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Investors for the project will be given Green Cards.

The Green Cards will enable investors to get the best of medical treatment at confessional rates. Investors can use the Green Card throughout their lifetime for discounted services and also for certain free services.
 
 
NOT FOR PUBLIC CIRCULATION
APPLICATION FORM FOR EQUITY SHARES
FOR SUBSCRIPTION IN PRIVATE PLACEMENT AS SPECIFIC CASE
To
The Board of Directors
KAKKANAD MEDICAL CENTRE
Regd. Office: Aswathy, Santhinikethan Gardens,
Kavumpady Road,
Muvattupuzha - 686 661.
Kerala, India. Tel: 0485-2812215, 2812283 (Corp.)
3090285, 2837759 (Off.), Fax: 0484-2812484
e-mail: drnnasokan@hotmail.com, sajeshasokan@hotmail.com
www.kmc-ekm.org, kmc@kmc_ekm.org
APPLICATION NO.
Application must be made n multiples of 100 subject to a minimum of 100 Equity Shares.
Amount Payable on application Rs. 1,000 per Equity Share at par
Date : - -
Cheque/Draft shuld be drawn in the name of KMC payable at Ernakulam
Dear Sirs,
I/We hereby apply for allotment to me / us the Equity Shares in your company. The amount payable for allotting the shares is remitted herewith. I / We note that the Board of Directors are entitled in their absolute discretion to accept or reject the application in whole or in part without assigning any reason whatsoever. I / We agree to accept the Equity Shares applied for or such lesser number as may be allotted to me/us subject to the terms of this application form and the Memorandum and Articles of Association of the company. I/We undertake that I/We will sign all such other documents and do all such other acts, if any, necessary on my/our part to enable me / us to be registered as the holder(s) of the Equity Shares which may be allotted to me/us. I / We authorise you to place my/our name(s) on the Register of Members of the company as the holder(s) of Equity Shares and to register my / our address(es) as given below.

Nationality and Residentship (Tick whichever is application)

  • I / We confirm that I am / We are Indian National(s) Resident in India and I am / We are not applying for the Equity Shares as      Nominee(s) of any person(s) Resident aborad or any Foreign National(s).

  • I am / We are Indian National(s) Resident in India and I am / We are applying for the said Equity Shares as Power of Attorney      Holder(s) of Non-Resident(s) mentioned below on Non-Repatriation basis.

  • I am / We are Indian National(s) Resident outside India and I am / We are applying for the said Equity Shares on my / our own      behalf on Non-Repatriation basis.

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  • No. of Equity Shares Applied In Figures In Words
    Amount Rupees
    Cheque/DD. No. Date
    Drawn On
    FIRST / SOLE APPLICANTS BANK ACCOUNT DETAILS
    Bank
    Branch Account No.
    Date of Birth of Minor
    Day
    Month
    Year
    Age
    TICK WHICHEVER IS APPLICABLE
    Status   Individual
    Registered Scoiety Company Statutory Corporation Parent/Guardian of Minor Trust
    Occupation
    Agriculture Business Professional Service Retired Housewife Student Others
    FIRST / SOLE APPLICANT                               USE ONE BOX FOR ONE ALPHABET LEAVING ONE BOX BLANK BETWEEN FIRST, SECOND & SURNAME
    NAME IN FULL (mr/Mrs/Miss
    FULLL ADDRESS (P.O. Box No. alone is not sufficient)
    PIN CODE
    FULL NAME OF FATHER/HUSBAND (Mr.)
    SECOND APPLICANT FULL NAME (Mr / Mrs / Miss)
    THIRD APPLICANT FULL NAME (Mr / Mrs / Miss)
     
    FIRST / SOLE APPLICANT
    SECOND
    THIRD
    USUAL SIGNATURE      
    PAN / GIR No.
    Circle / Ward / District
    TO BE FILLED IN ONLY IF THE APPLICATION IS FROM AN INSTITUTION
    Names of authorised Signatories
    Designation
    Signatures
    1. 1. 1.
    2. 2. 2.
    3. 3. 3.
     
    TO BE FILLED IN WHEN APPLICANT IS / ARE NRI(S)
    TO BE FILLED BY ALL APPLICANT SPECIMENT SIGNATURES
    LOCAL ADDRESS
    NRO / NRI A/c No.
    Name of Bank
    Address
    Sole / First Applicant  
    Second Applicant  
    Third Applicant  
     
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