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TATVA CHINTAN PHARMA CHEM LIMITED - Initial Public Offer - R FOR RESIDENT INDIAN Investors INCLUDING
Br
 16-31
oki
ng COmmon BID CUM Registered Office: Plot No. 502 / 17, GIDC Estate, Ankleshwar, Bharuch, Gujarat – 393 002, India; Telephone: +91 75730 46951 / +91 75730 46952 RESIDENT QIBs, NON-INSTITUTIONAL BIDDERS,
Ltd
Corporate Office: Plot No. 353, Makarpura GIDC, Vadodara, Gujarat – 390 010, India RETAIL INDIVIDUAL BIDDERS AND ELIGIBLE NRIs
.
APPLICATION FORM Contact Person: Apurva Dubey, Company Secretary and Compliance Officer; Telephone: + 91 75748 48533 / +91 75748 48534; E-mail: cs@tatvachintan.com
APPLYING ON A NON-REPATRIATION BASIS
23/
Website: www.tatvachintan.com; Corporate Identity Number: U24232GJ1996PLC029894
TEAR HERE

13
11
6- To, 100% BOOK BUILT Offer Bid cum
The Board of Directors
31
ISIN : INE0GK401011 Application
TATVA CHINTAN PHARMA CHEM LIMITED Company LEI no : 335800I28VDPT9WEFU68 Form No.
58219712
SUB-SYNDICATE MEMBER / REGISTERED BROKER / 1. NAME & Contact Details of Sole / First BIDDER
Members of the Syndicate STAMP & CODE SCSB / CDP/RTA / AGENT STAMP & CODE
Mr. /Ms./M/s.
Edelweiss Broking Limited

SUB-BROKER’S / SUB-AGENT’S STAMP & CODE SCSB BRANCH STAMP & CODE Address

Email

BANK BRANCH SERIAL NO. SCSB SERIAL NO. Tel. No. (with STD code) / Mobile
2. PAN of SOLE / FIRST BIDDER

3. bidder’s depository account details NSDL CDSL 6. Investor Status

Individual(s) - IND
Hindu Undivided Family - HUF*
Bodies Corporate - CO
For NSDL enter 8 digit DP ID followed by 8 digit Client ID / For CDSL enter 16 digit Client ID Systemically Important NBFCs
Banks & Financial Institutions - FI
4. Bid Options (Only Retail Individual Bidders can Bid at “Cut-off”) 5. Category Mutual Funds - MF
National Investment Fund - NIF
No. of Equity Shares Bid (In Figures) Price per Equity Share (`)/ “Cut-off” Retail Insurance Funds - IF
(Bids must be in multiples of (Price in multiples of ` 1 only) (In Figures only) Individual Insurance Companies - IC
Bid Bid Lot as advertised) Bidder Venture Capital Fund - VCF
Options Bid Price Retail Discount Net Price “Cut-off” Alternative Investment Fund - AIF
8 7 6 5 4 3 2 1 3 2 1 3 2 1 3 2 1 (Pleasetick) Non- Other QIBs - OTH
Institutional Non Resident Indian - NRI
(Non repatriation basis)
Option 1 Bidder
All entities other than QIBs, Bodies
Corporates and Individuals - NOH
(OR) Option 2 Please Specify__________________
QIB
Please Fill in Block Letters

*HUF should apply only through Karta (Application by

(OR) Option 3 HUF would be treated on par with individual).

7. PAYMENT DETAILS [IN CAPITAL LETTERS] PAYMENT OPTION : Full Payment 

Amount blocked (` in figures) (` in words) _____________________________________________________________________
ASBA
Bank A/c No.
Bank Name & Branch _____________________________________________________________________________________________________________________________
OR
UPI ID (Maximum
45 characters)
I/We (on behalf of joint BIDDERS, if any) hereby confirm that I/We have read and understood the terms and conditions of this COMMON Bid Cum Application Form, the
attached ABRIDGED PROSPECTUS AND THE GENERAL INFORMATION DOCUMENT FOR INVESTING IN PUBLIC ISSUES (“GID”) and hereby agree and confirm the ‘Bidder’s Undertaking’ as given
OVERLEAF. I/We (on behalf of joint BIDDERS, if any) hereby confirm that I/We have read the Instructions for filling up the COMMON Bid Cum Application Form given overleaf.
8B. signature OF ASBA BANK ACCOUNT HOLDER(s) MEMBERs OF the SYNDICATE / SUB - SYNDICATE
8A. signature OF SOLE/ first BIDDER MEMBER / R E G I S T E R E D B roker / SCSB / CDP /
(As per Bank records) RTA / Agent STAMP (Acknowledging upload of
I/We authorise the SCSB to do all acts as are necessary to make the application in the Offer. Bid in Stock Exchange system)
1)

2)

Date : ________________, 2021 3)

TEAR HERE
Acknowledgement Slip for Bid cum
TATVA CHINTAN PHARMA CHEM LIMITED Application
Members of the Syndicate / sub-syndicate
Member / Registered Broker / Form No.
58219712
Initial Public Offer - R SCSB / CDP / RTA / Agent
PAN of Sole / First Bidder
DP ID
/
CL ID

Amount blocked (` in figures) ASBA Bank A/c No./UPI Id Stamp & Signature of SCSB Branch
Bank Name & Branch

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

Telephone / Mobile Email
TEAR HERE
Printed by : www.westernpress.in

Stamp & Signature of Members of the Syndicate / sub-syndicate Name of Sole / First Bidder
Option 1 Option 2 Option 3
TATVA CHINTAN PHARMA

Initial Public Offer - R

Member / Registered Broker / SCSB / CDP / RTA / Agent

No. of Equity Shares
CHEM LIMITED -
TEAR HERE

Bid Price
Amount Blocked (` in figures) Acknowledgement Slip for Bidder

ASBA Bank A/c No./UPI Id _____________________________________________________________________________________ Bid cum

Application
58219712


Bank Name & Branch Form No.

Important Note : Application made using third party UPI ID or ASBA Bank A/c are liable to be rejected. TATVA CHINTAN PHARMA CHEM LIMITED 1