Form No.SH- 13
Nomination Form
(Pursuant to Section 72 of the Companies Act, 2013 and rule 19(1) of the Companies ( Share Capital and Debenture) Rules, 2014)


Name of the Company :
Address of the Company :
I/ we
1
2
3
the holder(s) of the securities particulars of which are given hereunder wish to make nomination and do hereby nominate the following persons in whom shall vest, all the rights in respect of such securities in the event of my/ our death.
1) PARTICULARS OF THE SECURITIES ( in respect of which nomination is being made)

Nature of Securities Folio No. No. of Securities Certificate No. Distinctive No. From Action
 
2) PARTICULARS OF NOMINEE/S –

a) Nominee Name
b) Date of Birth
c) Father’s/ Mother’s/ Spouse’s name
d) Occupation
e) Nationality
f) Address-1
Address-2
Address-3
City
PIN Code
g) eMail Address
h) Relationship with the Security holder

i) Specimen Signature of the nominee : ……………………………………….

3) IN CASE NOMINEE IS A MINOR –

a) Date of Birth
b) Date of Attaining majority
c) Name of guardian
d) Address-1
Address-2
Address-3
City
PIN Code

Name of all the holder(s)
(as appearing on the Certificate(s) ) 		Signature as per specimen recorded with Company
Sole/ 1st holder    
2nd holder    
3rd holder    
4th holder    
Signature of two Witnesses:

Complete Name and Address Signature with Signature with date
1.

2.		    
 

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