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NOMINATION FORM FORM DA3 Variation of the Nomination under Section 45ZA of the Banking Regulation Act 1949 and Rule 2 6 of the Banking Companies Nomination Rules 1985 in respect of the bank deposits. I/We name s and address es cancel the nomination made by me/us in favour of and hereby nominate the following person to whom in the event of my/our/minor s death the amount of the deposit particulars whereof are given below may be returned by Citibank N*A. DEPOSIT Nature of deposit Distinguishing No* Additional details if any NOMINEE Version 1. 2 Name Address Relationship with Depositor if any Age If nominee is a minor his date of birth as the nominee is a minor on this date I/we appoint Name Shri/Smt. /Kum* Age Address to receive the amount of the deposit in the account on behalf of the nominee in the event of my/our/minor s death during the minority of the nominee. The form should be signed after all details are completely filled* Space provided below for name s signature s and address es of witness es CV 05/12 WITNESS ES X Signature s / Thumb Impression s of depositor s Place Date Strike out if nominee is not a minor Where deposit is made / account is held in the name of a minor the nomination should be signed by a person lawfully entitled to act on behalf of the minor. I/We name s and address es cancel the nomination made by me/us in favour of and hereby nominate the following person to whom in the event of my/our/minor s death the amount of the deposit particulars whereof are given below may be returned by Citibank N*A. DEPOSIT Nature of deposit Distinguishing No* Additional details if any NOMINEE Version 1. 2 Name Address Relationship with Depositor if any Age If nominee is a minor his date of birth as the nominee is a minor on this date I/we appoint Name Shri/Smt. DEPOSIT Nature of deposit Distinguishing No* Additional details if any NOMINEE Version 1. 2 Name Address Relationship with Depositor if any Age If nominee is a minor his date of birth as the nominee is a minor on this date I/we appoint Name Shri/Smt. /Kum* Age Address to receive the amount of the deposit in the account on behalf of the nominee in the event of my/our/minor s death during the minority of the nominee. /Kum* Age Address to receive the amount of the deposit in the account on behalf of the nominee in the event of my/our/minor s death during the minority of the nominee. The form should be signed after all details are completely filled* Space provided below for name s signature s and address es of witness es CV 05/12 WITNESS ES X Signature s / Thumb Impression s of depositor s Place Date Strike out if nominee is not a minor Where deposit is made / account is held in the name of a minor the nomination should be signed by a person lawfully entitled to act on behalf of the minor. I/We name s and address es cancel the nomination made by me/us in favour of and hereby nominate the following person to whom in the event of my/our/minor s death the amount of the deposit particulars whereof are given below may be returned by Citibank N*A. DEPOSIT Nature of deposit Distinguishing No* Additional details if any NOMINEE Version 1. 2 Name Address Relationship with Depositor if any Age If nominee is a minor his date of birth as the nominee is a minor on this date I/we appoint Name Shri/Smt. /Kum* Age Address to receive the amount of the deposit in the account on behalf of the nominee in the event of my/our/minor s death during the minority of the nominee..

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