.:Rose Valley Assets Disposal Committee:.

Investor

Enter Certificate No.

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Investor Name:

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Certificate No.:

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Acknowledgement No.:

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Invested Amount:

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Status:

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Name of the investor(s)

Company Name

1st Investor

Age

Gender

Phone Number

Email Id

Aadhar Card No.

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

Name of the Bank of Investor

Name of the Branch

Name of the Branch Code

Savings Bank A/c No.

IFSC Code of the Bank

MICR of the Bank

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 TO BE PRODUCED 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

Name of the nominee(s)

Company Name

Name of the Nominee

Percentage of Share

Name of the deceased investor(S)

1st Investor

2nd Investor(in case of Joint holder)

Relationship of Nominee: with 1st Investor

Date of the Death of 1st Investor

Date of the Death of 2nd Investor

Name of the NOMINEE (printed in certificate)

Age

Gender

Phone Number

Email Id

Aadhar Card No.

Name of the Father / Husband

Address of NOMINEE

Street

Village/Town/City

Post Office

Police Station

State

District

PIN Code

BANK A/C DETAILS OF NOMINEE

Name of the Bank of Nominee

Name of the Branch

Name of the Branch Code

Savings Bank A/c No.

IFSC Code of the Bank

MICR of the Bank

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 TO BE PRODUCED 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

Name of the successor(s)

Company Name

Name of the Successor

Percentage of Share

Name of the deceased investor(S)

1st Investor

2nd Investor(in case of Joint holder)

Relationship of Successor: with 1st Investor

Date of the Death of 1st Investor

Date of the Death of 2nd Investor

Date of the Death of Successor

Relationship of Successor: with 1st Investor

Name of the Successor (printed in certificate)

Age

Gender

Phone Number

Email Id

Aadhar Card No.

Name of the Father / Husband

Address of NOMINEE

Street

Village/Town/City

Post Office

Police Station

State

District

PIN Code

BANK A/C DETAILS OF SUCCESSOR

Name of the Bank of Successor

Name of the Branch

Name of the Branch Code

Savings Bank A/c No.

IFSC Code of the Bank

MICR of the Bank

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 TO BE PRODUCED 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

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

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

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

Investor

BANK A/C DETAILS OF INVESTOR

Details of Investments

DOCUMENTS enclosed BY INVESTORS

BANK A/C DETAILS OF NOMINEE

Details of Investments

DOCUMENTS ENCLOSED BY NOMINEES

BANK A/C DETAILS OF SUCCESSOR

Details of Investments

DOCUMENTS ENCLOSED BY SUCCESSOR

Contact Information