APPLICATION FOR NOMINATION OF SHARES

I/we being the nominee in respect of the under mentioned shares of the Bank allotted to
the Late Shri / Smt. VIJAY MARUTIRAO BANGADE hereby agree to accept and hold
the said shares in my/our name(s) and also agree to pay all calls/arrears due on the said
shares and agree to be registered as member (S) in the Register of Member of the Bank
subject to the provision of the Memorandum & Articles of Association of the Bank.
Full Name of the Company

: BANK OF MAHARASHTRA

Number and full Description of

Shares allotted

: 345696701 TO 345696800

Number & Class of shares allotted

: EQUITY SHARES EACH RS. 10

Date of Death

: 30-03-2015

Full name of the Nominee(s)

: MADHURI VIJAY BANGADE

Name or title of the document(s)

Produced in support of the claim to
the shares allotted to the deceased.

Original Share Certificate

Attested copy of death certificate
: Self attested copy of Pan card

I/We undertake that in case there is any claim from any third party arising out of
transmitting the said securities in my/our names. I/we/our respective heirs, executors and
administrators defend and keep harmless and indemnify Bank OF Maharashtra from and
against any actions, causes, suits, proceedings, accounts, claims and demand whatsoever
on account of the said securities.
I/We declare that information given above is true and correct to my/our knowledge and
that I/we am/are the only nominee(s) in respect of the shares of the Bank allotted to the
deceased above named.
SIGNED & DELIVERED by me/us this -19 October 2015
Signature of Witness
Signature(s) of the nominee(s)
Full Name & Address of the Witness : RUTURAJ VIJAY BANGADE
2367 C Ward, Sonya Maruti Chowk,
Shaniwar Peth, Kolhapur 416 002
Particulars of the nominee(s) :
Shri/ Smt./ Kum.
Occupation Full Address
Fathers / Husbands Name
-----------------------------------------------------------------------------------------------------------MADHURI VIJAY
2367 C Ward,
VIJAY MARUTIRAO
BANGADE
Sonya Maruti Chowk,
BANGADE
Shaniwar Peth,
Kolhapur 416 002

AFFIDAVIT
(On non Judicial stamp paper of Rs.100/- )

I / We MADHURI VIJAY BANGADE ( Full Name(s) of holder(s) / applicants(s)

Solemnly affirm and say that what is stated in answer to the questions on the form of the
reverse and marked Q is true to our knowledge.

Date. ___________

________________________
Signature(s) of the applicant(s)

Solemnly affirmed at ______________________ on the ________day of_______20__

Full Name ___________________________
Of

Signed in presence

Address of
Magistrate /
Notary

Regn. No.

( Signature of Magistrate / Notary )