Form B - Declaration to be submitted by the new retail investor to the depository participant on purchase of eligible securities. - Rajiv Gandhi Equity Savings Scheme, 2012

1 [Form B [See paragraph 6(c) and (d)] Declaration to be submitted by the new retail investor to the depository participant on purchase of eligible securities. To Depository participant Address It is hereby informed that I have demat account no ................................... in ....................... depository participant and the following securities: (a) (b) (c) (d) (e) purchased in the aforesaid demat account on .............. are not to be included as investment for the purpose of the Rajiv Gandhi Equity Savings Scheme. Signature Name of the Investor: (first holder) Address of the investor: Permanent Account Number (PAN): ] ----------------------- Notes:- 1. Inserted vide Notification No. 51/2012, dated 23/11/2012