Date / /

Form No : TR12

Application Form for Transfer of Securities from BSE to DIFX

Please read all instructions carefully before filling up the form

A) Source Account Details in BSE

BSE-CDS Investor Number (IN)* .....
BSE-CDS Investor Name* .................
Investor's Account Number ..............
Execution Date for securities transfer*	/ / (dd/mm/yyyy)

B) Target Account Details in DIFX

DIFX BP Id* (11-digit) .....................
DIFX BP Name* ................................
DIFX BP Account No* ....................

C) Security Details

For official use

ISIN*	Security Name & Symbol*	Quantity (in figures)*	Quantity (in words)*	Instruction / Transaction No.
BH000A0KEZD7	Al Baraka Banking Group (BARKA)

Instructions:                      1.    The (*) fields are mandatory.                      2.    Please fill all the details in CAPITAL LETTERS.                      3.   Disclaimer Clause – Incorrect or Incomplete Instructions are liable to be rejected                           and no responsibility will lie on the BSE CDS for any loss incurred on account of                           the same.

Declaration

I request you to transfer the above mentioned securities from my aforesaid account held with you. I have read and understood all related laws and regulations in relation to transfer of securities and I agree to abide by the same as are in force from time to time for such transfer. I declare that the particulars given by me above are true and to the best of my knowledge.

BSE Broker's Name*:   Signature &Stamp *:______________________________

Signature of the BSE Investor/Representative

For Bahrain Stock Exchange use only

Acknowledgement

Action:- Accepted/Rejected the application from Mr/Ms _________________________as the sole/ first holder along with ______________ and _________________ as the second and third holders respectively for account transfer of the above mentioned securities. Entered By:_______________________   Posted By:______________________   Approved By:_____________________