Suven Life Sciences Limited


ELECTRONIC CLEARING SERVICE (CREDIT CLEARING)

MANDATE FORM Download ECS.doc

Shareholder's authorization to receive dividends through Electronic Credit Clearing Mechanism

1. Name of the first/sole shareholder :  
2. Folio no. / Client ID no. :  
3. Particulars of Bank account of first/ sole shareholder  
a) Name of the Bank :  
b) Branch, Address, Telephone no. of the branch :  
   
c) 9 digit code number of the Bank and branch  
appearing on the MICR cheque :

 

   
Issued by the Bank  
d) Account number :  
(as appearing on the cheque book/passbook)  
e) Account type:  
(S.B. account/current account or cash credit) :  
with code 10/11/13  
f) Ledger no. / Ledger folio no. :  
(If appearing on the cheque book/pass book)  

(In lieu of the bank certificate to be obtained as under, please attach a blank cancelled cheque, or photocopy of a cheque or the front page of the savings bank passbook issued by your bank, for verification of the above particulars).

I hereby declare that the particulars given above are correct and complete. If the transaction is delayed or not effected at all for reasons of incomplete or incorrect information, I will not hold Suven Pharmaceuticals Ltd. responsible. I agree to discharge the responsibility expected of me as a participant under the scheme.

Place:

Date: Signature of the Shareholder

Certified that the particulars furnished above are correct as per our records

Banks Stamp

Date: Signature of Authorized Official of the Bank

 

Note:

•  Please fill in the attached Mandate Form and sent it to:

•  The Depository Participant who is maintaining your Demat account in case your shares are held in electronic form.

•  The Address of our Registrar & Transfer Agent, Karvy Consultants Ltd., (unit: Suven Pharmaceuticals Ltd.), "Karvy House", 46, Avenue 4, Street No. 1, Banjara Hills, Hyderabad - 500 034.

•  Kindly note that the information provided by you should be accurate and complete in all respects and duly certified by your bank.

•  In case of more than one folio please complete details on separate sheets

•  The information provided by you will be treated confidential and would be utilized only for the purpose of effecting the payments meant for you. You also have the right to withdraw from this mode of payment by providing the company with an advance notice of 3 weeks.