Request for Nominee Update

To, Mutual Funds Operations Team ICICI Securities Ltd Shree Sawan Knowledge Park, Ground Floor, Plot No. D-507, T.T.C Ind Area, M.I.D.C, Turbhe, Opp. Juinagar Railway Station, Navi Mumbai 400705. Date : DD / MM / YY

I/ We undersigned holding ICICIdirect.com account Trading a/c number hereby request you to update the Nominee as mentioned below for AMC AMC Name under Folio Folio Numbers I/ We do hereby nominate Name of the Nominee in whom all rights and/or amount payable in respect of my Mutual Fund folios specified above shall vest in the event of my death. I/We understand that the new nominee details as requested by me will be updated only for the above mentioned folios where earlier the name of the existing nominee appeared. Name of the Guardian (in case of Minor) : ___________________________________ Relationship with the Holder : ________________________ Nominee Date Of Birth : _________________ Address of Nominee / Guardian : ____________________________________________________________________ Signature of Guardian

Signature of 1st Applicant

Signature of 2nd Applicant

Signature of 3rd Applicant

Name of 1st Applicant

Name of 2nd Applicant

Name of 3rd Applicant

Note : You can check the folio number in Unit Holdings under Mutual Fund Section once you login with your ICICI Direct user ID and password. Your trading account number starts with 85*****