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    Spark Series A Application Form

    Uploaded by

    venkyben123

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Spark Series A Application Form

    Uploaded by

    venkyben123
    7 views2 pages

    Original Title

    Spark Series a Application Form

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    7 views2 pages

    Spark Series A Application Form

    Uploaded by

    venkyben123

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    APPLICATION FORM

    (Debentures through private placement & for private circulation only)


    Date: DD
    / MM
    / YYYY
    Applicant Status : Individual HUF Partnership Trust Corporate Other
    1 APPLICANT DETAILS
    Date of Incorporation: / /
    Mode of Holding : Single Joint Anyone/Survivor(s)
    DD MM YYYY

    Name of the First Applicant :


    MR /Ms /M/s
    (as per the Pan Card)
    Father’s /Husband’s name :
    Date of Birth : / / DD MM YYYY
    PAN card no :

    Name of the Second Applicant :


    Mr. /Ms. /M/s.
    (as per the Pan Card)
    Father’s /Husband’s name :
    Date of Birth : / / DD MM YYYY PAN card no :
    2 COMMUNICATION ADDRESS
    Address:

    City State Pincode Country

    Mobile no : Alternative Mobile no. (optional) :


    (Send all notifications to this number)
    Email id (s) :
    3 BANK DETAILS OF APPLICANT
    Bank Name : Account Type : SB Current
    Account no.:
    Account
    Name :
    IFSC code : Branch (city) :
    MICR Code :
    Swift Code :
    Email us at : Investor.relations@incor.in
    4 INVESTMENT DETAILS
    Issuer: Voltran Electric Private Limited
    Registered Address: D.No.6-3-661/10/1, Sangeetha Nagar, Somajiguda, Khairatabad, Hyderabad- 500082,

    Telangana, INDIA

    Name of Debenture : Spark Series A

    Investment Amount: in words

    BANK DETAILS FOR REMITTANCE


    Account name : VOLTRAN ELECTRIC PRIVATE LIMITED
    Branch : New Delhi Bank Name : RBL Bank Account no. : 00014400813359 IFSC Code: RATN0000100

    5
    NOMINEE DETAILS
    I/we declare the following person(s) as the Nominee(s).
    Name of Nominee ID Proof Date of Birth Relationship Percentage %

    Note: Please submit copies of your PAN card, Address proof and cancelled cheque.

    Disclamer
    I/ We fully understand that the Debentures mentioned herein are not offered for sale or subscription to the public but are proposed to be privately
    placed with identified investors. I/ We would like to invest in subject to the clauses of the term sheet of the Debenture. I/ We have not received nor been
    induced by any rebate or gifts, directly or indirectly, in making this investment. I /We declare that the amount invested in the debenture is through
    legitimate sources only and is not designed for the purpose of contravention or evasion of any Act/ Regulations/ Rules/ Notifications/ Directions or any
    other Applicable Laws enacted by the Government of India or any Statutory Authority.

    I/ We, hereby declare and confirm that my/ our Electronic Signature has been affixed on the Debenture Application Form with my/ our due consent and
    without any coercion or undue influence after I/ We have been made to understand the terms & conditions of the Debentures issuance, pursuant to
    which I/ We have decided to invest. Further, I/ We hereby declare that the above particulars and information provided by me/ us are correct and confirm
    that my/ our electronic signature is legally tenable and is equivalent to my/ our manual/ handwritten signature.

    Signature of First Applicant : Date: / /


    DD MM YYYY

    Signature of Second Applicant : Place :

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