Bsence of the Cancelled Cheque, Our Company May Reject the Application Or It May Consider the Bank Details As Given on the Application Form at Its Sole Discretion
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APPLICATION FORM INDIAN RAILWAY FINANCE CORPORATION LIMITED COMMON APPLICATION FORM ISSUE OPENS ON : DECEMBER 8, 2015 (A Government of India Enterprise) (FOR RESIDENT APPLICANTS) Credit Rating : “CRISIL AAA / Stable” by CRISIL Limited, “[ICRA] AAA” by ICRA Limited, “CARE AAA” by CARE Limited FOR ASBA / NON ASBA ISSUE CLOSES ON* : DECEMBER 21, 2015 To, *For early closure or extension of the issue, refer overleaf Application The Board of Directors, 90000568 INDIAN RAILWAY FINANCE CORPORATION LIMITED Form No. PUBLIC ISSUE OF TAX FREE, SECURED, REDEEMABLE, NON-CONVERTIBLE BONDS IN THE NATURE OF DEBENTURES VIDE SHELF PROSPECTUS & PROSPECTUS TRANCHE I DATED DECEMBER 2, 2015 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 ‘Applicant’s Undertaking’ as given overleaf. I/we hereby confirm that I/we have read the instructions for filling up the Application Form given overleaf. TEAR HERE LEAD MANAGER/ CONSORTIUM / TRADING MEMBER STAMP & CODE SUB- CONSORTIUM MEMBER /BROKER’S SUB BROKER/AGENT ESCROW BANK / SCSB BRANCH BANK BRANCH REGISTRAR’S / SCSB DATE OF STAMP & CODE CODE STAMP & CODE SERIAL NO. SERIAL NO. RECEIPT 1. APPLICANT’S DETAILS - PLEASE FILL IN BLOCK LETTERS (Please refer to page 16 of the attached 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) Mr./Ms. Address Pin Code (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 Category IV Sub Category Code (Please refer overleaf) 3. PLEASE PROVIDE APPLICANT’S DEPOSITORY DETAILS (Please Refer to page 16 of The Attached 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 BONDS 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 28 of this Abridged Prospectus) Bank Details for payment of Refund / Interest / Maturity Amount (Mandatory) Name of the Nominee : _________________________________________________________ Bank Name : ____________________________________________Branch : ________________________________ If Nominee is Minor, Guardian’s Name : ____________________________________________ Account No.: __________________________IFSC Code : __________________MICR Code: ___________________ 5. INVESTMENT DETAILS (For details, please refer Issue Structure overleaf) Options / Series of Bonds Tranche I Series I A Tranche I Series II A Tranche I Series III A Coupon rate / Annualised yield (%) per annum for Category I, II, III 7.07 7.28 7.25 Options / Series of Bonds Tranche I Series I B Tranche I Series II B Tranche I Series III B Coupon rate / Annualised yield (%) per annum for Category IV 7.32 7.53 7.50 For Category I, II, III & IV Tenor 10 years 15 years 20 years Face Value / Issue Price ` 1,000 per Bond ` 1,000 per Bond ` 1,000 per Bond Frequency of Coupon / Interest Payment Annual Minimum Application and in the multiple of thereafter 5 Bonds (` 5,000) (individually or collectively, across all Series of Bonds) and in the multiple of One Bond (` 1,000 per Bond) thereafter No. of Bonds applied ETTERS Amount Payable (`) K L Grand Total (`) C O Our Company shall allot Tranche I Series IA/IB Bonds (depending upon the category of applicants) to all valid Applications, wherein the Applicants have not indicated their choice of the relevant series of Bonds. L B 6. PAYMENT DETAILS (Please tick () any one of payment option A or B below) IN Please write a Sole/First Applicant’s Name, Phone No. and Application No. on the reverse of Cheque/DD. Amount Paid (` in figures) (` in words) ILL F A. CHEQUE/ DEMAND DRAFT (DD) TO BE DRawn IN faVOUR OF “IRFC TaX FREE BONDS 2015 - ESCROW ACCOUNT - R” (B) ASBA Bank A/c No. Cheque/DD No. Dated D D M M Y Y ASBA A/c. Holder Name ____________________________________________________ LEASE P (in case Applicant is different from ASBA A/c. Holder) Drawn on (Bank Name & Branch) Bank Name & Branch ______________________________________________________ Please note that you cannot apply for the Bonds through the ASBA Process if you wish to be Allotted Bonds in Physical Form 6A. PAN & SIGNATURE OF 6B. PAN & SIGNATURE OF 6C. PAN & SIGNATURE OF 6D. Signature of ASBA Bank Account Holder(s) LEAD MANAGER’S / CONSORTIUM / SOLE/ FIRST APPLICANT SECOND APPLICANT THIRD APPLICANT (as per Bank Records)(for ASBA Option only) SUBCONSORTIUM MEMBER’S /BROKER’ S/ I/We authorize the SCSB to do all acts as are necessary to SUBBROKER’S/ TRADING MEMBER’S /SCSB PAN PAN PAN make the Application in the Issue BRANCH’S STAMP 1) (ACKNOWLEDGING UPLOAD OF APPLICATION IN STOCK EXCHANGE SYSTEM) (MANDATORY) 2) Furnishing PAN of the Applicant is mandatory including minor’s PAN in case of Date : ___________________, 2015 Application by minor. Please refer page 17 of the attached Abridged Prospectus 3) TEAR HERE Acknowledgement Slip for Lead Managers/ INDIAN RAILWAY FINANCE CORPORATION LIMITED Application Consortium/Sub-Consortium Member/ Form No. (A Government of India Enterprise) Brokers/Sub-Brokers/Trading Members / SCSB’s 90000568 DPID/ PAN CLID ` Date, Stamp & Signature of Escrow Amount Paid ( in figures) Bank & Branch Bank (Mandatory) Cheque / DD/ASBA Bank A/c No. Dated___________,2015 Received from Mr./Ms. /M/s. Telephone / Mobile Email TEAR HERE PUBLIC ISSUE OF TAX FREE, SECURED, REDEEMABLE, NON-CONVERTIBLE BONDS IN THE NATURE OF DEBENTURES VIDE SHELF PROSPECTUS & PROSPECTUS TRANCHE I DATED DECEMBER 2, 2015 Options/Series of Bonds Tranche I Tranche I Tranche I Date Stamp & Signature of Lead Name of Sole / First Applicant Series I A / I B Series II A / II B Series III A / III B Manager/Consortium/Sub-Consortium ___________________________________________ Issue Price (`/Bond) ` 1,000 ` 1,000 ` 1,000 Members/Trading Members/SCSB No. of Bonds applied for ___________________________________________ Applications submitted without being uploaded on the terminals of the Stock Amount Payable (`) Exchanges will be rejected. Grand Total (`) Acknowledgement Slip for Applicant TEAR HERE All future communication in connection with this application should Cheque / DD/ASBA Bank A/c No. Dated ,2015 be addressed to the Registrar to the Issue. For details, pleaser CORPORATION LIMITED CORPORATION INDIAN RAILWAY FINANCE INDIAN RAILWAY refer overleaf. Acknowledgement is subject to realization of Cheque Application 90000568 Drawn on (Name of Bank & Branch) / Demand Draft / /Availability of funds in the ASBA account. (A Government of India Enterprise) Form No. While submitting the Application Form, the Applicant should ensure that the date stamp being put on the Application Form by the Lead Manager/Consortium /Sub-Consortium Member/Broker/Sub Broker/Trading Member/SCSB matches with the date stamp on the Acknowledgement Slip APPLICANT’S UNDERTAKING I/We hereby agree and confirm that: 1. I/We have read, understood and agreed to the contents and terms and conditions of INDIAN RailwaY FINANCE CORPORATION LIMITED Shelf Prospectus dated December 2, 2015 and Prospectus Tranche - I dated December 2, 2015 (“Prospectus”) 2. I/We hereby apply for allotment of the Bonds to me/us and the amount payable on application is remitted herewith. 3. I/We hereby agree to accept the Bonds applied for or such lesser number as may be allotted to me/us in accordance with the contents of the Prospectus subject to applicable statutory and/or regulatory requirements. 4. I/We irrevocably give my/our authority and consent to SBICAP TRUSTEE COMPANY LIMITED to act as my/our trustees and for doing such acts as are necessary to carry out their duties in such capacity. 5. I am/We are Indian National(s) resident in India and I am/ we are not applying for the said Bonds as nominee(s) of any person resident outside India and/or Foreign National(s). 6. The application made by me/us do not exceed the investment limit on the maximum number of Bonds which may be held by me/us under applicable statutory and/or regulatory requirements. 7. In making my/our investment decision I/We have relied on my/our own examination of the company and the terms of the issue, including the merits and risks involved and my/our decision to make this application is solely based on disclosures contained in the Prospectus. 8. I/We have obtained the necessary statutory and/or regulatory permissions/approvals for applying for, subscribing to, and seeking allotment of the Bonds applied for. 9. I/We hereby undertake that I/We am/are and will be compliant with the Foreign Tax Account Compliance Act (“FATCA”). Please also refer to the disclaimer on Page 7 of the attached Abridged Prospectus. 10. Additional Undertaking, in case of ASBA Applicants: 1) I/We hereby undertake that I/We am/are an ASBA Applicant(s) as per applicable provisions of the SEBI Regulations; 2) In accordance with ASBA process provided in the SEBI Regulations and disclosed in the Prospectus, I/We authorize (a) the Lead Manager/Consortium /Sub-Consortium Members and Trading Members (in Specified cities only) or the SCSBs, as the case may be, to do all acts as are necessary to make the Application in the Issue, including uploading my/our application, blocking or unblocking of funds in the bank account maintained with the SCSB as specified in the Application Form, transfer of funds to the Public Issue Account on receipt of instruction from the Lead Manager, Registrar to the Issue, after finalization of Basis of Allotment; and (b) the Registrar to the Issue to issue instruction to the SCSBs to unblock the funds in the specified bank account upon finalization of the Basis of Allotment.