.:রোজ ভ্যালি সম্পদ নিষ্পত্তি কমিটি:.

Company Name :

1st Investor :

Age:

Gender:

Phone Number:

Aadhar Card No.:

Email Id :

2nd Investor (in case of Joint holder) :

Age:

Gender :

Phone Number :

Aadhar Card No.:

Name of the Father / Husband :

Address :

Street :

Village/Town/City :

Post Office :

Police Station :

State :

District :

PIN Code :

BANK A/C DETAILS OF INVESTOR

Bank Name:

Branch Name :

Branch Code :

Savings A/c No. :

IFSC Code :

MICR :

Details of Investments

Sl. No.	Investment Certificate No. / Bond No.	Name(s) of the Certificate holder	Date of Investment	Amount of Investment	Date of Maturity	Amount received at maturity / refunded by Company, if any	Amount of principle not refunded / Amount of Claim	Amount entitled to get

DOCUMENTS enclosed BY INVESTORS

Original Certificates of Investment
Original Copy of Acknowledgement, if Certificates are submitted to the company at maturity for refund
Photocopy of Identity proof (any of the followings): Pan card / Passport / Voter card / Aadhar card / Driving Licence
Photocopy of Address proof (any of the followings): Passport / Voter card / Aadhar card / Driving Licence / Electric Bill / Telephone Bill / Ration card
Photocopy of the front page of Bank Pass Book
Photocopy of Cheque foil / Cancelled cheque foil
Affidavit document /NOC on Affidavit with notarized (If any)

Company Name :

Nominee :

Age:

Gender:

Phone Number:

Aadhar Card No.:

Email Id :

Name of the Father / Husband :

Address :

Street :

Village/Town/City :

Post Office :

Police Station :

State :

District :

PIN Code :

Name of the deceased investor(S) :

1st Investor :

Date of the Death of 1st Investor :

Relationship of Nominee with 1st Investor :

2nd Investor(in case of Joint holder) :

Date of the Death of 2nd Investor :

Name of the NOMINEE (printed in certificate) :

Percentage of Share :

BANK A/C DETAILS OF NOMINEE

Bank Name:

Branch Name :

Branch Code :

Savings A/c No. :

IFSC Code :

MICR :

Details of Investments

Sl. No.	Investment Certificate No. / Bond No.	Name(s) of the Certificate holder	Date of Investment	Amount of Investment	Date of Maturity	Amount received at maturity / refunded by Company, if any	Amount of principle not refunded / Amount of Claim	Amount entitled to get

DOCUMENTS ENCLOSED BY NOMINEES

Original Certificates of Investment
Original Copy of Acknowledgement, if Certificates are submitted to the company at maturity for refund
Original or Attested copy of Death Certificate of Investor(S)
Photocopy of Identity proof (any of the followings): Pan card / Passport / Voter card / Aadhar card / Driving Licence
Photocopy of Address proof (any of the followings): Passport / Voter card / Aadhar card / Driving Licence / Electric Bill / Telephone Bill / Ration card
Photocopy of the front page of Bank Pass Book
Photocopy of Cheque foil / Cancelled cheque foil
Affidavit document /NOC on Affidavit with notarized (If any)

Company Name :

Successor :

Age:

Phone Number:

Aadhar Card No.:

Email Id :

Name of the Father / Husband :

Address :

Street :

Village/Town/City :

Post Office :

Police Station :

State :

District :

PIN Code :

Name of the deceased investor(S) :

1st Investor :

Date of the Death of 1st Investor :

Relationship of Successor with 1st Investor :

2nd Investor(in case of Joint holder) :

Date of the Death of 2nd Investor :

Nominee :

Date of the Death of Nominee :

Name of the SUCCESSOR (printed in certificate) :

Percentage of Share :

BANK A/C DETAILS OF SUCCESSOR

Bank Name:

Branch Name :

Branch Code :

Savings A/c No. :

IFSC Code :

MICR :

Details of Investments

Sl. No.	Investment Certificate No. / Bond No.	Name(s) of the Certificate holder	Date of Investment	Amount of Investment	Date of Maturity	Amount received at maturity / refunded by Company, if any	Amount of principle not refunded / Amount of Claim	Amount entitled to get

DOCUMENTS ENCLOSED BY SUCCESSOR

Original Certificates of Investment
Original Copy of Acknowledgement, if Certificates are submitted to the company at maturity for refund
Original or Attested copy of Death Certificate of Investor(S)
Original or Attested copy of successor Certificate
Photocopy of Identity proof (any of the followings): Pan card / Passport / Voter card / Aadhar card / Driving Licence
Photocopy of Address proof (any of the followings): Passport / Voter card / Aadhar card / Driving Licence / Electric Bill / Telephone Bill / Ration card
Photocopy of the front page of Bank Pass Book
Photocopy of Cheque foil / Cancelled cheque foil
Affidavit document /NOC on Affidavit with notarized (If any)

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