NORTHERN IRELAND CENTRAL INVESTMENT FUND FOR CHARITIES

CHARITY DETAILS

WITHDRAWAL FORM

1.

Name of Charity

Postcode

Extension

WITHDRAWAL DETAILS2.

£

• Withdraw entire holding:

Address for Charity correspondence

HM Revenue & Customs’ Charity reference number

Fund reference number e.g. INV 1

Requests for withdrawals from the NI Central Investment Fund for Charities will be processed upon receipt at the latest available unit/share price. The current unit/share price is available at www.dsdni.gov.uk/vc-nicif.

The fund reserves the right however to use the next monthly unit/share valuation e.g. in a volatile market.

Please select one of the following withdrawal options:

Withdraw the following number of units/shares

Withdraw the following amount from the holding

• Withdraw part of holding:

PAYMENT INSTRUCTIONS3.

Please choose one of the payment alternatives below:

Postcode

Name of bank/building society

Branch address

Name of account

Sort code

Account number

Roll number (if applicable)

• Cheque

Only select this option if you currently receive your dividend by cheque. Payment will be made to the payee currently associated with your holding.

• Bank/building society account

Payment will be made to the account currently associated with your holding. Please confirm bank/building society details below.

- -

Daytime contact number

DECLARATIONS4.

As the authorised officials of the Charity, we confirm for and on behalf of the Charity that:

• We are the current authorised officials of the Charity and have all the necessary consents, powers and authorities to make this withdrawal on the Charity’s behalf.

• We have taken any and all advice required, do not require any further consent and will not be in breach of any provision under the governing documentation of the Charity or any regulatory provision in making this withdrawal.

PLEASE NOTE: Any withdrawal request must be accompanied by at least two authorised signatories recognised by the Department.

FIRST AUTHORISED OFFICIAL

Capacity

Signature

Name

Date

SECOND AUTHORISED OFFICIAL

THIRD AUTHORISED OFFICIAL

Capacity

Capacity

Signature

Signature

Name

Name

Date

Date

Please return this completed withdrawal form to:

NI Central Investment Fund for Charities,

c/o Department for Social Development,

The Lighthouse Building,

4th Floor,

1 Cromac Place,

Gasworks Business Park,

Ormeau Road,

Belfast BT7 2JB

Further Information is available from:

Tel.: 02890 829 240

E-mail: colin.alderdice@dsdni.gov.uk

Web: www.dsdni.gov.uk/vc-nicif

Issued by Northern Ireland Central Investment Fund for Charities (NICIFC). NI CIFC is managed by the Department for Social Development through recognised fund managers, and its investment policy is guided by a locally based Advisory Committee appointed by the Department.

Northern Ireland Central Investment Fund for Charities is a registered charity.

Charity Tax Reference Number XR 3429.

The Northern Ireland Central Investment Fund for Charities recommends that Charities provide at least two authorised signatures. The Fund will not accept responsibility if only one signature is given.