I/We hereby authorise you (HB Portfolio Ltd) to credit all future dividends, if any, in respect of my holding in your company to my bank account as detailed below by Electronic Clearing Service introduced by Reserve Bank of India:


1. Share Holder's Name (in Block letters) : ____________________________________


2. Folio No./DP ID & Client ID No. : ____________________________________


3. No. of Shares held : ____________________________________


4. Name of the Bank : ____________________________________


5. Branch Name & Address : ____________________________________





6. Account Type : SB A/c Current A/c Others___________

(Mark " " in the appropriate box) (Please specify)


7. Ledger Folio No. of the Account : _____________________________________


8. Bank Account Number : _____________________________________

(as appearing on Cheque Book)



9. Nine digit code number of the Bank and :

Branch appearing on the MICR Cheque *












* Please attach photocopy of a cheque or a blank cancelled cheque issued by your Bank relating to your above account for verifying the accuracy of the code number.



I/We hereby declare that the particulars given above are correct and complete. If credit is not

effected for reason(s) of incomplete or incorrect information, I/We will not hold the Company






Signature of the First holder

Dated: (as appearing in the Company's/DP's records)