Form A
[See paragraph 5(b)]
Declaration to be submitted by the
investors to the depository participants for availing the benefits under
the Rajiv Gandhi Equity Savings Scheme.
Name of the Investor:
(first holder)
Address of the investor:
Permanent Account Number (PAN):
1. It is hereby certified that* ---
(a) I do not
have a demat account and I have not
traded in any derivatives.
(b)I have
demat account no _________________ in ____________________ depository
participant but I have not traded in any equity shares or derivatives in this
account.
(c)I have a
joint demat account no _________________ in ____________________ depository
participant but I am not the first account holder.
2. I hereby declare that I have
read and understood all the terms and conditions
of the Rajiv Gandhi Equity Savings Scheme.
3. It is hereby verified that I
am an eligible new retail investor for availing the benefits under the Rajiv
Gandhi Equity Savings Scheme.
4. I undertake to abide by all
the requirements and fulfill all obligations under the Scheme, and will comply with all the
terms and conditions of the Scheme.
5. I understand that, in case I
fail to comply with any condition specified in the Scheme, the benefits availed there under
will be withdrawn and the tax shall be
payable by me accordingly.
Signature of the
Investor
Place:
Date:
* Tick which
ever is appropriate.