Exhibit 99(a)(1)(C)
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Return to: |
| HMS Income Fund, Inc. | |
| 430 W. 7th Street | |
| Kansas City, Missouri 64105 | |
| Hines Securities, Inc. | |
| Toll-Free: 888.220.6121 | |
| Fax: 713.966.2661 |
NOTICE OF WITHDRAWAL OF TENDER REGARDING SHARES HELD IN HMS INCOME FUND, INC.
COMPLETING AND RETURNING THIS FORM WILL RESCIND YOUR SHARE REPURCHASE REQUEST. PLEASE ONLY COMPLETE AND RETURN THIS FORM IF YOU WISH TO RESCIND YOUR PENDING SHARE REPURCHASE REQUEST FOR THE OFFER DATED AUGUST 30, 2013.
The undersigned recognizes that upon the receipt on a timely basis of this Notice of Withdrawal of Tender, properly executed, the shares (the “Shares”) of HMS Income Fund, Inc. (the “Company”) previously tendered will not be purchased by the Company.
Information
Tendered pursuant to the Offer to Purchase dated August 30, 2013.
The offer and withdrawal rights will expire at, and this Notice of Withdrawal must be received by the Company either by hand-delivery, mail or facsimile before 5:00 P.M., Central Time, on September 27, 2013, unless the offer is extended.
COMPLETE THIS NOTICE OF WITHDRAWAL AND RETURN TO THE FOLLOWING ADDRESS:
HMS Income Fund, Inc.
430 W. 7th Street
Kansas City,
Missouri 64105
Phone: 888.220.6121
Fax: 713.966.2661
You are responsible for confirming that this Notice of Withdrawal is received by the Company at the address above.
| One | Investor Information | |
| Print name(s) as registered on the account. |
Name(s) On the Account
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HMS Account Number
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Social Security Number or TIN on Account | |
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Financial Advisor Name and Phone Number
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| 1 |
| Two | Withdrawal Request | ||
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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 _________________________ , 2013.
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.
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| Three | Authorized Signatures | ||
| Sign exactly as your account is registered |
Investor Name (Please Print) Signature Date
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Investor Name (Please Print) Signature Date
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| 2 |