Latabai Balashiram Panmand

Address: Gavthan Mhaskewadi, Mhaskewadi, Ahmadnagar Chombhut Maharashtra 414305

Contact:9819922226
Email: shaileshpanmand@gmail.com

ISSUE OF DUPLICATE SHARE CERTIFICATE CUM ALONG WITH IEPF 5

Date: - , 2023
To,
KFin Technologies Ltd
Karvy Selenium, Tower- B, Plot No. 31 & 32, Financial district, Nanakramguda, Serilingampally
MandalHyderabad,Telangana500032
Phone: 040 - 67161500 / 18003454001
Email: einward.ris@karvy.com

Unit: JSW STEEL LIMITED

DP Id: - 1204720031478060
Folio No.: JSW0175912
Subject: Issue of Duplicate share certificate cum along with IEPF-5

Dear Sir,

This is with reference to the email received from your end dated regarding details of shares and
dividend; I/we would like to put forth the following:

I/We Latabai Balashiram Panmand , C/O Balvant Baban Dhavan, Aged 58 An Indian Inhabitant
Residing Atgavthan Mhaskewadi, Mhaskewadi, Ahmadnagar Chombhut Maharashtra 414305, Solely
/ jointly hold shares of JSW STEEL LIMITED having40 shares with aged an Indian Inhabitant resident
of and c/o aged an Indian inhabitant residing at , registered in my/our name bearing Folio No.
JSW0175912.

All these shares have been transferred to IEPF on account of non-claiming of dividend for the period of
seven consecutive years or more.

Further note that out of 40 shares, shares are lost / stolen / misplaced.

Details of shares transferred to IEPF are as follows:

Folio No. Certificate No. Distinctive From Distinctive To No. of shares

JSW0175912 2562843 2391803381 2391803420 40
JSW0175912 - -
JSW0175912 - -
JSW0175912 - -
JSW0175912 - -

Details of Dividend transferred to IEPF are as follows:

Folio No. Dividend amount

JSW0175912 1546

I/We hereby attach the below mentioned documents to support my claim for issuance of Duplicate Share
Certificate for shares and claiming of all40 shares from IEPF-5.
ENCLOSURES

S. NO PARTICULARS ANNEXURES
Email received from your end
1. Annexure I
Acknowledgement of IEPF 5 e- Form
2. Annexure II
Duly signed copy of IEPF e-form
3. Annexure III
Indemnity Bond in Original on stamp paper of Rs. 500/-
4. Annexure IV
Affidavit For Address Mismatch On NJS of Rs.100/-
5. Annexure V
Indemnity Bond along with two witnesses for issuance of Duplicate share Annexure VI
6.
certificate on required NJS
Affidavit for issuance of Duplicate Share Certificate on required NJS
7. Annexure VII

8. Self-attested copy of PAN, Aadhar of Latabai Balashiram Panmand , , Annexure VIII

Self -attested copy of PAN & Aadhar of witnesses
9. Annexure IX
Signature attestation letter from Bank (Form ISR - 2)
10. Annexure X
Original Canceled Cheque
11. Annexure XI
Self-attested and duly certified Client Master List
12. Annexure XII
Form ISR - 1
13. Annexure XIV
Form ISR - 4
14. Annexure XV
Form ISR - 3 or Form SH - 13
15. Annexure XVI

Therefore you are requested to transfer our shares from IEPF account to our demat account having Folio
ID 1204720031478060 along with issuing a duplicate share certificate in respect of 40 shares.

For further queries, please contact me at 9819922226 or Email shaileshpanmand@gmail.com.

Thanking you in anticipation,

Latabai Balashiram Panmand

 Indemnity Bond

To
The Investor Education and Protection Fund Authority
Ground Floor, Jeevan Vihar Building, 3,
Sansad Marg, New Delhi, Delhi 110001

In consideration of the payment of Rs 1546 and No. of shares 40 being the amount and shares due to me
as Dividend on Equity Shares (Dividend on Equity / Preference shares / matured deposits / matured
debentures /application money due for refund / interest accrued on/Dividend credited to IEPF under
Companies Act, 1956 or Companies Act, 2013/ Dividend credited to General Revenue Account under
Companies Act, 1956 / others, specify)# for the Financial Year FROM 2009-2010 TO 2013-2014 FROM
2016-2017 TO 2021-2022 from M/s JSW STEEL LIMITED out of the Investor Education and Protection
Fund by the Authority, I/We Latabai Balashiram Panmand care of Balvant Baban Dhavan & care of do
hereby agree and undertake to indemnify the Investor Education and Protection Fund Authority to the
extent of any claim not exceeding the amount hereinbefore mentioned which may be preferred against the
Investor Education and Protection Fund Authority, and which it has to lawfully discharge.

Signature

Date:
Place:

Witnesses:

1. Signature with date

Name
Address

2. Signature with

date Name
Address

* For ensuring timely processing of the claim, please ensure to make all the entries

# Strike off whichever is not applicable

 8135

Form ISR-4
(see circular No. SEBI/HO/MIRSD/MIRSD RTAMB/P/CIR/2022/8 dated January 25, 2022
on Issuance of Securities in dematerialized form in case of Investor Service Requests)
Request for issue of Duplicate Certificate and other Service Requests
(for Securities - Shares / Debentures / Bonds, etc., held in physical form)
Date:___ /___ /______

A. Mandatory Documents / details required for processing all service request:

I / We are submitting the following documents / details and undertake to request the Depository
Participant to dematerialize my / our securities within 120 days from the date of issuance of
Letter of Confirmation, received from the RTA/Issuer Company (tick ü as relevant, refer to the
instructions):
·Demat Account No. (If available): 1204720031478060
Provide Client Master List (CML) of your Demat Account from the Depository Participant*
Provide the following details, if they are not already available with the RTA (see SEBI circular dated
November 03, 2021 in this regard)

PAN GWTPP9639H, and Specimen Signature

Nomination / Declaration to Opt-out

* (Your address, e-mail address, mobile number and bank details shall be updated in your folio from the
information available in your CML). You can authorize the RTA to update the above details for all your
folios. In this regard, please refer to and use Form ISR-1 in SEBI circular dated November 03, 2021.

B. I / We request you for the following (tick relevant box)

. Claim from Unclaimed

. Issue of Duplicate certificate
Suspense Account
. Replacement / Renewal / Exchange of securities .Endorsement
certificate
.Sub-division / Splitting of securities certificate . Consolidation of Folios
. Consolidation of Securities certificate .Transmission
. Transposition (Mention the new order of holders here)

C. I / We are enclosing certificate(s) as detailed below**:

Name of the Issuer Company

Folio Number
Name(s) of the security holder(s) as per the certificate(s)
Certificate numbers
Distinctive numbers
Number & Face value of securities

** Wherever applicable / whichever details are available

D. Document / details required for specific service request:

I. Duplicate securities certificate
II. Claim from Unclaimed Suspense Account
 Securities claimed

III. Replacement / Renewal / Exchange of securities certificate

(that is defaced, mutilated, torn, decrepit, worn out or where the page on the reverse is fully utilized)
IV. Endorsement
V. Sub-division / Splitting of securities certificate
VI. Consolidation of securities certificate/Folios
VII. Transmission
VIII.Transposition

Provide / attach original securities certificate(s) for request for item numbers III to VIII above.

Declaration: All the above facts stated are true and correct to the best of my / our knowledge and belief.

Security Security
Security Holder 1 / Claimant
Holder 2 Holder 3

Signature

Latabai Balashiram Panmand

Name

Gavthan Mhaskewadi, Mhaskewadi,

Full address Ahmadnagar Chombhut Maharashtra
414305
414305
PIN

After processing the service request, the RTA shall issue a ‘Letter of Confirmation’ to the securities
holder/claimant, which is valid only for 120 days. Using this ‘Letter of Confirmation’, the securities
holder/claimant shall request the DP to dematerialize the securities, failing which the securities shall be
credited to the Suspense Escrow Demat Account of the Company.
 FORM –A AFFIDAVIT
[For issuance of duplicate securities]
Note: This indemnity is to be executed in the presence of a Public Notary/Gazetted Officer
[Submitted in non-judicial stamp paper of Rs.100]

I/We, Latabai Balashiram Panmand Son / Daughter Of Balvant Baban Dhavan Residing At Gavthan
Mhaskewadi, Mhaskewadi, Ahmadnagar Chombhut Maharashtra 414305, having Permanent Account
No (s) GWTPP9639H, Son / daughter of residing at , having Permanent Account No (s) and Son /
daughter of residing at , having Permanent Account No (s) do hereby solemnly affirm and state on oath
as follows.

1. That I/We, LATABAI BALASHIRAM PANMAND , and (“all the shareholders ”) hold the following
(number of) securities under Folio no.JSW0175912in JSW STEEL LIMITED (name of the company) in my/
our name as single holder / joint holder:

No. of
Company Name Folio No. Certificate No. Dist. From Dist. To
Shares
JSW STEEL
JSW0175912 2562843 2391803381 2391803420 40
LIMITED
- -
- -
- -
- -

2. I/We Latabai Balashiram Panmand , and further swear / solemnly declare that I/ we am/are
applying for issue of duplicate certificate(s) to me/us on the ground that the original security(ies)
certificate(s) has/have been misplaced / not found by me/us, despite a diligent search made by me/us in
that behalf.

3. I/We Latabai Balashiram Panmand , and further swear /solemnly declare that the said securities are
not sold or pledged or deposited by way of security to any person/company.

4. I/We Latabai Balashiram Panmand , and hereby further swear / solemnly declare that if, after the
duplicate share certificate(s) is / are issued to us as aforesaid, the original security(ies) certificate(s) is
/ are at any time subsequently, found, recovered or traced by us or by anyone on our behalf, then, we
unconditionally undertake not to deal with the said original share certificate(s) in any manner whatsoever
(whether by physical transfer or dematerialization or as security or pledge) and further unconditionally
undertake to promptly surrender the original share certificate(s) to the Registrar and Transfer Agent /
Company, for cancellation.

5. I/We Latabai Balashiram Panmand , and am/are making the above solemn declaration on oath with
full knowledge of the fact that in the event the original security (ies) certificate(s) issued is /are found,
recovered and traced by me/us and instead of surrendering the same is / are dealt with by me/us as
aforesaid, the Company will be at liberty to adopt civil and / or criminal proceedings against me/us for
my/our failure to promptly surrender the original security (ies) certificate(s), for cancellation and for
breach of my/our solemn declaration and undertaking not to deal with the original security (ies)
certificate(s) in any manner whatsoever as aforesaid at my/our entire risk as to cost and consequences.

Signature of all deponents:

1. Latabai Balashiram Panmand

 VERIFICATION

I/We hereby solemnly affirm and state that what is stated herein above is true to our knowledge and
nothing has been concealed therein and that we are competent to contract and entitled to rights and
benefits of the above mentioned securities.

Deponent(s) (1) Latabai Balashiram Panmand

(2)
(3)

Solemnly affirmed at . Signature of the Deponent(s):

Signed before

me Place:

Date :

Signature of Notary with Official Seal of Notary & Regn. No.

 Form-B INDEMNITY
[For issuance of duplicate securities]
Note: This indemnity is to be executed in the presence of a Public Notary /Gazetted Officer
[Submitted on non-judicial stamp paper of appropriate value]

I/We, Latabai Balashiram Panmand Son / Daughter Of Balvant Baban Dhavan Residing At Gavthan
Mhaskewadi, Mhaskewadi Ahmadnagar Chombhut Maharashtra 414305, having Permanent Account No
(s) GWTPP9639H, Son / daughter of residing at , having Permanent Account No (s) and Son / daughter of
residing at , having Permanent Account No (s) do hereby solemnly affirm and state on oath as follows.

1. That I/we, am/are the sole/joint holder/s of the Securities in following folios JSW0175912. I/We request
you to issue duplicate certificate(s) for securities, as detailed below in my/our name(s):

No. of
Company Name Folio No. Certificate No. Dist. From Dist. To
Shares
JSW STEEL
JSW0175912 2562843 2391803381 2391803420 40
LIMITED
- -
- -
- -
- -

**In case of non-availability of Certificate Nos./Distinctive Nos./ Folio nos., security holder shall obtain the
same from RTA.

2. That the above securities were acquired by me/us for valuable consideration out of my/our own
investment/ funds against allotment in Public Issue/allotment in Right Issue or acquired from the
market/through inheritance in the year(s) ………….

3. I/We hereby jointly and severally agree and undertake to indemnify and keep indemnified, saved,
defended, harmless, the aforesaid (JSW STEEL LIMITED) and its successors and assigns for all time
hereafter against all losses, costs, claims, actions, demands, risks, charges, expenses, damages, etc.,
whatsoever which you may suffer and/or incur by reason of your, at my/our request, issuing the said
Duplicate Securities as herein above mentioned, to the undersigned.

IN WITNESS WHEREOF the said 1) Mr. /Ms.

And 2) Mr. /Ms. #, have hereunto set
their respective hands and seals this day of ________________________________________
Address Of First Holder / Applicant :
Signature Of All Holder(S) / Applicant(S) :
Gavthan Mhaskewadi, Mhaskewadi Ahmadnagar Chombhut
Maharashtra 414305 Latabai Balashiram Panmand

Pin Code: 414305

Tel. No. 9819922226
FOR OFFICE USE ONLY
Email Id Shaileshpanmand@Gmail.Com
Signature Checked By :
Date

Signed before

me at:

on :

Signature of Notary / JMFC

Official stamp & seal of the Notary Magistrate/ Notary & Regn. No.: