MR DIY-DIF

MITI ALLOTTEE DELIVERY INSTRUCTIONS FORM (“DIF”)

PIN/STAPLE THIS FORM IS FOR THE USE OF BUMIPUTERA INVESTORS APPROVED BY
REMITTANCE THE MINISTRY OF INTERNATIONAL TRADE AND INDUSTRY ONLY

To: TRICOR INVESTOR & ISSUING HOUSE SERVICES SDN BHD

UNIT 32-01, LEVEL 32, TOWER A, VERTICAL BUSINESS SUITE, AVENUE 3, BANGSAR SOUTH, NO. 8, JALAN
KERINCHI, 59200 KUALA LUMPUR

ATTN: IPO TEAM – DIY MITI APPLICATION

TEL: 603-2783 9299 / FAX: 603-2783 9222

I/We hereby request for the Allocated Placement Shares to be credited into the securities account(s) maintained with
Bursa Malaysia Depository Sdn Bhd (“CDS Account”) as follows:-

Full CDS Account Number - -

Full Name of CDS Account

(including Account Qualifier and
Beneficial Owner)
IC No./ Passport
Account No./ Co. Reg No
Qualifier

(if any) Address

Full Name of
Beneficial Beneficial Owner
Owner
IC No./ Passport
(as per the No./ Co. Reg No
requirement
Occupation /
of the
Principal Activity
Securities
Commission)
Address

Allocated Placement Shares

I/We attach together with this DIF a copy of my Photocopy of NRIC (both sides) together with banker’s cheque/ cashier’s
order only. Bank Name __________________ and bank draft/ banker’s cheque/ cashier’s order No._________________
for RM ___________________ for total amount payable for the above shares accepted.
We further confirm that the beneficial owner stated above is/will be the ultimate beneficial owner of the said number of
Placement Shares and that the information about the ultimate beneficial owner as stated above is true and correct.

My/Our contact information in connection to this DIF is as follows:-

Contact Person: ……………………………………………… Contact No.: …………………………………………….
Email : ……………………………………………………..….

Yours sincerely,

………………………………………………………
(with company stamp, if corporation)
Name:
Date