Prospectus - Manulife Insurance Berhad

UTAPPMASTER APPLICATION FORMIn compliance with the Capital Markets and Services Act 2007, this form should not be circulated unless accompanied by the Prospectus.Please read and understand the Prospectus(es) and Supplementary Prospectus (if any) for the Fund(s) to be invested and the Terms and Conditions as specifiedoverleaf before completing this form. Please complete in BLOCK LETTERS and tick (✓) where appropriate.Individual Joint CorporateInitial InvestmentAdditional InvestmentStaff HR :Agent HOS :1. PARTICULARS OF FIRST INDIVIDUAL APPLICANTYou must be 18 years of age and above as at the date of this application. Please attach certified true copy/verified copy of your NRIC or Passport.Full Name (as per NRIC / Passport)Title :Mr Ms Madam Others, please specify :Date of Birth :DD– M M –YYYYNRIC No. : – –Passport No. :Gender :MaleFemaleRace : Malay Chinese Indian Others Religion : Muslim Non MuslimMarital Status :SingleMarried Divorced WidowedNo. of Dependents (please indicate):Nationality :Malaysian, BumiputeraMalaysian, Non-Bumiputera Non-Malaysian, please specify :2. PARTICULARS OF JOINT APPLICANTFull Name (as per NRIC / Passport / Birth Certificate)Title :Mr Ms Madam Others, please specify :Date of Birth :DD– M M –YYYYNRIC No. : – –Passport / Birth Certificate No. :Gender : Male Female Race : Malay Chinese Indian OthersNationality :Malaysian, BumiputeraMalaysian, Non-Bumiputera Non-Malaysian, please specify :3. PARTICULARS OF CORPORATE APPLICANTName of CorporateCompany / Registration No :Date of Incorporation :DD– M M –YYYYNature of Business :Corporate Status : Bumiputera Non-bumiputera Non-Malaysian ControlledContact Person 1 :Designation :Contact Person 2 : Designation :4. CONTACT DETAILSAddress :Postcode : Email :Tel No : –(House) –(Mobile)–(Office)ext.–(Fax)Employment / Business DetailsName of Employer / Firm / Business :Address :Postcode :Tel :–Occupation : Source of Income :Employment Business Savings / InheritanceIf own business, state percentage of shareholdings / ownership : Nature of Business :0812_V2Manulife Asset Management Services Berhad(formerly known as Manulife Unit Trusts Berhad) (834424-U)10th Floor, Menara Manulife, 6, Jalan Gelenggang, Damansara Heights, 50490 Kuala LumpurTel: 03-2719 9228 Fax: 03-2719 9119 Email: my_utservice@manulife.comweb: www.manulife.com.myPAGE: 1Prospectus in respect of the Manulife Shariah - Dana Ekuiti