be rejected and no responsibility will lie on the DIFX CSD for any loss incurred on account of the same. |
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| Declaration | |||||||||
| I request you to transfer the above mentioned securities from my aforesaid account held with you. I have read and understood all related laws and regulations in relation to transfer of securities and I agree to abide by the same as are in force from time to time for such transfer. I declare that the particulars given by me above are true and to the best of my knowledge. | |||||||||
| Signature of the DIFX Business Partner |
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| For Dubai International Financial Exchange use only |
| Acknowledgement |
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Action:- Accepted/Rejected the application from Mr/Ms ____________________________ as the sole/ first holder along with _______________ and ______________________ as the second and third holders respectively for account transfer of the above mentioned securities. |
| Signature of DIFX CSD Manager_______________________________ |