8/13/2019 Mut Hoot 73533434

1/1

Acknowledgement Slipfor Lead Managers/Co-Lead Managers/Lead Brokers/

Sub Brokers/Trading Members/SCSB

MUTHOOT FINANCELIMITED

ApplicationForm No.

Application

Form No.

Name of Sole / First Applicant

Cheque / DD/ASBA Bank A/c No.

Bank & Branch

TEAR HERE

Stamp & Signature of Banker

Cheque / DD/ASBA Bank A/c No. Dated

Received from Mr./Ms.

Telephone / Mobile Email

Amount Paid (`in figures) Bank & Branch

PANDPID

/CLID

TEAR HERE

Grand Total(`)

No. of NCDs applied for

Series I I I I II IV V VI VII VIII IX X XI

Acknowledgement Slip for Applicant

Date Stamp & Signature of Lead/Co-Lead Managers/Lead Brokers/Sub

Brokers/Trading Members/SCSB

2. Investor Category (Please refer overleaf) Category I Category II Category III Sub Category Code (Please refer overleaf)

3. IN CASE OF APPLICATION IN DEMATERIALISED FORM, PLEASE PROVIDE APPLICANTS DEPOSITORY DETAILS

Option* I II III IV V VI VII VIII IX X XI

Issue Price (` / NCD) ` 1,000/- ` 1,000/- ` 1,000/- ` 1,000/- ` 1,000/- ` 1,000/- ` 1,000/- ` 1,000/- ` 1,000/- ` 1,000/- ` 1,000/-

Frequency of Interest Payment Monthly Monthly Monthly Annual ly Annual ly Annually N A N A N A N A N A

Tenor 24 Months 36 Months 60 Months 24 Months 36 Months 60 Months 400 Days 24 Months 36 Months 60 Months 72 Months

Coupon Rate (% per annum) for category I 10.75% 11.25% 10.75% 11.25% 11.50% 11.25% N A N A N A N A N A

Coupon Rate (% per annum) for category II & III 11.50% 12.00% 11.50% 12.00% 12.25% 12.00% N A N A N A N A N A

Effective Yield (Per annum) for category I 10.75% 11.25% 10.75% 11.25% 11.50% 11.25% 10.75% 11.25% 11.50% 11.25% 11.50%

Effective Yield (Per annum) for category II & III 11.50% 12.00% 11.50% 12.00% 12.25% 12.00% 11.00% 12.00% 12.25% 12.00% 12.25%

Amount (` / NCD) on Matur ity for categ ory I ` 1000/- ` 1000/- ` 1000/- ` 1000/- ` 1000/- ` 1000/- ` 1,118.92/- ` 1,237.66/- ` 1,386.20/- ` 1,704.12/- ` 1,921.54/-

Amount (` / NCD) on Maturity for category II & III ` 1000/- ` 1000/- ` 1000/- ` 1000/- ` 1000/- ` 1000/- ` 1,121.71/- ` 1,254.40/- ` 1,414.36/- ` 1,762.34/- ` 2000/-

Minimum Application

No. of NCDs applied

Amount Payable (`)

Grand Total

NSDL / CDSL

6. PAYMENT DETAILS (Please tick (33333) any one of payment option A or B below) PAYMENT OPTION : Full Payment

D D M M Y Y

TE

ARHERE

TEAR

HERE

PLEASEF

ILLINBLOCKLETTERS

MUTHOO

TFINANCE

LIM

ITED

Amount Payable (`)

Issue Price (`)/ per NCDs

Dated

*Our Company would allot Option IV Secured NCDs to all valid applications, wherein the applicants have selected only Secured NCDs, but have not indicated their choice of the relevant options of the Secured NCDs. Our Company would allot Option XI Unsecured NCDs to all valid applications,wherein the applicants have selected only Unsecured NCDs. Our Company would allot Option IV Secured NCDs to all valid applications, wherein the applicants have neither selected Secured NCDs nor Unsecured NCDs.

APPLICATION FORM(FOR RESIDENT APPLICANTS)

ApplicationForm No.

ISSUE OPENS ON : DECEMBER 27, 2013

ISSUE CLOSES ON* : JANUARY 27, 2014

I/We hereby confirm that I/We have read and understood the terms and conditions of this Application Form and the attached Abridged Prospectus and agree to the 'Applicant's Undertaking' as given overleaf. I/We herebyconfirm that I/We have read the instructions for filling up the Application Form given overleaf.

PUBLIC ISSUE OF SECURED AND UNSECURED REDEEMABLE NON CONVERTIBLE DEBENTURES ("NCDs") VIDE PROSPECTUS DATED DECEMBER 23, 2013

To, The Board of Directors,MUTHOOT FINANCE LIMITED

LEAD /CO -LEAD MANAGERS /LEAD BROKERS/TRADING MEMBERS STAMP & CODE ESCROW BANK / SCSB BRANCH STAMP & CODESUB-BROKER/AGENTS STAMP & CODE BANK BRANCH SERIAL NO. REGISTRARS / SCSB SERIAL NO.

1. APPLICANTS DETAILS - PLEASE FILL IN BLOCK LETTERS (Please refer to instruction no. 27 of this Abridged Prospectus)

D D M M Y Y Y Y

First Applicant (Mr./ Ms./M/s.)

Date of Birth Name of Guardian (if applicant is minor)

Address

Pin Code (Compulsory)

Tel. No/ Mobile Email

Second Applicant (Mr./ Ms./M/s.)

MUTHOOT FINANCE LIMITEDCredit Rating : [ICRA]AA-/Negative by ICRA and CRISIL AA-/Negative by CRISIL

COMMON APPLICATION FORMFOR ASBA/NON ASBA

DATE OF RECEIPT

NOMINATION (Please see point no. 61 of this Abridged Prospectus)Name of the Nominee :If Nominee is Minor, Guardians Name :

4. IN CASE OF APPLICATION TO HOLD THE NCDs IN PHYSICAL FORM, PLEASE PROVIDE FOLLOWING DETAILS(Please enclose self attested copies of the KYC Doccuments along with the Application Form. For list of KYC documents, please refer overleaf)

Bank Details for payment of Refund / Interest / Maturity Amount (Mandatory)

Bank Name : Branch :

Account No.: IFSC Code :

Applications submitted without being uploaded on the terminals of the Stock Exchangeswill be rejected.

While submitting the Application Form, the Applicant should ensure that the date stamp being put on the Application Form by the Lead Manager/Co-Lead Managers/Lead Brocker/Sub Brockers/Trading Members/SCSB matches with the date stamp on the Acknowledgement Slip.

For NSDL enter 8 digit DP ID followed by 8 digit Client ID / For CDSL enter 16 digit Client ID

* For early closure/ extension of the Issue, refer page 22 of this Abridged Prospectus

(B) ASBA

Bank A/c No.ASBA A/c. Holder Name __________________________________________________(in case Applicant is different from ASBA A/c. Holder)

Bank Name & Branch ____________________________________________________

7D.SIGNATUREOFASBABANKACCOUNTHOLDER(s)(AS PERBANKRECORDS) (For ASBA option ONLY)

1)

I/We authorize the SCSB to do all acts as are necessary to makethe Application in the Issue

2)

3)

7A. PAN & SIGNATURE OFSOLE/ FIRST APPLICANT

7B. PAN & SIGNATURE OFSECOND APPLICANT

Date : ___________________, 20___PAN is mandatory including Minors PAN in case of Application by Minor.

Please refer point 28 on page 12 of the Abridged Prospectus

LEAD MANA GER/CO-LEAD MANAGER/ LEAD BROK ERS/SUB BROKERS/ TRADING MEMBERS/

SCSB BRANCHS STAMP(Acknowledging upload of Applicationin Stock Exchange system) (Mandatory)

Please write a Sole/First Applicants Name, Phone No. and Application No. on the reverse of Cheque/DD.

PUBLIC ISSUE OF SECURED AND UNSECURED REDEEMABLE NON CONVERTIBLE DEBENTURES ("NCDs") VIDE PROSPECTUS DATED DECEMBER 23, 2013

Total No. of NCDs:

` 1,000/-

` 10,000 (10 NCDs) (for a ll options of NCDs, e ither taken indiv idually or collectively)

7C. PAN & SIGNATURE OFTHIRD APPLICANT

All future communications in connection with this application should beaddressed to the Register to the Issue. For details, please refer overleaf.Acknowledgement is subject to relaisation of Cheque/DD/Availabilityat Funds in the ASBA account. Applications submitted without beinguploaded on the terminals of the Stock Exchanges will be rejected.

Please note that you cannot apply for the NCDs through the ASBA process if you wish to be Allotted the NCDs in physical form.

Third Applicant (Mr./ Ms./M/s.)

Prin

tedB

y:Crystalcf

l_mum

@crys

talforms.c

om

-022-6

6140900

Amount Paid (`in figures) (`in words)

(A) CHEQUE/ DEMAND DRAFT (DD) in favour of Escrow Account

Cheque/DD No. Dated

Drawn on (Bank Name & Branch)

Muthoot Finance NCD Public Issue

5. INVESTMENT DETAILS (For details, please refer Issue Structure overleaf) Applicants cannot apply for Allotment of NCDs under Options VII, VIII, IX, X and XI in physical form.

Total Amount Payable:

Muthoot Securities Ltd -3226

73533434

73533434

73533434