Share Application

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SHARE APPLICATION Ref.

No Date:
FORM

To:
Name of the first Applicant
Father’s/ Husband’s Name
Address

Nationality

Occupation

Status Individual/ Company/ Body Corporate/ Non Resident/


Resident/ Karta
Name of Second Applicant
Father’s/ Husband’s Name
Name of Third Applicant
Father’s/ Husband’s Name

Dear Sirs, Dated. …………………. 200


As discussed and agreed, I/We hereby apply for the ------------------------ Shares of the Company,
having a face value of Rs ----------------/- per ------, as stated below in BLOCK 3. I/we have remitted /
remit herewith, the amount specified in Block 5 being the amount payable on application @ Rs.__/-
per __(inclusive of share premium of Rs. ……. per share).
I/We agree to accept the __(s) applied for or such lesser number as may be allotted to me/us by the
Company subject to the terms and conditions mutually agreed between me and the Company subject
to the provisions of Foreign Exchange Management Act, 1999 and the Rules
/Regulations/Notifications/Guidelines issued by the Govt. of India/Reserve Bank of India in this behalf
and the provisions of the Companies Act, 1956 and the rules and regulations made thereunder and the
provisions of the Memorandum and Articles of Association of the Company, this Application Form,
Share Certificates and any other Law, Rules and Regulations and other documents as may be
relevant/applicable, if any,
I/We undertake that I/we will comply with the aforesaid as may be applicable to me/us from time to
time and will sign all such other documents and do all such other acts, deeds and things, if any, that
may be necessary on my/our part in this regard and to enable me/us to be registered as the holder(s) of
the __(s) which may be allotted to me/us by the Company. I/We authorize you to place my/our
name(s) on the Register of Members of the Company as the holder(s) of Preference/Equity Share(s)
that may be so allotted to me/us.
I/We declare that I am/we are Resident*/Non-Resident* Shareholder(s), and that I/we are
remitting/have remitted the funds for the Shares herein applied for from funds in my/our
NRE/FCNR/NRO A/c. in India. I/we also confirm that I am/we are not applying for the ____as
nominees(s) of any person(s) who is/are Indian National(s) or who is/are Resident in India.

* Delete whichever is not applicable.


Type of Share: Equity/ Preference/ _________________

REGD. NO. OF SHARE NO. OF AMOUNT PAYABLE AMOUNT PAID ON


FOLIO NO. (S) HELD SHARE (S) @ Rs 10/- PER APPLICATION
(BLOCK 1) AT PRESENT APPLIED SHARE @ Re. 10/- PER
(BLOCK 2) & (BLOCK 3) (BLOCK 4) SHARE
TYPE (BLOCK 5)

Amount paid (Currency


and also equivalent Rs. in
Words)
Drawn on
(Name of Bank and Branch)
By Cheque / Draft / T.T. No. Dated 200
Wire transfer /
Payable at/transferred to
(Name of Bank and Branch)

Signature of applicant/s

For office use First Applicant __________________

Date of allotment: Second Applicant _________________


Folio No. allotted:

Third Applicant __________________

____________________________________
SIGNATURE (with Company stamp/seal)

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