This document is a share application form submitted to XYZ Pvt. Ltd. The applicant is applying for a specified number of shares of Rs. 10 each and has submitted the corresponding application money. The form provides details of the applicant such as name, father's name, occupation, PAN, and signature. It also includes details of nominees and depository account if the applicant wants dividends credited to their bank account.

1. SHARE APPLICATION FORM
Date:
To
THE BOARD OF DIRECTORS
XYZ PVT. LTD.
ADDRES.
Dear Sirs,
I/We hereby apply to you for allotment to me/us of the shares of Rs. 10/- each stated below. The amount shown below is remitted herewith
towards the share application money. I/We authorize you to place my/our name/s on the Register of Members of the Company as the holder(s)
of the shares that may be allotted and to register my/our address/es given below:
Number of Shares In Figs: In Words:
Amount paid
In Figs
Rs.
In Words
Rs.
Cheque/Demand Draft dated
Cheque/Demand Draft No.
Drawn on
(Name of Bank and Branch)
(1) Sole / First Applicant
Name in Full
Father's Name
Occupation
PAN
Signature
(2) Second Applicant
Name in Full
Father’s Name
Occupation
PAN
Signature
(3) Third Applicant
Name in Full
Father's Name
Occupation
PAN
Signature
Address: ____________________________________________________________________________________________________________
______________________________________________________________________________________________________________________

2. If you want your dividends, if any, credited to your a/c with any bank in India, then fill in this box giving
details of your account to which such payment if any to be credited.
A/c No. Name of the Bank
Name of Account Holder
Branch Address
Nominee's Name _____________________________ Nominee's Address ___________________________
Relationship with nominee __________________________ Name of Introducer _________________
DEPOSITORY ACCOUNT DETAILS
Depository Name:
Depository Participant Name:
DP – ID:
Beneficiary Account Number:
Notes:
1. Cheques / Demand drafts should be in the name of “XYZ Private Limited”.