MANULIFE (SINGAPORE)PTE. LTD.

1 INTERBANK GIRO APPLICATION Please To countersign any amendments The use of correction fluid/tape is not allowedAnd for 3rd party payor (for change of Bank Account for GIRO) Please complete and submit the Policy Details Change Form (Section 4C) togetherwith this Interbank GIRO Application Form with your identification documents1 FOR APPLICANT S COMPLETIONM anulife (Singapore) Pte. Ltd. Reg. No. 198002116 DNeed Help?Please contact yourFinancial Representativefor further , you may call ourClient Services Officersat6833 8188orvisit us at8 Cross Street #01-01A, MANULIFE Tower, Singapore 048424during service BANK S COMPLETIONTo : MANULIFE (Singapore) Pte.

2 Application is herebyREJECTED(Please ) for the following reason(s) :Signature DiffersAccount Operated by Signature / ThumbprintSignature IrregularWrong Account NumberThumbprint must be taken & witnessed at bank s branchOthers:..Version10182 FOR MANULIFE (SINGAPORE) PTE. LTD. S COMPLETIONB a n kBranchManulife (Singapore) Pte. Ltd. s Bank Account Number7 1 7 10 0 30 0 3 9 0 0 9 5 4 2 Completed?You may submit the completed and signed form with all relevant documents to us through:Mail-8 Cross Street #15-01, MANULIFE Tower, Singapore 048424 Billing Organization sReference Number(s)/Policy Number(s)Name of Billing of Code / Account (s) of Account Holder(s).

3 NRIC / Passport No(s)..Contact Number(s) of Account Holder(s).. MANULIFE (SINGAPORE) PTE. thumbprint(s), please visit the bank s branch with your identification documents,your thumbprint needs to be verified by the Bank s (s) / Thumbprint(s) of Account Holder(s) as in Bank s RecordsIf you wish to understand the list of purposes for which your personal data may be used or disclosed, you may refer tothe Statement of Personal Data Protection located at our website ( )Name & Signature of Approving OfficerDateINTERNAL USE - FOR MANULIFEDoc IDNB106PA017 I / We hereby instruct you to process MANULIFE (Singapore) Pte.

4 Ltd. s instructions to debit my / our account. You are entitled to reject MANULIFE (Singapore) Pte. Ltd. s debit instruction if my /our account does not have sufficient funds and charge me /us afee for this. You may also at your discretion allow the debit even if this results in an overdraft on the account and impose charges accordingly. This authorisation will remain in force until terminated by your written notice sent to my / our address last known to you or upon receipt of my / ourwritten revocation through MANULIFE (Singapore) Pte. Account Holder Details & AuthorisationA.

5 Policy Owner DetailsFull Name of Policy / Passport Name(s).