Express Building, 4th Floor, 14 - E - Road, Churchgate, Mumbai - 400 020.

Broker / Agent Code Sub Broker / Sub Agent Code Date and Time of Receipt Registr ar Serial No. TO BE FILLED IN CAPITAL LETTERS. Pl. use one box for each letter, leaving one bo x blank between two words. Please tick whichever is applicable. EXISTING FOLIO NO. Name of Sole / 1st applicant INVESTOR DETAILS Add 1 Add 2 City District Sr. No. RGETF Reliance Gold Exchange Traded Fund (RGETF) An open-ended Gold ETF PAN 1st applicant PAN 2nd applicant PAN 3rd applicant BANK ACCOUNT DETAILS FOR REFUND (MANDATORY) (Refer Instruction No. 5) A/c. type SB Current NRO NRE FCNR Account No. Bank Branch Address Branch City PIN I/We authorise Reliance Mutual Fund to credit Dividend / Redemption proceeds dir ectly into the above mentioned bank account electronically: Submission of MICR CODE/CANCELLED CHEQUE is mandatory for refund (if any) throug h ECS facility. I/We hereby request that the redemption payment due to me/us may be sent by phys ical cheque/warrant by Post or Courier to my mailing address my bankers cheque DECLARATION & SIGNATURE/S (Refer Instruction No. 7) SIGNATURE/S I/We would like to invest in Reliance Gold Exchange Traded Fund subject to terms of the Offer Document and subsequent amendments thereto. I/We have read the instructions and the Offer Doc ument before filling the Application Form. I/We have understood the details of the scheme and I/We have n ot received nor been induced by any rebate or gifts, directly or indirectly, in making this investmen t. APPLICABLE TO NRIs ONLY I/We confirm that I am/We are Non-Resident of Indian Nationality/Origin and I/We hereby confirm that the funds for subscription have been remitted from abroad through normal banking cha nnels or from funds in my/ our Non-Resident External/Ordinary Account/FCNR Account. Place : _________________________________ Date : _____________________ Sole / 1st applicant Guardian Authorised Signatory 2nd applicant Authorised Signatory MODE 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

ers Source of Funds: SB Current NRO NRE* FCNR* Rupee Draft purchased abroad* Other* Pl. Specify Account No. ____________________________________________________ Cheque / DD date DD No. DD Charges (Rs.) Cheque No. Net Cheque / DD Amount (Rs.) E-MAIL COMMUNICATION I/We wish to receive the following documents through e-mail in lieu of physical document(s): Account Statement Newsletter Annual report / Abridged Accounts Any other informa tion 3rd applicant Authorised Signatory Received from __________________________________________________________________ ___________________________________ an application for allotment of Units under Reliance Gold Exchange Traded Fund - Dividend Payou t Option. Cheque / DD No. _________________________________________ Dated ________________ ____________ Rs. ______________________________ Drawn on (Bank Name) ___________________________________________________________ ________________________________________________ Acceptance of the Application is subject to the application being complete in al l respects and submission of the relevant required documents. Signature, Da