M/s Modicare Ltd.

,
New Delhi

Re: Bonus Cheques – Transfer of Fund into my Bank Account

Dear Sirs,

This is to inform you that I (__________________________________) am a Modicare Consultant

having MCA No.____________

This is to conrm that I would like my Bonus Cheque amount be transferred to my Bank Account as
per the following details:

1. Name as Registered in my Bank:____________________________________________

2. Complete Bank Name with Branch:_________________________________________
3. Bank Account No. (for NEFT/RTGS):________________________________________
4. IFSC Code:_____________________________________________________________
5. My email account is ______________________________________________________
6. My correct telephone number is ____________________________________________

The Bank details in point number 3 and 4 have been veried by my Bank. I enclose herewith a leaf of
cancelled cheque/Passbook/Latest Bank Statement copy pertaining to the above mentioned
account.

This letter is to authorize you to credit my amount to the abovementioned account number.

I have understood that this facility is applicable to me only in the event of my earning Bonus Amount
in particular month/months as per the policy of the Company and the above information is found to
be correct. The facility will get activated only after 30 days from the date of application.

I shall undertake to advise you in future in writing in the event I am not interested to continue this
facility.

Thanking you,

Yours faithfully,

(Name of the Consultant)

Address

Enclosure: As above