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Express Building, 4th Floor, 14 - E - Road, Churchgate, Mumbai - 400 020.Broker / Agent Code Sub Broker / Sub Agent Code Date and Time of Receipt Registrar Serial No.TO BE FILLED IN CAPITAL LETTERS. Pl. use one box for each letter, leaving one box blank between two words. Please tick whichever is applicable.EXISTING FOLIO NO. Name of Sole / 1st applicantINVESTOR DETAILSAdd 1Add 2CityDistrictSr. No. RGETFRelianceGold Exchange Traded Fund (RGETF)An open-ended Gold ETFPAN 1st applicantPAN 2nd applicantPAN 3rd applicantBANK ACCOUNT DETAILS FOR REFUND (MANDATORY) (Refer Instruction No. 5)A/c. type SB Current NRO NRE FCNR Account No.BankBranchAddressBranch

City PINI/We authorise Reliance Mutual Fund to credit Dividend / Redemption proceeds directly into the above mentioned bank account electronically:Submission of MICR CODE/CANCELLED CHEQUE is mandatory for refund (if any) through ECS facility.I/We hereby request that the redemption payment due to me/us may be sent by physical cheque/warrant by Post or Courier to my mailing address my bankers chequeDECLARATION & SIGNATURE/S (Refer Instruction No. 7) SIGNATURE/SI/We would like to invest in Reliance Gold Exchange Traded Fund subject to termsof the Offer Document andsubsequent amendments thereto. I/We have read the instructions and the Offer Document before filling theApplication Form. I/We have understood the details of the scheme and I/We have n

ot received nor beeninduced by any rebate or gifts, directly or indirectly, in making this investment.APPLICABLE TO NRIs ONLYI/We confirm that I am/We are Non-Resident of Indian Nationality/Origin and I/Wehereby confirm that thefunds for subscription have been remitted from abroad through normal banking channels or from funds in my/our Non-Resident External/Ordinary Account/FCNR Account.Place : _________________________________ Date : _____________________Sole / 1st applicantGuardianAuthorised Signatory

2nd applicantAuthorised SignatoryMODE OF PAYMENT / SUBSCRIPTION (Mandatory) (Refer Instruction No. 12)Gross Amount Invested (Rs.)Gross Amount (in words) ________________________________________________________

_______________________________________________________________________________________________________Drawn on ______________________________B_a_n_k_______________________________ __

_____________B_r_a_n_c_h______________ _____________C_i_ty_____________* Please attach a photocopy of instrument or Account Debit Certificate from Bank

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ersSource of Funds: SB Current NRO NRE* FCNR* Rupee Draft purchased abroad* Other*Pl. SpecifyAccount No. ____________________________________________________Cheque / DD date DD No. DD Charges (Rs.) Cheque No. Net Cheque / DD Amount (Rs.)E-MAIL COMMUNICATIONI/We wish to receive the following documents through e-mail in lieu of physicaldocument(s):Account Statement Newsletter Annual report / Abridged Accounts Any other information3rd applicantAuthorised SignatoryReceived from __________________________________________________________________

___________________________________ an applicationfor allotment of Units under Reliance Gold Exchange Traded Fund - Dividend Payout Option.Cheque / DD No. _________________________________________ Dated ________________

____________ Rs. ______________________________Drawn on (Bank Name) ___________________________________________________________

________________________________________________Acceptance of the Application is subject to the application being complete in all respects and submission of the relevant required documents.Signature, Da