7/30/2019 Alliance Equity Form PDF
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SHARE APPLICATION FORM(Private & confidential, not for
circulation)
To:M/S: ALLIANCE Agritech & Land
Developers Limited
Shiv 15/102-6, R- Shivpur, Bharlai,Varanasi-221003 , Uttar
PradeshIndiaSir/Madam,Sub: APPLICATION FOR PRIVATE PLACEMENT OF
EQUITY SHARES OF RS.10/- EACH
Please refer to the offer document issued by you. Having read
and understood the terms of offerand the instructions , apply for
the allotment of equity shares to me/us. The application is an
irrevocable offerby me/us. The amount payable on application as
shown below is remitted . On allotment , please place my/ourname(s)
on the Register of shareholder(s). I/We bind myself/ourselves by
the provisions as contained in thescheme.
In Figures In words Date:No. of shares. FOR OFFICE USE ONLY
Date of receipt of applicationSl. No:
Amount (Rs) I am/we are applying as (Tick) whichever is
applicableCheque/Demand Cheque/ Date Amount Individual ( )Society/
Trust ( )Draft drawn on DD No Mutual Fund ( )Company ( )
Others ( )
APPLICANTS NAME IN FULL Name of father/ husband Sex AgeSole
/FirstSecondThirdNominees Name forsole/first applicantName (IN
CAPITAL LETTERS): .Address :
.Phone No:__________________ Mobile No:
____________________________Fax:_________________E-mail
:__________________Applicant PAN
SIGNATURES
Sole/First
SPECIMEN
applicantSole/ First Second applicantSecond Third applicantThird
Nominee
... Here..Tear
Address for Correspondence: NAME/S:.. ReceiversM/s: ALLIANCE
Agritech &Land Developers Ltd. CHEQUE/DEMAND DRAFT DRAWN
StampShiv 15/102-6, R- Shivpur,Bharlai, Distt-
Varanasi-221003,Uttar Pradesh, India ON.,
CHEQUE/DD NO:...DT:AMOUNT RS.:.
Received onPlease draw the Cheque/DD in favour of :M/S;
ALLIANCE Agritech & Land Developers Ltd.
Note: Cheques and Drafts are subject to realization.
