REPURCHASE / REDEMPTION
FORM
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ZUARI INVESTMENTS
LIMITED [Regd Office: Jaikissan Bhawan, Zuarinagar,Goa-403726.(India)] Corporate Office: 2nd Floor, F- Block, International Trade Tower, Nehru Place, New Delhi - 110019 (India) Tel.: 91-11-6413319, 6294194
Fax : 91-11-6413391 | |
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DP ID : IN 301055 |
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No.______ |
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RFN |
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I/We offer the below mentioned securities for repurchase/redemption and declare that my/our account be debited by the number of securities to the extent of my/our repurchase/redemption request and proceeds to be paid to me/us by cheque/bank draft. I/we hereby declare that the below mentioned person(s) are the beneficial owners of the securities mentioned.
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Account Number |
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Account Holder Name |
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No. of Securities to be Repurchased/Redeemed |
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(in words) |
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(Integers) |
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And (Fractions) |
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Name of the Security |
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Name of Issuing Company |
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Face Value |
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ISIN |
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Specimen Signature(s)
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Name(s) of holder
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Signature
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Sole/First Holder |
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Second Holder |
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Third Holder |
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Participant
Authorisation
Received the above mentioned securities for repurchase/redemption from:
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Account No. |
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ISIN |
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Date |
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Name of the First Holder |
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This application form is verified with the details of the beneficial owner's account and certified that the application form is in order. The account has balances to accept the repurchase/redemption request. It is also certified that the beneficial owners signatures are verified and found in order.
The order details of the beneficial owners as extracted from the records are enclosed.
Forwarded by :
Name
Signature
(Seal)
Acknowledgment
We hereby acknowledge the receipt of repurchase/redemption request for ________________ no. of securities of _____________________________ (security details) from _____________________ (name) holding a/c No. ___________.
Participant's
Signature
(Seal)
Date: