APPLICATION FORM FOR FIXED DEPOSIT SCHEME TATA TATA MOTORS LIMITED Registered Ofice: Bombay House, 24, Homi Mody Street, Mumbai - 400001 IM FINANGIALSERVIGES PVT. LTO] Please write in BLOCK LETTERS and tek (9) th ive hereby apply for he placement of a di ae as priate box. ted Deposit with your Company as per the details given below:- NAME OF THEDEPOSITOR(S) (FIRST NAME infu (MIDDLE NAME (SURNANE PANN sori senatan Sera neta ic anna oan ott hot we pte = Metie try fr al appears) anoness| f Ta. Eval CATEGORY Pee) aryere STATUS Plase(_) ayow | DEPOSIT PAYABLE TO Pas anyere CITATA MOTORS SHAREHOLDER (May attach dernat statement) © CJPUBLIC D. RESIDENT INDIVIDUAL C1 First Named Depositor C1 Either or Survivor EDP & Clr Ne fur Aryan or Sartor Liewpcovee no PARTICULARS OF OTHER DEPOSITS [NAVE oF compli oO o CISENIOR CITIZEN (Atach age proof document) Ves No Peas see ssvaters Toms scandens ferme 1. ihyes FOR Nets Date SCHEME A SCHEME, B Pease ) anyore (Clovarterty [] MonTHLY | [_] 2 YEARS [_] 3 YEARS | [_] CUMULATIVE 2 YEARS [C] cumuLarive 3 Years Rs datea FRESH DEPOSIT AMOUNT (MINIMUM RS.20,0007- & IN MULTIPLES OF RS.10,000";) RENEWAL OF DEPOSIT Please (_)any ene Fupees chOD No. FOR No, drawn on: (BR) en for Rs. Maturity Date DEDUCTION OF INCOME TAX Please ) any one (leace se netuetane in ID Form 18H 156 (in duplicate) is enclosed. Therelre, dont deduct Income Tax. Teime &Canditns tem nea) 1 Otters, Please specly ‘Bank Detalie for InteresuPrincipal payment of Sl e/First Applicant (Please refer to Instructions in the Terms and Condlions Kem nos.3 & 108) [Savings / (1 Curent Please) any one [Interest other than en matutiy) option Please( anyone 1 BNECS 1 By Cheque Aczount No Bank's Name [rnc NOMINATION (OPTIONAL) _ (Please see instructions in Terms and Conaions,liem No.6) Where the deposits inthe name a a miner, the nomination shoul be signed by person lawful ented to act on behalf of the miner We Perebyreminae the folowing person oes the amount payable te mel, on mou death Nominee's name Guardian's Name (ther tan Appteant nears Nararee = Mira] Tgnatare of Nemsnes (eptenal) Adress ofthe Nominee! Guardian I Ph Tel ‘Signature of Appleanis) tor nomination ‘Winesses Signature Name & Aaerees 1 Soloist Applicant Second Applicant The Applicant 2, Fororreceuse ony DECLARATION CENEHAL ety ech hal arma pid eth ol yagi secs, Dancer Oa feet song sing ptm ay ah per) Me ec hal borane eps rete ‘pple enacts estos ih sb en os payee pose om Factor Sean th hc Tech 8 Te TOS we decd wai —— St Salon or pe ~ We fw mad & apne ae by he ated bs & cers gig te Dept ad dc a a Sh $$ ME strani oplan ne beam re Peel SIGNATURE OF THE APPLICANTS (umean sous sgn he spre ino ee SOLEFRST APPLICANT SECOND APPLICANT THIRD APPLICANT Pyinip i. Da lerCoe Ns, etme tae sepia Shh Enel kta Fale. Erle D | genameniseoe, hod Sign Courier to: JM FINANCIAL SERVICES PVT LTD.02/003 Anushka New Link Road,Oshiwara Andheri West Mumbai- 400053.