ING BANK A.Ş.
178 days maturity, TRY 300,000,000* Nominal Bills Public Issue
O R D E R
F O R M
INVESTOR INFORMATION
Institutional Investors
Contact Information
Institution Name
:
Tax I.D.
:
Address
:
City
:
Country
:
Tel
:
E-mail
:
@
Order Size
Amount of Bills Demanded
:
Minimum Denomination (1,000 - Increments of 1.00)
Minimum Allocation Required (Optional)
:
I have read and accepted all the terms and conditions disclosed in the offering circular "Sermaye Piyasası Aracı Notu", the summary "Özet" and the prospectus "İhraççı Bilgi Dokümanı ", which were published on the Public
Disclosure Platform (www.kap.gov.tr), ING Bank (www.ingbank.com.tr) and İŞ Investment (www.isyatirim.com.tr) websites on 11.25.2014. By signing this form, I hereby oblige myself to fulfill all my responsibilities defined in the
"İhraççı Bilgi Dokümanı", "Özet" and "Sermaye Piyasası Aracı Notu".
(*)The total offering size can be increased up to TRY 450 million depending on the final book size.
Date :
Signature :
THIS SECTION WILL
Amount of Bills allocated
BE FILLED BY THE ARRANGER
:
Brokerage House Code
:
Branch Code
Application Number
:
:
Brokerage House Approval
Below defined individuals or legal entities cannot place orders for receiving the bonds and bills
Individuals being permanent residents of Iran, Cuba, Myanmar, North Korea, Sudan, South Sudan or Syria or the legal entities established in these countries or regardless of
the place of establishment, legal entities which are owned by above noted individuals
The definition of US person:
•
U.S. citizenship or lawful permanent resident
•
U.S. birth place
•
U.S. address (residence, correspondence, or P.O. Box)
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Only address on file is “in care of” or “hold mail” or U.S. P.O. Box
•
Power of Attorney or signatory authority granted to person with U.S. address
•
Instructions to transfer funds to U.S. accounts or directions regularly received from a U.S. address
•
Any individual, when ING is dealing with or receives instructions through an investment advisor or manager located in the U.S., or other representative of such
individual located in the U.S.
•
Legal entity whose mother company is a US registered entity;”
A copy of this form will be delivered to the Investor
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