DECLARATION FORM

Under section 17(3) of the Foreign Investment (Amendment) Act - 2004, a foreign investor must provide the Chief Executive of Investment Tata Mutual Fund with information concerning its business activities for statistical purposes.

I/We, the undersigned investors declare that the investment project registered with the Investment Tata Mutual Fund commenced its operation as per the details given below:

Type of business activity/sector:

Trading name of business (if applicable)

Contact Person

Contact Phone

Contact Email

Contact Details

Select Plan 1 Year 2 Year 3 Year 4 Year 5 Year

Investment Amount

* OR enter the amount manually as from min.1000 rupees

Years of Investment

I agree all the terms and conditions

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(The information supplied in this form will be kept confidential and used for Investment Adira recording purposes. Only aggregate information will be released for statistical purposes.)