HALAL FUND INDEMNITY FORM

#Halalinvestments

Surname

Other names

Passport (Upload/Take Selfie)

Residential Address

Residential State

Registered Phone Number

Registered Email Address

Number of Units (Figure)

Number of Units (Words)

Bank Name

Bank Account Name

Bank Account Number

BVN

Acceptance Terms

I/We do solemnly and sincerely declare that I/we am/are the registered holder of units of the Lotus Capital Halal Investment Fund (“The Fund”).

My/our original certificate has been lost or destroyed. Neither the units nor the certificate thereto has been transferred, charged, lent or deposited or dealt with in any manner whatsoever that affects my/our absolute title thereto.

In consideration of your issuing a purchase statement/redeeming the above units in the absence of the original certificate, I/we (jointly and severally) hereby covenant to indemnify and forever keep you and The Fund indemnified against any and all claims, actions and demands (and any expenses thereof) which may be made against you or The Fund. I/We undertake to pay on demand, all payments, losses and expenses suffered or incurred by you in consequence of your complying with this request.

I/We undertake to deliver the original certificate to the Fund Manager for cancellation should the same ever be recovered

Signature & Authorization

Individual Unit Holder

Joint Unit Holder

Joint Unit Holder II

Name

Address

Occupation

Date

Authorized Signature and Stamp of Bank or Insurance Company

HALAL FUND INDEMNITY FORM

#Halalinvestments

Address List

Social Media

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