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application form
(FOR resident Applicants)

RURAL ELECTRIFICATION CORPORATION LIMITED

COMMON APPLICATION FORM

FOR ASBA / NON ASBA

(A Government of India Undertaking)

Credit Rating : [CRISIL] AAA (stable) by CRISIL Limited, CARE AAA by CARE Limited, ICRA AAA by ICRA Limited and
IND AAA / Stable by India Ratings & Research Private Limited

ISSUE OPENS ON : October 27, 2015

ISSUE CLOSES ON* : November 4, 2015

*For early closure or extension of the issue, refer overleaf

Application
To, The Board of Directors,
Form No.
RURAL ELECTRIFICATION CORPORATION LIMITED
PUBLIC ISSUE OF TAX FREE, SECURED, REDEEMABLE, NON-CONVERTIBLE BONDS IN THE NATURE OF DEBENTURES VIDE SHELF PROSPECTUS AND PROSPECTUS TRANCHE I DAteD October 21, 2015

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 Applicants Undertaking as given overleaf. I/we hereby confirm
that I/we have read the instructions for filling up the Application Form given overleaf.
ESCROW BANK / SCSB BRANCH
BANK BRANCH
REGISTRARS / SCSB
DATE OF
SUB- CONSORTIUM MEMBER /BROKERS
SUB BROKER/AGENT
LEAD MANAGER/ CONSORTIUM MEMBER/TRADING MEMBER STAMP & CODE
SERIAL NO.
RECEIPT
CODE
STAMP & CODE
SERIAL NO.
STAMP & CODE

23/12695-32

990373

1. APPLICANTS DETAILS - PLEASE FILL IN BLOCK LETTERS (Please refer to point no. 29 of the attached Abridged Prospectus)
First Applicant (Mr./ Ms./M/s.)
Date of Birth D D M M Y Y Y Y
Address

Name of Guardian (if applicant is minor) Mr./Ms.

Pin Code (Compulsory)

Tel No. (with STD Code) / Mobile

Email

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

Third Applicant (Mr./ Ms./M/s.)
2. Investor Category (Please refer overleaf) Category I

Category II

Category III

Category IV

Sub Category Code (Please refer overleaf)

3. PLEASE PROVIDE APPLICANTS DEPOSITORY DETAILS

(Please Refer To Point No. 29 Of The Attached Abridged Prospectus) 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)
Nomination (Please see point no. 83 of this Abridged Prospectus)
Name of the Nominee :_________________________________________________________________
If Nominee is Minor, Guardians Name :____________________________________________________

Bank Details for payment of Refund / Interest / Maturity Amount (Mandatory)

Bank Name & Branch :____________________ MICR Code :_____________________
Account No.: __________________________ IFSC Code : ______________________

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

Please Fill in Block Letters

Options / Series of Bonds

Coupon rate (%) per annum for Category I, II, III
Annualised yield (%) per annum for Category I, II, III
Options/ Series of Bonds
Coupon rate (%) per annum for Category IV
Annualised yield (%) per annum For Category IV

Tranche I Series 1A
6.89%
6.89%
Tranche I Series 1B
7.14%
7.14%

Tranche I Series 2A
Tranche I Series 3A
7.09%
7.18%
7.09%
7.18%
Tranche I Series 2B
Tranche I Series 3B
7.34%
7.43%
7.34%
7.43%
For Category I, II, III & IV
10 years
15 years
20 years
` 1,000 per Bond
` 1,000 per Bond
` 1,000 per Bond
Annual
5 Bonds (` 5,000) (individually or collectively, across all Series of Bonds) and in the multiple of 1 Bond (` 1,000) thereafter

Tenure
Face Value/Issue Price
Frequency of Coupon / Interest Payment
Minimum Application and in the multiple of thereafter
No. of Bonds applied
Amount Payable (`)
Grand Total (`)

Our Company shall allocate and allot Tranche I Series 1A/ Series 1B (depending upon the category of applicants) to all valid applications, wherein the Applicants have not indicated their choice of the relevant Series of Bond.
6. PAYMENT DETAILS (Please tick () 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) to be drawn in favour of REC Tax Free Bonds 2015 Escrow Account R
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 bonds through the ASBA process if you wish to be allotted bonds in physical form

7a. pan & signature OF

SOLE/ first APPLICant

7b. pan & signature OF

SECOND APPLICant

7C. PAN & signature OF

third APPLICant

pan

pan

pan

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)
2)

Furnishing PAN of the Applicant is mandatory including minors PAN in case of

Application by minor. Please refer point no. 31 of the attached Abridged Prospectus

Date : ___________________, 2015

RURAL ELECTRIFICATION
CORPORATION LIMITED

(A Government of India Undertaking)

3)

TEAR HERE

Application
Form No.

Acknowledgement Slip for Lead Managers/

Consortium Member/Sub-Consortium Member/
Brokers/Sub-Brokers/Trading Members / SCSBs

DPID/
CLID

LEAD MANAGERS / CONSORTIUM /

SUBCONSORTIUM MEMBERS /BROKER S/
SUBBROKERS/ TRADING MEMBERS /SCSB
BRANCHS STAMP
(Acknowledging upload of Application in
Stock Exchange system) (Mandatory)

PAN

Amount Paid (` in figures)

Date, Stamp & Signature of Escrow

Bank (Mandatory)

Bank & Branch

Cheque / DD/ASBA Bank A/c No.

Dated___________,2015

Received from Mr./Ms. /M/s.

Telephone / Mobile

Email

(A Government of India Undertaking)

RURAL ELECTRIFICATION
CORPORATION LIMITED

TEAR HERE

TEAR HERE
PUBLIC ISSUE OF TAX FREE, SECURED, REDEEMABLE, NON-CONVERTIBLE BONDS IN THE NATURE OF DEBENTURES VIDE SHELF PROSPECTUS AND PROSPECTUS TRANCHE I DAteD October 21, 2015
Options/Series of Bonds
Issue Price (`/Bond)
No. of Bonds applied for
Amount Payable (`)
Grand Total (`)

Tranche I
Series 1A / 1B
` 1,000

Cheque / DD/ASBA Bank A/c No.

Drawn on (Name of Bank & Branch)

Tranche I
Series 2A / 2B
` 1,000

Tranche I
Series 3A / 3B
` 1,000

Date Stamp & Signature of Lead Manager/ Name of Sole / First Applicant
Consortium Members/Sub-Consortium
___________________________________________
Members/Trading Members/SCSB

___________________________________________

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

Acknowledgement Slip for Applicant

Dated

,2015

All future communication in connection with this application should

be addressed to the Registrar to the Issue. For details, please refer
overleaf. Acknowledgement is subject to realization of Cheque /
Demand Draft availability of funds in the ASBA account.

Application
Form No.

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

990373

990373

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