NIFMT DOCUMENT CENTRE

Interstate Application Form

Use this form to record an application involving a change of state of residence, correspondence address or project servicing location. Approval and processing are subject to verification and applicable terms.

Applicant Details

Application / Form Number

Application Date

Applicant / Customer Full Name *

Email Address *

Mobile Number

Address

Current State

Requested State *

Current Correspondence Address

New / Requested Address

Related Project

Reason for Interstate Request

Additional details / remarks

Declaration: I confirm that the details entered are accurate to the best of my knowledge. This application is subject to review, verification, applicable project terms and applicable law. Submission of this form does not guarantee approval, investment acceptance or returns.

I have reviewed the information and declaration above.

Applicant Signature / Date

For NIFMT — Verification / Authorised Signatory