mut hoot 76010939
TRANSCRIPT
-
7/31/2019 Mut Hoot 76010939
1/1
COMMON APPLICATION FORM
FOR ASBA / NON ASBA
ISSUE OPENS ON : SEPTEMBER 17, 2012
ISSUE CLOSES ON* : OCTOBER 5, 2012MUTHOOT FINANCE LIMITED
Credit Rating: [ICRA] AA-/ STABLE BY ICRA AND CRISIL AA-/STABLE BY CRISIL
ApplicationForm No.
PL
EASE
FILLIN
BLOCK
LETTERS
TEAR
HERE
TEAR
HERE
To, The Board of DirectorsMUTHOOT FINANCE LIMITED
PUBLIC ISSUE OF SECURED REDEEMABLE NON CONVERTIBLE DEBENTURES (NCD) VIDE PROSPECTUS DATED SEPTEMBER 9, 2012
I/We hereby confirm that I/We have read and understood the terms and conditions of this Application Form and the attached Abridged Prospectus and agree to the Applicants Undertaking as given overleaf. I/Wehereby confirm that I/We have read the instructions for filling up t he Application Form given overleaf.
#MEMBER OF SYNDICATE / TRADING MEMBER STAMP & CODE SUB- BROKERS/AGENT S CODE ESCROW BANK / SCSB BRAN CH STAMP & CODE BANK BRANCH S ER IAL NO. REGISTRARS / SCSB SERIAL NO. DATE OF RECEIPT
MUTHOOT SECURITIES LTD.
3226
DPID / CLID PAN
Amount Paid (`in figures)______________________ Bank & Branch ____________________________________________ Stamp & Signature of Banker
Cheque / DD / ASBA Bank A/c No. ______________________________________________ Dated ____________________
Received from Mr./Ms./M/s.______________________________________________________________________________
Telephone/Mobile ___________________________ Email ____________________________________________________
-----------------------------------------------------------------------------------------------------TEAR HERE----------------------------------------------------------------------------------------------------
Acknowledgement Slip for#Members
of Syndicate / Trading Member / SCSBApplication
Form No.
MUTHOOT FINANCE
LIMITED
MUTHOOTFINANCE
LIMITED
Option I II III IV V
Issue Price (`) `1000 `1000 `1000 `1000 `1000
No. of NCDs applied for
Amount Payable (`)
Grand Total Total No. of NCDs Total Amount Payable (`)
Cheque / DD/ASBA Bank A/c No. ___________________________________________Dated _____________Bank & Branch ___________________________________________________________________________
Stamp & Signature of #Membersof Syndicate/ Trading Member /
SCSB alongwith the date stamp(mandatory)
Name of Sole / First Applicant
__________________________________________________________________
Acknowledgement Slip for Applicant
Acknowledgment is subject to realisation of Cheques /
DD/Availability of funds in the ASBA account
ApplicationForm No.
APPLICATION FORM
(FOR RESIDENT APPLICANTS)
#Member of Syndicate will have the same meaning as disclosed in the Prospectus, which includes Lead Managers, Lead Brokers and sub-brokers.
*For Early Closure / Extension of the Issue refer to page 3 of Abridged Prospectus
While submitting the Application Form, the Applicant should ensure that the date stamp being put on the Application Form by the #Member of the Syndicate/Trading Member/SCSB matches with the date stamp on the Acknowledgement Slip.
1. APPLICANTS DETAILS - PLEASE FILL IN BLOCK LETTERS (Please refer to page no. 10 of the Abridged Prospectus)
First Applicant (Mr./ Ms./M/s.)
Date of Birth* D D M M Y Y Y Y Name of Guardian (if applicant is minor**)(* Compulsory in case of application to hold the NCDs in physical form)
Address __________________________________________________________________________________________________________________________
PIN (compulsory)__________________ Tel. No. (with STD Code) / Mobile _________________________ Email _______________________________________
Second Applicant (Mr./ Ms./M/s.)
Third Applicant (Mr./ Ms./M/s.)
2. Investor Category (Please refer overleaf) Category I Category II Category III Sub Category Code (Please refer overleaf)
3. IN CASE OF APPLICATION TO HOLD NCD IN DEMATERIALISED FORM, PLEASE PROVIDE APPLICANTS DEPOSITORY DETAILS(Please refer to page no. 11 of the Abridged Prospectus) For NSDL enter 8 digit DP ID followed by 8 digit Client ID / For CDSL enter 16 digit Client ID
NSDL / CDSL
4. IN CASE OF APPLICATION TO HOLD THE NCDs IN PHYSICAL FORM, PLEASE PROVIDE FOLLOWING DETAILS(Please enclose self attested copies of the KYC Documents along with the Application Form. For list of KYC documents, please refer overleaf)
NOMINATION (Please see page no. 27 of the Abridged Prospectus)
Name of the Nominee : _____________________________________________
If Nominee is Minor, Guardians Name : ________________________________
Bank Details for payment of Refund / Interest / Maturity Amount
Bank Name, Branch: ______________________ MICR No. : _______________
Account No.: ____________________ IFSC Code : ______________________
5. INVESTMENT DETAILS (For details, please refer Issue Structure overleaf)Option I II III IV VIssue Price (`/NCD) `1000 `1000 `1000 `1000 `1000Coupon/Frequency of Interest Payment 11.50% p.a./ Annual 11.75% p.a./ Annual 11.75% p.a./ Monthly 12.00% p.a./Annual N.A.Tenor 24 months 36 months 60 months 60 months 72 months
Minimum Application `10,000 (10 NCDs) (for all options of NCDs, namely Option I, Option II, Option III, Option IV and Option V either takenindividually or collectively)
No. of NCDs applied
Amount Payable (`)Grand Total Total No. of NCDs Total Amount Payable (`)
6. PAYMENT DETAILS^ (Please tick () any one of payment option A or B below) (Please write Application No., Sole/First Applicant Name & Tel. No. on reverse side of the Cheque / DD)
Amount paid in (` infigures)
(` inwords)
(A) CHEQUE/DEMAND DRAFT (DD) in favour of Escrow Account
Muthoot Finance NCD Public Issue.
(B) ASBA
Cheque / DD No. Dated D D M M Y Y Bank A/c. No.
Drawn on (Bank Name & Branch) SCSB Name & Branch
^ For further details, please refer to page no. 14 of the Abridged Prospectus.
7A. SIGNATURE OF SOLE/ FIRST APPLICANT 7B. SIGNATURE OF SECOND APPLICANT 7C. SIGNATURE OF THIRD APPLICANT
PAN PAN PAN
Dated : _________________________________ , 2012
PAN is mandatory. Please refer point 29 on page 12
of the Abridged Prospectus.
7D. SIGNATUREOF ASBA BANKACCOUNT HOLDER(S) (AS PERBANK RECORDS) (FOR ASBA
OPTION ONLY)
#MEMBER OF SYNDICATE /TRADING MEMBER / SCSB
BRANCHS STAMP(Acknowledging upload of application
in Stock Exchange System)I/We authorize the SCSB to do all acts asare necessary to make the Application in
the Issue
1
2
3
-----------------------------------------------------------------------------------------------------TEAR HERE----------------------------------------------------------------------------------------------------
(**Please refer to instruction (d) overleaf)
76010939
76010939
76010939