Shareholder Confirmation Form

Sri Baashyam Associates Limited

A Corporate & Public Limited Company

A Mutual Fund Company

CIN : U45400TZ2021PLC035776 | IPO No. : INE0KE201017 | PAN : ABFCS6612M

TAN : CMBS21978F | GSTIN : 33ABFCS6612MIZ5

74/1, VCTV Main Road, Erode - 638 001. TN. INDIA. | Ph: 0424 - 4543678 | E-mail: sbalnew2021@gmail.com

Share Confirmation Form

Date :

To
The Secretary

My Demat Account Number is and
I agree to abide by the rules and regulations of Samaj at all times.

I am sending herewith Rs.

towards

Shares. (Rs. 10 per share)

👤

Member's
Photo

Click to Upload

Signature of Applicant (Draw in the box below):

Draw inside the lines. Cleared on click.

01 Personal Details

Name

Date of Birth

Occupation

Native of Place

Religion

I am a Share Holder of

02 Address & Contact Information

Office Address

Residence Address

Office Ph

Office Mobile

E-mail

Residence Ph

Residence Mobile

Communication at

Office Residence

03 Admin Section (For Office Use)

Received Rs.

on Date

Receipt No. (R.No.)

by Cash / Cheque Details

Admitted as Shareholder on

Shareholder Form