PSB-ESPS APPLICATION FORM

An offer of upto 5,00,00,000 new equity shares in aggregate of face value of Rs 10/- each at an offer proce of Rs 20.19
per equity share by Punjab & Sind Bank (issuer) to its eligible employees under Punjab & Sind Bank - Employee
share Purchase Scheme (PSB - ESPS) (hereinafter referred to as " Scheme ")
SNO DETAILS PARTICULARS / INFORMATION

1 Employee ID

2 Full Name ( as in Demat Account)

3 Scale

4 Designation

5 Date of Joining the Bank

6 Present Place of Posting

7 Complete Address
8
Contact Number

a)

b)

9 Corporate E-mail id, if any

10 Personal E-mail id, if any

11 PAN

12 Name of the Depository

13 DPID

14 Client ID

15 Name of the DP

16 Number of Share Eligible

17 Number of Share Applied

18 Offer Price Per Share RS. 20.19

19 Application Amount (in Rs.)

Bank Account details (For lien with an amount

20
equal to 19 above)

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VERIFICATION
I…………………………………………………………..hereby confirm that I have read and understood the
instructions for filling up this application form along with the terms and conditions specified in the HO HRD
Circular no. 3083 dated 28.05.2019 containing the detailed offer document alongwith other stipulations.
It is also confirmed that I have read the disclaimer given in the said circular and acknowledge and agree to the risk
involved in investing in the captioned offer.

Further, I confirm that I have also read and under stood the terms of the offer to the Eligible Employees under the
Scheme.
I hereby affirm that I am an Employee of the Bank eligible to participate in the offering made under the scheme.

I hereby assert that I have read and understood the Bank's policy for prevention of Insider Trading and understood
the provisions contained therein.

I hereby certify that the information provided by me in this application form is ture and accurate in all respects.
I hereby authorize Punjab & Sind Bank to deduct TDS from my salary for the purpose of Tax on the value of
perquisite arising out of this offer.
I hereby authorize Punjab & Sind Bank to mark lien in my A/c No.……………………………………………… With
an amount of Rs……………………… towards my Share Application Money for ………………………………….
Equity Shares applied by me under the Scheme.

Place :………………………………

Date :………………………………. Signature of Employee

A/c No. …………………………………………………………………………………. Liened with an amount of

Rs………………….……….. Against the application submitted by the employee.

Place :………………………………..

Date :……………………………….. Signature of Branch Official