Private & Confidential – Not for circulation Rate of Interest – 5.00% p.a.

POWER FINANCE CORPORATION LTD. Tenure – 5 years

(A Govt. of India Undertaking)
Application Number
(A Navratna Company)
FUNDING FOR A Regd. Office: Urjanidhi, 1 Barakhamba Lane, Connaught Place, New Delhi- 110001
BRIGHTER APPLICATION FORM FOR NON-CONVERTIBLE, NON-CUMULATIVE, REDEEMABLE, SECURED, TAXABLE BONDS,
TOMORROW SERIES-IV WITH BENEFITS UNDER SECTION 54EC OF INCOME TAX ACT, 1961 20014660
(PLEASE CAREFULLY READ INFORMATION MEMORANDUM FOR PRIVATE PLACEMENT BEFORE FILLING UP THIS FORM)
Broker's Name & Code Sub Broker's Name & Code Bank Branch Serial No. & Stamp FOR USE BY COLLECTING BANK BRANCH

999-DIRECT Date of receipt of application Date of credit of Cheque / DD in

PFC Account
Registrar’s reference no.

Dear Sirs,
I/We have read and understood the Information Memorandum for Private Placement. I/We bind myself/ourselves to their provisions and apply for allotment. Please place my/our name(s) on the register of Bondholder(s).
No. of Bonds - (Minimum 2 Bonds) (Maximum 500 Bonds) Bank A/c Number from
Cheque / Demand Draft Drawn on Cheque / Demand Draft
which investment is Dated
In Numbers (Name of the Bank and Branch) / UTR No.
made
In Words
Issue Price of Bond Rs. 10,000 per bond
Amount Payable (Rs.) = No. of Bonds x Rs. 10,000 per bond
Amount in Numbers (Rs.)
Amount In Words (Rs.)
I/We are applying as (Tick) whichever is applicable
Banks/Commercial RRB/ Financial Institutions Company Mutual Fund Firms NRI (Mention Country of Residence) Individuals HUF Others ( specify)
Co-Operative
BOND CERTIFICATE MODE (TICK) ANY ONE
Physical Mode Demat Mode DP ID No Client ID No

FIRST/ SOLE APPLICANT'S NAME IN FULL

Date of Birth (if minor)

SECOND APPLICANT'S NAME IN FULL (ONLY IN CASE OF INDIVIDUALS)

THIRD APPLICANT'S NAME IN FULL (ONLY IN CASE OF INDIVIDUALS)

FATHER'S NAME FOR FIRST / SOLE APPLICANT IN CASE OF INDIVIDUALS

FIRST/SOLE APPLICANT'S ADDRESS IN FULL (DO NOT FILL IN NAME AGAIN)

CITY PIN
CODE
Mobile Email

BANK PARTICULARS FOR PAYMENT OF INTEREST/REDEMPTION WARRANT (PLEASE ENCLOSE CANCELLED CHEQUE OF BELOW ACCOUNT NO.)
Bank Name Account No

Branch Name / Address Account Type SB A/c Current A/C Cash Credit A/c NRO A/c

FOR NECS/RTGS/NEFT PAYMENT

IFSC Code MICR Code
Abstract of Form - SH-13 (Nomination Form) (For Individual Only) Name of Authorised Signatory(ies) Designation
(Other than Individual)
Name of Nominee…………………………………………………………………………………………………………………….
1…………………………………………… 1………………………………………….
Address………………………………………………………………………………………………………………………………….
PAN / AADHAAR No. of Nominee……………………………………………. Relation with Applicant………………………. 2…………………………………………… 2………………………………………….
In case of Nominee is Minor: Disclaimer : The Bond Issue is being made strictly on a private placement basis. It is not and should not
Name of Guardian................................... ………………………………… be deemed to constitute an offer to the public in general. It cannot be accepted by any person other
Date of Birth (if minor). .....................................Signature of Nominee/Guardian (optional) than to whom it is directed.
(One Nominee per application)
DECLARATION: “I /We certify that the aggregate investment made/being made by me/us in 54EC Capital Gain Tax Exemption Bonds during the current financial year does not exceed Rs. 50 lakhs and the sources of funds is
capital gain on land or building or both”. I/ We declare that the investment has been made from the First Applicant’s own Bank Account.
PAN OCCUPATION SIGNATURE
FIRST APPLICANT
SECOND APPLICANT
THIRD APPLICANT
…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….
ACKNOWLEDGEMENT SLIP POWER FINANCE CORPORATION LIMITED
( To be filled in by the Sole/First Applicant ) (A Navratna Company) Application Number
Regd. Office : Urjanidhi, 1 Barakhamba Lane, Connaught Place, New Delhi- 110001 20014660
PFC Capital Gain Tax Exemption Bonds-SERIES-IV
No. of Bonds Amount (Rs.) Date Accepting Officer's
Received from Mr./Mrs./Ms………………………………………. (Max. 500) Signature & Bank's Seal
In Numbers
Phyical / Demat Mode (Tick whichever is applicable)
In Words
DPID & CLIENT ID
NO (if applicable)

Address…………………………………………………………………………………………………………………………….. Cheque / DD No……………………………… dated…………………………drawn on ………………………………………………………………….

……………………………………………………………………………………………………………………………………………… ……………………………………….For Rs…………………………………………………………………………………………………………………………….

In words……………………………………………………………………………………….………………………………………………………………………….
 POWER FINANCE CORPORATION LIMITED
KNOW YOUR CUSTOMER FORM (KYC) - APPLICABLE TO INVESTOR APPLYING IN PHYSICAL MODE
1. Name of Applicant (1st Applicant)/HUF/Corporate/Firm/Trust/Funds etc.

2. PAN / DIN (Issued by MCA, Wherever applicable)

3. Permanent Address (with telephone nos.) in case of Individual and HUF

APPLICANT’S UNDERTAKING
I/We hereby agree and confirm that:

1. I/We have read, understood and agreed to the contents and terms & conditions of Power Finance Corporation Limited Private Placement Information
Memorandum for Bond SERIES-IV, provisions of Section 54EC of Income Tax Act, 1961 and other related laws.
2. I/We confirm that the information provided in this form is true & correct and I/We enclose herewith Self attested copies of KYC Documents.
3. I/ We understand and agree that Interest rate for application amount credited in PFC's Collection Account is 5.00% p.a.
4. The Source of Funds for the investment is Capital Gains arising from the transfer of land or building or both.

Applicant’s Signature

VERIFICATION

I.............................................................................................................................. do hereby declare that what is stated in the application is true to the best of my
knowledge and belief.

Verified today, the………………………………. day of ……………………………

Place………………………………..

……………..……………………………
Signature of the declarant

FORM NO. 60 (See second proviso to rule 114B)

Form of declaration to be filled by a person who does not have a Permanent Account Number (PAN) and who enters into any transaction specified in rule 114B
1. Full name and address of the declarant……………………………………………………………………………………………………………………………………………………
2. Particulars of transaction…………………………………………………………………………………………………………………………………………………………………………
3. Amount of the transaction: .......................................................................................................................................................................
4. Are you assessed to tax? ...........................................................................................................................................................................
5. if yes,
(i) Details of Ward/Circle/Range where the last return of income was filed ………………………………………………………………………………………….
(ii) Reasons for not having permanent account number………………………………………………………………………………………………………………………..
6. Details of the document being produced in support of address in serial no. 1 above ………………………………………………………………………………..

Documents as an address proof (Any one of the following) :

Ration Card or ADHAAR Card; (b) Passport; (c) Driving Licence; (d) Voter Identity Card; (e) Copy of the electricity bill or telephone bill showing residential address;
(f) Any other document or communication issued by any authority of the Central Government, State Government or local bodies showing residential address; (g)
Any other valid documentary evidence in support of his address given in the declaration.

Applicant’s Signature

Registrar and Transfer Agent (R&TA) : Any further communications in connection with this application (quoting the application number) should be
addressed to KFin Technologies Private Limited (Formerly known as “Karvy Fintech Private Limited”) Selenium Tower B, Plot Nos. 31 & 32, Financial
District, Nanakramguda, Serilingampally Mandal, Hyderabad – 500032, P: +91 40 6716 2222, F: +91 40 2343 1551, Contact Person : Mr. M Murali Krishna
& Mr. R.Williams, Tel: +91 40 67162222, Fax : +91 40 23431551. Email : [email protected], Website : www.kfintech.com

PFC Investors Service Cell: Power Finance Corporation Ltd, Urjanidhi, 1, Barakhamba Lane, Connaught Place, New Delhi - 110001
Toll Free No. : 1800-11-5080, Tel. : +91 11 23456000, Fax.: +91 11 23456293, Email : [email protected], Website : www.pfcindia.com
 INSTRUCTIONS FOR INVESTORS
1) Application Forms must be completed in BLOCK LETTERS IN ENGLISH. A blank space must be left between two or more parts of the name.

2) Minimum investment - 2 Bonds of Rs. 10,000/- each and Maximum investment - 500 Bonds amounting to Rs. 50 lakhs in a financial year.

3) a) Investors are required to submit the duly filled in Application Form along with necessary enclosures at the designated branches of collecting banks- HDFC
Bank, Indusind Bank, YES Bank, ICICI Bank, Kotak Mahindra Bank or Canara Bank. Demand Draft or account payee Cheque should be drawn in favour of "PFC
Capital Gain Bonds". UTR details in case of investment by RTGS/NEFT, must be mentioned in the relevant box in the application form.

b) For details of designated bank branches, please refer Information Memorandum (IM) or visit our website: www.pfcindia.com.

c) Applicant should mention his name, address and application number on the reverse of the Cheque/ Demand Draft. Cash, Money Orders or Postal Orders will
NOT be accepted.

d) Investors are advised in their own interest to fill up complete details of their bank particulars alongwith a cancelled cheque. In absence of such information,
the interest & redemption warrants shall be mailed at given address at applicant's sole risk.

e) A copy of the Information Memorandum for the bond issue containing all the details of the issue is available at PFC’s website www.pfcindia.com

4) Application once submitted cannot be withdrawn and subscription amount will not be refunded.

5) The application should be submitted during banking hours at any of the Collection Branches of the banks to the bond issue as mentioned in the Information
Memorandum for the bonds. Outstation Demand Draft should be made payable at any of the designated collection centres mentioned in Information Memorandum.
Bank charges for such applications will be borne by applicants. PFC assumes no responsibility for any applications/ cheques / demand drafts lost in mail or late / short
credit of Application Money.

6) In case the investor has applied for and not yet been allotted the PAN then he is required to furnish a copy of the acknowledged Form 49A and on subsequent
allotment of PAN, he should submit a copy of PAN to RTA. In case PAN has not been allotted he is required to furnish a declaration in Form 60.

7) In case of application under the Power of Attorney or by Limited Companies or other corporate bodies, a certified copy of the Power of Attorney or a copy of the
approval of the relevant authority, as the case may be should be submitted along with the Application Form.

8) In case a partnership firm makes investments, the application is required to be made in the name of the partnership firm and the application form can be signed by
any partner(s) authorised to do so in this behalf and affixing a rubber stamp of the firm.

9) The applications would be accepted as per the provisions of the IM of the issue & other applicable rules and regulations. Applicants are deemed to have read the IM
and are supposed to be well versed with terms and conditions of the offer. PFC is entitled, at its sole and absolute discretion, to accept or reject any application, in
part or in full, without assigning any reason. An application form that is not complete in all respects is liable to be rejected and would be returned by PFC to the
applicant along with invested amount (if any) without any interest.

10) It is advisable that investor keeps a photocopy of the application form and mentions his/her mobile number, email ID in the application form.

11) In case of Bonds allotted under Demat Mode, the demographic details will be picked up from the DP ID/ CLIENT ID i.e Payment warrants would be prepared in
favour of sole/ first applicant and issued as per the details identified by the Bondholder's Demat Account. Bank details mentioned in the application form would
not be considered for making payment of interest and redemption of principal amount in case of bonds allotted in Demat Mode.

12) In case, where the investor applies for bonds under Physical Mode, all the Payment Warrants will be issued as per the details captured in the Register of
Bondholders and any discrepancy arising due to wrong information furnished in the application form shall be at the applicant's sole risk. As a matter of precaution
against possible fraudulent encashment of interest/redemption warrants due to loss/ misplacement, applicants are requested to mention the full particulars of
their bank account, as specified in the Application Form and also attach a cancelled cheque of the account mentioned.

13) ISSUE HIGHLIGHTS : Interest rate is 5.00 % payable annually on July 31st. Lock in period of 5 years (No transfer/premature redemption is permitted). The Bonds will
automatically redeem after expiry of five years. Bonds are AAA rated by CRISIL, ICRA and CARE.

14) Interest/Redemption shall be paid by way of warrant/NECS/RTGS/NEFT payable at par at all locations to the bondholders by the bank. Interest is payable annually
on July 31st every year till date of redemption.

15) Tax will not be deducted at source for resident Indians as PFC has been exempted from deduction of TDS under section 193 (iib) of the Income Tax Act, 1961 (vide
Ministry of Finance’s notification no. 27/2018 dated 18th June 2018). However, TDS shall be deducted in case of NRI / non-resident investors. NRI must mention the
name of the Country in the box appearing against the status of NRI overleaf.

16) PFC reserves the right to revise the coupon rate and/or close the issue by giving a notice.

17) For status of allotment/ servicing or any other details, please contact our RTA/ PFC Investors Services Cell.

18) PFC shall not be responsible for denial of benefit under Section 54EC of the Income Tax Act, 1961 to the investor and any consequences arising thereof.
ALL INVESTORS TO PROVIDE

• Self-attested copy of PAN Card (In case of Joint application, self-attested PAN copy of all the applicants) or Form 60 where bond application
size is Rs. 50,000/- or more.
• Photo Copy of cancelled Cheque for NEFT/RTGS facility.

I. For Resident Indian Nationals

Documents in support of Name and Address (copies attested by Gazetted Officer/Notary/Self Attested in case of Individual only)

a) AADHAAR Card
b) Passport
c) Driving License
d) Identify Card issued by any institution
e) Copy of the electricity bill or telephone bill showing residential address
f) Any document or communication issued by any authority of the Central Government, State Government or local bodies showing residential address
g) Voters Identity Card
h) Ration Card

II. For NRIs/ Other foreign eligible investor

a) Passport-Mandatory
b) Driving License

III. For Corporate-Investor

Documents in support (copies attested by Company Secretary/Director)

a) Certificate of Incorporation and Memorandum & Articles of Association

b) Resolution of the Board of Directors and identification of those who have authority to operate
c) Power of Attorney granted to its managers, officers or employees to transact business, on its behalf
d) Copy of PAN/PAN Allotment letter.

IV. For Partnership Firms-Investor

Documents in support (copies attested by Notary)

a) Registration certificate, if registered

b) Partnership deed
c) Power of Attorney granted to a partner or an employee of the firm to transact business on its behalf
d) Any officially valid document identifying the partners and the persons holding the Power of Attorney and their addresses
e) Telephone bill in the name of firm/partners

V. Trust & Foundations-Investor

Documents in support (copies attested by Notary)

a) Certificate of registration, if registered

b) Power of Attorney granted to transact business on its behalf
c) Any officially valid document to identify the Trustees, Settlors, Beneficiaries and those holding Power of Attorney, Founders/Managers/ Directors and their
addresses
d) Resolution of the managing body of the Foundation/Association
e) Telephone bill
f) Copy of PAN/PAN Allotment letter (otherwise exemption certificate issued by IT Authorities)