Return to: HMS Income Fund, Inc. 430 W. 7th Street Kansas City, Missouri 64105 Hines Investor Relations Toll-Free: 888.220.6121 |
One | Investor Information | |||
Print name(s) as registered on the account. | Name(s) On the Account | |||
HMS Account Number | Social Security Number or TIN on Account | |||
Financial Advisor Name and Phone Number | ||||
Two | Withdrawal Request | |||
The undersigned hereby withdraws the tender of its Shares to the Company for purchase by the Company that previously was submitted by the undersigned in a Letter of Transmittal dated _________________________ , 2014. This tender was in the amount of: o All Shares as of the Expiration Date, or o _____________ Number of Shares. The undersigned recognizes that upon the receipt on a timely basis of this Notice of Withdrawal of Tender, properly executed, the Shares previously tendered will not be purchased by the Company. | ||||
Three | Authorized Signatures | |||
Sign exactly as your account is registered | Investor Name (Please Print) Signature Date | |||
Investor Name (Please Print) Signature Date |