CRYSTO GRAPHITES PVT. LTD. Manufacturer of Natural Crystalline Graphite Powder & Flakes VIP Plot No-130, Ekamra Vihar, IRC Village,
Nayapali, Bhubaneswar, State- Orissa, India -751015 Phone No- 0674-2550681, 6547968, Mob- 9238377968, Fax-0674-2550681
Email .ID [email protected]
APPLICATION FOR ALLOTMENT OF PREFERENCE SHARES
Date:
ToThe Board of Directors………………………………..……………………………….…………………………..
Dear Sirs,
I/We hereby apply for allotment of the 13% Preference Shares mentioned herein
below.
The amount payable on application as shown below is remitted herewith.
I/we hereby agree to accept the Preference Shares applied for, or such lesser
number as may be allotted to me/us subject to the term mentioned overleaf and
the Memorandum and Article of the Company.
I/We understand that I/We shall sign such other documents and do all such acts,
if any, necessary on my/our part, to enable me/us to be registered as the holder
(s) of Preference Shares in respect to which this application may be accepted.
I/we agree to accept the shares subject to laws as applicable, guidelines, notifications
and regulations relating to the issue of capital and listing of securities issued from
time to time by SEBI / Government of India / RBI or other authorities.
I/we hereby solemnly declare that I am/we are not applying the Preference Shares in
contravention of Section 269 SS of the Income Tax Act, 1961.
I/we hereby solemnly declare that I am/we are not applying the Preference Shares in
contravention of Section 68A of the Companies Act, 1956.
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Crysto Graphites Pvt. Ltd.
I/we give below the following particulars for your information
Date :
______________
In figures In words
Number of shares applied for
Payment Details (Rs. In figures ) (Rs.In words)
Number of shares applied for
Amount Per Share
(i.e. face value of the share )
Premium, if any
Total Amount
Cheque/Draft/TT No. & Dated
Drawn on
Investment for the period 1 2 3 4 5 6 7
(1) Sole/First Applicant; Name Surname
Name in Full
Father’s Name/Husband
Address :
Occupation: Age :
Nationality :
PAN No. :
Income Tax Circle / Word/Dist.
Usual Signature
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(2) Second Applicant Name Surname
Name in Full
Father’s Name/Husband
Address :
Occupation : Age :
Nationality :
PAN No. :
Income Tax Circle / Word/Dist.
Usual Signature
(3) Third Applicant Name Surname
Name in Full
Father’s Name/Husband
Address :
Occupation : Age :
Nationality :
PAN No. :
Income Tax Circle / Word/Dist.
Usual Signature
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Sole /first Applicant’s Bank Details (For Dividend)
Bank Name
Branch / Address
City
Type of Account (please specify)
Account No.
MICR Code of the Bank
Details of Nominee :
Name
Address
Date of Birth (if minor)
Name of Guardian
Signature of the Nominee
Specimen Signature 1st Applicant
1st Applicant 2nd Applicant 3rd Applicant
Crysto Graphites Pvt.Ltd. Plot no 130, VIP Area, Ekamra Vihar, IRC Village, Nayapalli, Bhubaneswar. State- Orissa, India-751015
Acknowledgement Slip
Received from ______________________________ an application for _______
Preference shares of Rs. 10/- each for cash at a premium of Rs._______ per
share along with cash/cheque/draft/TT No. __________ for Rs.
__________/- dated _______ drawn on ____________________, Branch being the
application payable thereon.
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INSTRUCTIONS
1. Application must be completed in Block letters in English, if not complete in every respect, are liable to be rejected.
2. Signature should be any one of the following languages namely English or Hindi. Signatures in languages other than those, including thumb impression must be attested by a Magistrate under his official seal.
3. In the case of an application signed under a Power of Attorney, the relevant of Attorney or other authority as the case may be or a certified copy thereof must be registration along with the application or ledged separately at the Registered Office of the Company.
4. Cheques/Bank Drafts should be crossed “Account Payee Only” and made payable to “CRYSTO GRAPHITES PVT. LTD.” at Bhubaneswar
5. The Board of Directors reserves the right to accept or reject any application in whole or in part without assigning any reason. Whereas applications are rejected in full or no share allotted against it the whole of the application money will be refunded to the applicant.
6. In case application is for shares of total nominal value of Rs. 50,000/- or more then Permanent Account Number allotted under the Income Tax Act, 1961 should be mentioned in the relevant column in the application. In case, the PAN has not been allotted, the applicant should mention “not allotted”. Application forms without this information will be considered incomplete and are liable to be rejected. Please enclose copy of PAN Card.
7. The Application is meant only for use by the Residential Indian.
8. Attention of applicants is drawn to sub-section (i) of Section 68A of the Companies Act, 1956, which is reproduced below :
Any person who :
a. Makes in a fictitious name, an application to a company for acquiring or subscribing for any shares therein of
b. Otherwise induces a company to allot, or register any transfer of shares therein to him, or to any other person in a fictitious name, shall be punished with imprisonment for a term which may extend to five years.
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