Fgnp tbr:givirrgirrtinraiion Service

or seekingprior sanclionundcrRule 18(2)o1'theRaih.vay

propertv.
in respecttlf imnlov:tble
(Conduct)ltules.lt)66 for transactiott

Namc and dcsignaliotr

')
Scale o1'pa1.iurd presetrtpal'

). I ' u r p r l s ct l f a p l t l i c ; . t t i t r t ts a l l c t i ( ) l l
lbr transactj6nipropcr intinlationof
transactiotr.

/1
a. or
Whether plopertf is being acclt-tit'ed
clisposcdof1.

5. or disposal
(a) l'robabledaieof acquisititln
of'propertt,

(). VIodeo f acquisition/disposal

t. a) Full detailsatroutlttcationr iz \lunicipal

n o . .S t r e e tV, 'i l l a g c .l a l u k a .D i s t r i c a t ncl
St;rtein u'hicirsituated.
b) l)escriptionof the propertyin the case
of cultivableland,dr1'or ilrigatediand
c) Whetherf}cehoidor leaseholil
d) Whethcrthe applicant'sintet'est
i n l h c p t r p c r t yi s i r t t i r l l o t p a r t( l l l c a s c
of partialintet'e st . the cxtetttof such
iutercsturtrstbe irtdicated )
e ) I r r c a s c t t f l l t c l l ' i t l l S s C l i t ) l ti : l t t ) t
e . r c l u s ier l f i n t h e n a t n eo l - t h eC o r t .
sen'atrt.partictllafs tt1'or,vnershipand
sharesof each rnentber.

8. price of the propen)'

Salcl Pr-rrchase
(\4arket Value in thc caseoi'tiifts)

In cascof'acquisitiolt.soulceof/stlltrces
frorn rvhich tlnanccdproposedto bc
financed).
( a) t l r r ri l r g s
P c t ' s o l t lS
(b) Otl-iersourcesgivittu dctails

10. In caseol'disposalol'propcrtl' :
i rrtirnatiotrobtained/
r,vasrequisitc sanction/
given1'orits acquisition.(A cop,vof the
acknos'ledgcnlent
salrctiol)/ shouldbe attached)
I] a- Name & acldrcssof the party' w'ith *'hotn :
transactiouis proposed to be rnade/has bcen
nratle.
b- Is the parn'r'elated to tl-reapplicant?Il'so.
staleihr: relatiorrshilt :
c- Did the appiicanthiive an1'dcalin;'.s u'ith :
I'he parly in liis olllcial capacitval an)'
t i r n e. o t ' i s t h e a p p l i c a n tl i k c l 1 ' t o l t a v ea n y
dealinesrvittrhinr in thc neiir ftrturc'.)
d- I-iou,'r.r'asthc trrttsactiottat'raltgcd'/
(\\hetlrcr through llrv statLtton'bod-v or
a private agencv thror-rghaclvertisctlent
or thr:ouglrll'iends aud relatircs. l'rrll
particularsto be gir"cn) :
l?.. ln thc caseof acquisitioub1' Gif-t n'hetltcr
sanctionis aiso lequired under Rulc l-i rtt'
t h e R a i l s a v S c r r r i c c( C ' o n d r r c R t ) L r l e sl"9 ( 1 6 :
13. An1' othcr rcler'autfact u'hich tl"re
applicantnrar like to u-tcutit.rtt.

D[,CI,ARATI()N

I herebl'declarethat the parlicularsgiven aboveare

true. I reqlrest that I rna,v be giYen pcrmissionto acqrrire/disposeo1 propertyas described
abovefiorn/to the part.vwhose name is r"equired in itenr I 1 above.

OR
l. thcproposed
irercbvintirnate disposal
acqr-risitionr
of the propertv hv nrc as detailed above. I dcclare that the particulars given above ate true.

Signature.

Station: D es i g n a t i o r. .l . . .

[)ate:

Note
to the requirement.
l. In the abovetbrnr.diflerentportionsnra)'beusedaccorclittg
2. Wlrereprerious sanctinnis askedlirr the. applicationshoultlbe submittedat least30 days
befirrethe ploposeddateo1'thctransactiotr.
 sanctionrutderRule l8(3) of the RailwaySer-vice
Forrnlbl giving intitnationor sceltittgprer,'ious
(C'onduct)Rules.1966tbr transactiotr in respectof movableProPert,v.

Name oi' the (loverutnc:trlSen'ant

) Scale of pa-vattclprescnt pa)'

3. P u l p t l s cr r f ' a p p l i c l r t i t l l rs l i t t c t i o l t
lbr transactiorrii n titrtati on oI-t ratrsactiott.

4. or
Whetherpropcrl!' is hcing acclttireti
disposedo11'

(a) Probabledaleof acqr.risition or disposal

ol'propcrtl,'
acqr.riredi
(b) If the propertf is alreradl.
clisposed of Acttraldateof transactiott

6. (a) I)cscriptiouot'thcplopcrtl'
(11'clei
(i.e.('ar/Scootet',/N4otor
Rcl'rip.erator/ Radioil{adiograrn/
Jeu'ellerl'/lnsuranccPoiiciesctc.
(b)Make.Nlorlel(andalsor:cgislrilliott
ncl.in caseof'Vehiclcs)u'het'cnecessal'Y

1. Modeof acquisition/disposal
( Purchasc/ L,ease
Sale/Giftiiv{ortgagei or
otheru'isc).

8. Sale/ Pr.rrclrase pricc ot'tlie pfol,1dr1\

( M a r k e t V a l u c i n t l r ec a s co J ' ( i i l i s )

() ,c()rlrce
In caseof accluisitiort. of financc.from
rvhich trnanced1-rroposecl to bc flnanced).
(a) PcrSorraiSar irrirs :
(b) Other sr)Ltrcesgiving details :

t0. In caseof disposalof'propertl'

n'as reqrrisite sancliorti ittl i rn irti on obtainecl/
uircn tilr its acquisilion.
(A copl' of thc sanctiorl,ii'tckttolr ledgemenl
should be attachcd)

ll
a- Name & addrcsso1-the parr.vi,rith w'hotn :
transactiottis ltroposed to be nradei
has been made.
 lf-so.
b- Is ttrepirrtl iclatecito thc anplicant.')
statcthe rclationship

c- Dici the applicant ftut'. u,l. deiilings rvith :

Ihe party'in his official cnnacityat ariv
time. or is the applicantlikell to have an,v
dealings ri'ith him in the nr'ar l1ilLlre?

d - N a t r r r eo i - o l ' { l c i atl l c a l i n g sw i t l i t h e
:
|al't)

e- Hor.r'as the tratts:ictionarratrgecl')

(Whether tltrouglt al)\' stattltorybodr' or
a plivate agcnc)'thlough fi'ienclsanci
lr-rllpartictrlarsto be given)
rclartir,cs. :

12. l n t h e c a s eo f a c q r r i s i t i o b n r C i t ' t st l r e t l t c r
sattctiottis also requircduncicrRr.rlel[l o1'
'.
l ) t r l ' : s .l 9 ( 1 6
t h t tR a i l r r a r S r l r \i c e ( ( . o t t t i t r c R

I i. ,\nr other rclcr attt lirct ri lrich tirc

applicantma1'like to tt.tt:trtictt.

DIi(ll,ARz\]'ION

I hereby,clcclarethat the particLllarsgiven above are

truc. I requestthat i ruar hc uirr-n ltcnnission to acqrrireidisltosc ol'properly as described
abovc fl"orn/tothe pai'tr riltosc ttittnciS tlcntioned itt itern 11 above.
(,)R
I. irttinratethe acquisition/disposaloi tl're
here[r-,-
given above are lruc.
iibore. I cleclarethat the ltarticuiar-s
propert\.b1nre as d..:tailei'l

Signature.

Station: D e s i s n a t i o.i .l . . .

I)ate:

Note
to recluirentettt.
portionsnral'betrsetlaccordingl
1. tn thc abovctbrnr.ciilTcrcnt
2. Wlrere plevior-tssanctionis askeclfbr. iipplicationshould be sttbmittedat least 30 days
betbrethe proposcdciatcof'the trrittsr-tclioti.
Form for giving intimation under ltule I tt(4) of
CCS(Conduct) Rulcs, 1966 ftrr transactions in sharcs
debcnturcsand investmcntin mutual lirnd schemes
securities,
etc.

1. Narncanddcsignation.

2. Scalcof'payandprcsentpay.

3. Dclails of- cach transactionmadc in sharcs, sccuritics,

mutualfundsschemectc.duringthe calendaryeaf.
debentures,

is madc:-
ol-thcparly/firmwith whomtransaction
4. Parliculars

(a) Is pafly rclatcdto thc applicant'/

(b) l)id the applicanthavc any dealingswith the party in his

officialcapacityat any timc or is thc applicantlikcly to havcany
dcalingwith him in thc ncar{Lrturc.

5. Sourccor sourccsliom nhich {lnanccd:-

(a)Personal
savings.

givingdetails
(b) Othcrsolrrces

likc to mcntion.
6. Anv othcrrclcvantlerctuhich Applicantma.v-

I herebydeclarcthatthe particularsgivenabove
I)cclar:ation:
arctruc.

Station:
Signaturc:
| )ate:
l)esignaticln: