India Infoline Finance Limited
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COMMON APPLICATION FORM INDIA INFOLINE FINANCE LIMITED APPLICATION FORM ISSUE OPENS ON : SEPTEMBER 5, 2012 FOR ASBA / NON ASBA “ ‘[ICRA]AA- (STABLE)’ BY ICRA AND ‘CRISIL AA-/STABLE’ BY CRISIL” (FOR RESIDENT APPLICANTS) ISSUE CLOSES ON* : SEPTEMBER 18, 2012 *‘For Early Closure / Extension of the Issue refer to page 3 of Abridged Prospectus To, The Board of Directors Application INDIA INFOLINE FINANCE LIMITED Form No. PUBLIC ISSUE OF UN-SECURED REDEEMABLE NON CONVERTIBLE DEBENTURES (SUB-ORDINATED DEBT) (“NCD”) VIDE PROSPECTUS DATED 27 / 08 / 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 ‘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. #MEMBER OF SYNDICATE / TRADING SUB-BROKER’S/AGENT’S CODE SCSB BRANCH STAMP & CODE BANK BRANCH REGISTRAR’S / SCSB DATE OF TEAR HERE MEMBER STAMP & CODE SERIAL NO. SERIAL NO. RECEIPT 1. APPLICANT’S DETAILS - PLEASE FILL IN BLOCK LETTERS (Please refer to page no. 11 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$) (* Compulsory in case of application to hold the NCDs in physical form) ($Please refer to instruction (d) overleaf) 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 IN DEMATERIALISED FORM, PLEASE PROVIDE APPLICANT’S DEPOSITORY DETAILS (Please refer to instruction (e) overleaf.) (Please refer to page no. 9 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. 22 of the Abridged Prospectus) Bank Details for payment of Refund / Interest / Maturity Amount Name of the Nominee : ____________________________________________ Bank Name, Branch: ______________________ MICR No. : _______________ If Nominee is Minor, Guardian’s Name : _______________________________ Account No.: ____________________ IFSC Code : ______________________ 5. INVESTMENT DETAILS (For details, please refer Issue Structure overleaf) Option I II III Issue Price (`) ` 1,000 ` 1,000 ` 1,000 Coupon/Frequency of payment 12.75% per annum / Monthly 12.75% per annum / Annually NA Maturity 72 months from the Deemed Date of Allotment Minimum Application ` 5,000 (5 NCDs) (for all options of NCDs, namely Options I, II and III, either taken individually 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 & Phone No. on reverse side of the Cheque / DD) Amount paid in (` in figures) (` in words) (A) CHEQUE/DEMAND DRAFT (DD) in favour of “India Infoline Finance (B) ASBA Limited - NCD Escrow” PLEASE FILL IN BLOCK LETTERS Cheque / DD No. Dated D D M M Y Y Bank A/c. No. Drawn on (Bank Name & Branch) Bank Name & Branch 7A. SIGNATURE OF SOLE/ FIRST APPLICANT 7B. SIGNATURE OF SECOND APPLICANT 7C. SIGNATURE OF THIRD APPLICANT 7D. SIGNATURE OF ASBA BANK #MEMBER OF SYNDICATE / ACCOUNT HOLDER(S) (AS PER BANK TRADING MEMBER / SCSB RECORDS) (FOR ASBA OPTION ONLY) BRANCH’S STAMP (Acknowledging upload of application I/We authorize the SCSB to do all acts as are necessary to make the Application in the Issue in Stock Exchange System) PAN PAN PAN 1 PAN is mandatory. Please refer point (B) on 2 Date _________________, 2012 page 12 of the Abridged Prospectus. 3 -----------------------------------------------------------------------------------------------------TEAR HERE---------------------------------------------------------------------------------------------------- INDIA INFOLINE Acknowledgement Slip for #Members Application FINANCE LIMITED of Syndicate / Trading Member / SCSB Form No. 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---------------------------------------------------------------------------------------------------- # Name of Sole / First Applicant Option I II III Stamp & Signature of Members of Syndicate/ Trading Member / _________________________________ Issue Price (`) SCSB alongwith the date stamp _________________________________ No. of NCDs applied for (mandatory) Amount Payable (`) Application Form No. TEAR HERE Grand Total Total No. of NCDs Total Amount Payable (`) Acknowledgement Slip for Applicant Cheque / DD/ASBA Bank A/c No. _____________________________________________ Dated _____________ INDIA INFOLINE Acknowledgment is subject to realisation of Cheques / FINANCE LIMITED Bank & Branch ______________________________________________________________________________ DD/Availability of funds in the ASBA account # Member of Syndicate will have the same meaning as disclosed in the Prospectus, which includes Lead Managers, Co-Lead Managers, Lead Brokers and Sub Brokers * For further details, please refer to page no. 10 & 12 of the 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.” IN THE NATURE OF FORM 2A - MEMORANDUM CONTAINING SALIENT FEATURES OF THE PROSPECTUS 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 INDIA INFOLINE FINANCE LIMITED Prospectus dated August 27, 2012 (“Prospectus”) 2 I/We hereby apply for allotment of the NCDs to me/us and the amount payable on application is remitted herewith. 3. I/We hereby agree to accept the NCDs 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 IDBI Trusteeship Services Ltd., 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 NCDs 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 NCDs 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 NCDs applied for. 9. 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 disclosedin the Draft Prospectus/Prospectus, I/We authorize (a) the #Member of Syndicate/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 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. 3) In case the amount available in the specified Bank Account is insufficient as per the Application, the SCSB shall reject the Application. Additional Undertaking in case the Applicant wishes to hold the NCDs in physical form: 1. In terms of Section (8)(1) of the Depositories Act, 1996, I/we wish to hold the NCDs in physical form. 2. I/We confirm that the Information provided in this form is true and correct and I/We enclose herewith self attested copies of the KYC Documents. 3. I/We confirm that we do not hold any Demat Account. ISSUE