Application for notification under Schedule V [Table: Sl. No.7.Note 5(a)(iii)(D)] (Pension Fund)

Part A: Particulars ofthe Pension Fund

1.

Name:

(refer Note 1)

2.

Address:

(refer Note 2)

3.

Communication Address in India:

(refer Note 3)

4.

Permanent Account Number (PAN):

5.

Tax Identification Number (TIN), if available:

(refer Note 4)

6.

Created under the law of (please mention the name of the foreign country including any of its political constituents like province/state/local body etc.)

7.

E-mail Id:

8.

Contact Number:

Country

Code

Number

9.

Other details to be provided as separate enclosure:

(attach as per Note 5)

Part B: Certification

The applicant is a Pension Fund and interested in making investment in terms of Schedule V [Table: Sl. No. 7] and therefore, it is requested that necessary notification in terms of Schedule V [Table: Sl. No.7.Note 5(a)(iii)(D)] may kindly be issued. It is hereby certified that the Pension Fund satisfies all the conditions mentioned in Schedule V [Table: Sl. No. 7] and rule 282.

Verification

I, , hereby affirm that the information provided in this application is true and correct to the best of my knowledge. I have not concealed any relevant fact.

I am submitting this application in my capacity as (designation), holding PAN and I

am competent to verify and submit this application.

Anne

xure

Particulars

A-1

Documents constituting the Pension Fund and amendments (if any)

A-2

Any other relevant information