ZanSec - Repurchase Form

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Submitting your repurchase request...

1 Repurchase

2 Bank Details

3 Signatures

4 Submit

TIMIZA UNIT TRUST SCHEME

APPLICATION FOR REPURCHASE (REPURCHASE FORM)

INVESTORS ACCOUNT NO:	INVESTORS FULL NAME:	NO. OF UNITS TO BE REPURCHASED	NAV PER UNIT	REPURCHASE AMOUNT:

BANK DETAILS

Account Name:
Bank Name:
Branch Name:
Account Number:

Terms & Conditions: I/We hereby request you to repurchase the above units or units equal to the repurchase amount at the applicable "repurchase price" as determined by the Company. I/We shall have no claim hereafter against the Company in respect of the units repurchased. I/We confirm having read the terms and conditions printed overleaf and I/We agree to abide by the same.

Signature of Applicant 1

Name of the authorized signatory
Signature
Phone number:
Date (DD-MM-YYYY):

Signature of Applicant 2

Name of the authorized signatory
Signature
Phone number
Date (DD-MM-YYYY)

FOR OFFICIAL USE ONLY – To be completed by Interviewing Officer

Identification verified:
Received by:
Signature:
Verified by:
Signature:

DAR ES SALAAM OFFICE │ 1st Floor, VIVA Towers, A.H. Mwinyi Road, P.O. Box 5366, Tel +255 22 2103433, +255 756 111 888 info.dsm@zansec.co.tz
ZANZIBAR OFFICE │ 3rd Floor, Michenzani mall, Karume road, P.O. Box 2138, Tel +255 24 223 8359, info.znz@zansec.co.tz
Cell +255 755 898 425, +255 786 344 767 │ www.zansec.co.tz