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APPLICATION FORM
(FOR RESIDENT APPLICANTS)

D. S. KULKARNI DEVELOPERS LIMITED

Credit Rating : 'CARE BBB+ by CARE

To, The Board of Directors,

D. S. KULKARNI DEVELOPERS LIMITED

COMMON APPLICATION FORM ISSUE OPENS ON : AUGUST 4, 2014

ISSUE CLOSES ON* : AUGUST 26, 2014
FOR ASBA/NON ASBA
* For early closure of the Issue, refer page 3 of this Abridged Prospectus
Application
Form No. 53000564

PUBLIC ISSUE BY D.S.KULKARNI DEVELOPERS LIMITED ("COMPANY" OR THE "ISSUER") OF SECURED REDEEMABLE NON-CONVERTIBLE DEBENTURES OF FACE VALUE OF ` 5,000 EACH FOR OPTION I, II AND IV AND ` 25,000 EACH FOR OPTION III, ("NCDs"),
AGGREGATING UPTO ` 10,000 LAKHS (HEREIN REFERRED TO AS THE "BASE ISSUE SIZE") WITH AN OPTION TO RETAIN OVER-SUBSCRIPTION UPTO ` 10,000 LAKHS AGGREGATING UPTO ` 20,000 LAKHS (HEREINAFTER REFERRED TO AS THE "OVERALL ISSUE SIZE").
I/We hereby confirm that I/We have read and understood the terms and conditions of this Application Form and the attached Abridged Prospectus and agree to the 'Applicant's Undertaking' as given overleaf. I/We hereby confirm that I/We have read the instructions for filling up the Application Form given overleaf.

LEAD MANAGER /LEAD BROKERS/TRADING MEMBERS STAMP & CODE

SUB-BROKER/AGENTS STAMP & CODE ESCROW BANK / SCSB BRANCH STAMP & CODE BANK BRANCH SERIAL NO. REGISTRARS / SCSB SERIAL NO. DATE OF RECEIPT

Karvy Stock Broking Ltd.

23/07701-38
1. APPLICANTS DETAILS - PLEASE FILL IN BLOCK LETTERS (Please refer to instruction no. 25 of this Abridg ed Prospectus)
First Applicant (Mr./ Ms./M/s.)
Date of Birth
D D M M Y Y Y
Address

Name of Guardian (if applicant is minor)

Pin Code (Compulsory)

Tel. No. (With STD Code) / Mobile

Second Applicant (Mr./ Ms./M/s.)

Email

Third Applicant (Mr./ Ms./M/s.)

2. Investor Category (Please refer overleaf)

# In case of DSK Employees^$, Existing Equity Shareholders*, Senior Citizen, Servicemen, Ex-servicemen and Women, please tick the appropriate category below in order to avail addition coupon and mention the relevant sub
category code under serial no. 2.
Category I
^If the Applicant is a DSK Employeeplease mention Employee ID: _________________ Company Name :_______________________________________________
Sub Category
* If the applicant is an Existing Equity Shareholder Please mention Folio No./Client Id _________________
Category II
$
Please refer to Mandatory Kyc Documentation Requirements For Dsk Employees, Existing Equity Shareholders, Senior Citizen, Servicemen, Ex-servicemen And Women on Page 2 of this Abridged Prospectus.
Code#
Category III
For Additional KYC documents to be submitted in case of DSK Employees, Existing Equity Shareholders, Senior Citizen, Servicemen, Ex-servicemen and Women, please see overleaf.
3. IN CASE OF APPLICATION IN DEMATERIALISED FORM, PLEASE PROVIDE APPLICANTS DEPOSITORY DETAILS
For NSDL enter 8 digit DP ID followed by 8 digit Client ID / For CDSL enter 16 digit Client ID

NSDL /
CDSL
4. IN CASE OF APPLICATION TO HOLD THE NCDs IN PHYSICAL FORM, PLEASE PROVIDE FOLLOWING DETAILS
(Please enclose self attested copies of the KYC Documents along with the Application Form. For list of KYC documents, please refer overleaf )
Bank Details for payment of Refund / Interest / Maturity Amount (Mandatory)
NOMINATION (Please see point no. 71 of this Abridged Prospectus)
Name of the Nominee :
Branch :
Bank Name :
If Nominee is Minor, Guardians Name :
Account No.:
IFS Code :

PLEASE FILL IN BLOCK LETTERS

5. INVESTMENT DETAILS (For details, please refer Issue Structure overleaf)

6. PAYMENT DETAILS (Please tick (P

) any one of payment option A or B below)
Please write a Sole/First Applicants Name, Phone No. and Application No. on the reverse of Cheque/DD.

Amount Paid (` in figures)

(` in words)
(A) CHEQUE/ DEMAND DRAFT (DD) in favour of DSKDL - NCD Escrow Account
Dated D D M M Y Y

Cheque/DD No.
Drawn on (Bank Name & Branch)

(B) ASBA
Bank A/c No.
ASBA A/c. Holder Name __________________________________________________
(in case Applicant is different from ASBA A/c. Holder)
Bank Name & Branch ____________________________________________________
Please note that you cannot apply for the NCDs through the ASBA process if you wish to be Allotted the NCDs in physical form.

7B. PAN & SIGNATURE OF

SECOND APPLICANT

7C. PAN & SIGNATURE OF

THIRD APPLICANT

7D. SIGNATURE OF ASBA BANK ACCOUNT HOLDER(s)

(AS PER BANK RECORDS) (For ASBA option ONLY)

I/We authorize the SCSB to do all acts as are necessary to make

the Application in the Issue

1)

LEAD MANAGER / LEAD BROKERS/

SUB BROKERS / TRADING MEMBERS/SCSB
BRANCHS STAMP
(Acknowledging upload of Application
in Stock Exchange system)(Mandatory)

2)
Date : ___________________, 2014

Furnishing PAN is mandatory. Please refer point no. 29 of the Abridged Prospectus.

3)

TEAR HERE
Application
Form No.

Acknowledgement Slip
for Lead Manager / Lead Brokers / Sub Brokers
/ Trading Members/SCSB

D. S. KULKARNI DEVELOPERS LIMITED

DPID
/
CLID

53000564

PAN

Amount Paid (` in figures)

Stamp & Signature of Banker

Bank & Branch

Cheque / DD/ASBA Bank A/c No.

Dated

Received from Mr./Ms.

Telephone / Mobile

Email

D. S. KULKARNI
DEVELOPERS LIMITED

TEAR HERE
&

TEAR HERE
PUBLIC ISSUE BY D.S.KULKARNI DEVELOPERS LIMITED ("COMPANY" OR THE "ISSUER") OF SECURED REDEEMABLE NON-CONVERTIBLE DEBENTURES OF FACE VALUE OF ` 5,000 EACH FOR OPTION I, II AND IV AND ` 25,000 EACH FOR OPTION III, ("NCDs"),
AGGREGATING UPTO ` 10,000 LAKHS (HEREIN REFERRED TO AS THE "BASE ISSUE SIZE") WITH AN OPTION TO RETAIN OVER-SUBSCRIPTION UPTO ` 10,000 LAKHS AGGREGATING UPTO ` 20,000 LAKHS (HEREINAFTER REFERRED TO AS THE "OVERALL ISSUE SIZE").

Series
Issue Price (`)/ per NCDs

I
` 5,000/-

II
` 5,000/-

III
` 25,000/-

IV
` 5,000/-

Date Stamp & Signature of

Name of Sole / First Applicant
Lead Manager / Lead Brokers / Sub
Brokers/Trading Members/SCSB

No. of NCDs applied for

Acknowledgement Slip for Applicant

Amount Payable ( `)
Grand Total (`)

Total No. of NCDs

Cheque / DD/ASBA Bank A/c No.

Bank & Branch

Applications submitted without being uploaded on the terminals of the Stock Exchanges
will be rejected
.

Total Amount Payable (`)

Dated

All future communications in connection with this application should be

addressed to the Register to the Issue. For details, please refer overleaf.
Acknowledgement is subject to
Realisation of Cheque/DD/Availability at Funds in the ASBA account.
Applications submitted without being uploaded on the terminals of the
Stock Exchanges will be rejected.

Application
Form No.

53000564

While submitting the Application Form, the Applicant should ensure that the date stamp being put on the Application Form by the Lead Manager/Lead Broker /Sub Broker / Trading Members/SCSB matches with the date stamp on the Acknowledgement Slip.

Printed By : Crystal cfl_mum@crystalforms.com - 022-66140900

7A. PAN & SIGNATURE OF

SOLE/ FIRST APPLICANT

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