Application For Caliming of Unpaid Dividend

Download as pdf or txt
Download as pdf or txt
You are on page 1of 2

DECLARATION FOR CLAIMING UNPAID/UNCLAIMED DIVIDEND

To
Arihant Superstructures Limited
Secretarial Dept.,
302, Persipolis Building
Plot No. 74, Sector – 17, Vashi,
Navi Mumbai – 400 703

Dear Sir,

Re: Issue of duplicate dividend Warrant(s)/credit the unclaimed dividend amount to my Bank
A/c. for/of Rs. _____________________for the Year__________ under DP ID/Folio
No.(s)______________________________________________ in respect of________________ Equity Shares

1. I/We _____________________________________________________________ wish to inform you


that the aforesaid original Dividend warrant(s) mailed to me/ us has/ have not been received by
me/ us and seems to have been lost in postal transit. I/We hereby declare and confirm that I/we
have not got the aforesaid Dividend warrant(s) encashed, pledged or deposited by way of
security of the said original dividend warrant or not have realized through my/ our bankers.

I/We also further confirm that said unclaimed dividend amount has/have not been credited to
my given bank a/c no.

I/We also undertake that if the aforesaid original dividend warrant(s) is / are hereafter found, I/
we shall return / surrender the said original dividend/ interest/ redemption warrant(s) to the
Company for cancellation.

I/We hereby request the Company to issue me/ us duplicate dividend warrant(s) in lieu of the
aforesaid original warrant(s)/ credit the said unclaimed dividend amount to my Bank A/c no.
and also undertake to reimburse the Company, all claims, demands, actions, liabilities and
expenses which may be made or incurred by the Company on account of issuing the said
duplicate dividend warrant(s) to me/us/crediting the said unclaimed dividend amount to my
bank a/c no.

2. In the event of the Company issuing the duplicate dividend warrant(s) to me/ us and if
thereafter the Company finds that the original dividend warrant(s) has/ have already got
encashed by me/ us, then I/we undertake to refund to the Company the amount of the original
warrant(s) together with an interest @ 18% p.a. by means of a Demand Draft issued in favour of
the Company payable at Navi Mumbai immediately within 7 (seven) days on hearing from the
Company and in case of default, I/we also hereby authorized the Company to adjust the said
sum from any future payments due to me/ us under the above DP ID(s)/Folio(s).
Kindly, issue the fresh dividend warrant in my/our favour /credit the unclaimed dividend amount
in my bank a/c no.:

Sr.No. DP ID/Folio No. No. of Shares Financial Year Dividend Amount

Total

Dated this ___________ day of _________________, 20____ at _____________ (place)

Name of the Holder(s) Signature of the Holder(s)

1. 1.

2. 2.

3. 3.

Signature of Witness: ____________________________________________________

Address of Sole/ 1st holder: ________________________________________________

Note: To avoid the incidence of fraudulent encashment of the warrants/ to directly credit the
unclaimed dividend amount to the bank a/c of the Member/(s), the Members are requested to
intimate the Company under the signature of the sole/ first joint holder, the following information:

1. Name of Sole/ First/ Joint Holder & Folio No. ___________________________________

2. Particulars of Bank Account, viz.

i) Name of the Bank _____________________________________________________

ii) Name of Branch ______________________________________________________

iii) Complete Address of the Bank with Pin code _______________________________

iv) Account Type, whether Savings (SB) or Current Account (CA)_________________

v) Bank Account No. allotted by the Bank ____________________________________

vi)9 Digit MICR Code appearing on the MICR Cheque issued by the Bank (please attach the
photocopy of a Cheque or a blank cancelled Cheque issued by your bank for verifying the
accuracy of the code number.

You might also like