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Form 'D’
[See paragraph 15]
NOMINATION
We .. Nowsondota... atotiad, wel... (Name and address), -
the holder/s of Stock certificate/BLA No 2022/2124. for the loan .SS2.Seaeo 2 3-2
hereby nominate the following person/s who shall on my/our death have the right to
the Government securities/Bonds and receive payment of the amount for the time
being due on the Government securities / Bonds specified below:
Madsen ef Nomnce— 33% SHEE
PARTICULARS OF NOMINEE: 1) 5G StHicisoy form 0 IO ere
ety
Date |Amount | Dateof | Fullname with | Date | Relation- | Particulars
of | Rs. | repayment] expanded of | shipto | ofbank
issue Mahood} initials and birth | holder/s | account
. address of | incase
nominee of
minor
23)¢ 2% /6 13) [Man isHa Wet 2o0F9200|F4+
NRE ENDER Srey
To be filled in case if nominee is minor: As .....
the sole nominee above is a minor on this date, UWe appoint Shri/Smt/Kum
NAL . to receive the amount for the time being
due to the above Government securities/Bond in the event of my/our death during the
minority of the said nominee .. NE.. a -
If the nomination is in substitution of the one already made: This nomination is in
substitution of the nomination dated ....!Y). . made by me/us and registered
on your books at ... which shall stand cancelled on registration
of this nomination.
(Signature(s) of the Stock Certificate holder (s)
Place:
Date: /BLA holder(3))
: Dow “uv 3
Signature with name and address of witnesses: Pasa SHAH 30
1
a
Acknowledgment
‘We acknowledge having registered the nomination in favour of
(Name of nominees) for the Stock Cettificate/BLA No. .
loan . .. and the nomination registration no, is .
Please quote the above nomination registration no. in all communication pertaining £0
change or cancellation of nomination.
for the
Authorised Official .
Date: ......
