Jeevan Usha

7/27/2019 Jeevan Usha

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JEEVAN USHA BONDSApplication Form

Period 60 months

Jeevan Associate Code :

Office : Code ___________, Location _______________, State___________

______________________________________________________________________________

ToManager (Bonds)

Jeevansuraksha Capital Ltd.

91, Kunj Society,Alkapuri,Vadodara 390 007.

Dear Sir,

I/We ___________________________________________ hereby agree that the terms

and conditions mentioned in overleaf for conversion of Jeevan Usha bonds

.

Name of the Applicant

Age

Occupation

Father / Husbands Name

If applicant is minor

( Name of Guardian)

Postal Address


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Permanent Address

Signature of the Applicant

Bank Details :

Account Number

Bank Name

Branch

Telephone : (M)

First Nominee Name

Relationship

Age

Percentage

Second Nominee Name

Relationship

Age

Percentage

Signature of the Nominees :

(1)_________________________(2)____________________________

Name of the Introducer & Code

Signature

Total Amount Cheque/DD/ Cash

In words

In Figure

Date

Bankers Name

Branch Name


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PAN Card No.

If minor signature by Guardian

______________________________________________________________________________

DECLARATION

Name (First holder) I/We

_____________________________________________________, redeem the

__________________________________ no. of bonds amounting

Rs.__________________________.

______________________________________________________________________________

Proof of Address :

Driving License

Electricity Bill

Passport

Ration Card

Telephone Bill (BSNL/MTNL)

Voter ID Card

Or Any other ( Please give details)

__________________________________________________________________________

Proof of Identity

PAN Card

Passport

Driving License

Voter ID

Or Any other (Please give details)

______________________________________________________________________________

Signature of Applicant

TERMS & CONDITIONS

1. Bonds :

(a) Applicant may apply for minimum 02 Bonds of Rs.6,000/- each and deposit

Rs.200/- per month upto 60 months and in addition, applicant may deposit


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Rs.100/- per month. Any such deposit may be made on

weekly/monthly/quarterly/half yearly / yearly basis.

(b) Company reserves right to reject any of the applications without assigning any

reason/s whatsoever.

(c) These bonds are not issued for the purpose of listing on any Stock Exchange.

1. Maturity Period :

Maturity period of the bond is 60 months.

2. Mode of Payment :

(a) All payments will be done by Cheque/Demand Draft/Cash to the Company

against valid Receipt issued by the authorized official of the Company. In case

of payment made otherwise then in any mode stated herein, the applicant will

himself be solely responsible.

(b) Payment above Rs. 20,000/- will be accepted only by Cheque/Demand draft.

(c) Payment will be considered as duly received only after the cheque/demand

draft is realized.

(d) Outstation cheques will not be accepted in any circumstances

3. Options available to Bond Holders :

(a) Bond holder may opt to convert the bond into 01 fully paid up equity share of

Rs. 10 at a premium of Rs. 990 per share against the paid up value mentioned

on the Bond. For this purpose, the Bond holder will require to communicate

the option of conversion between the period of 59th to 60th month from the

date of application along with necessary payment.

(b) Redemption :


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(i) The bond will be redeemed in full as per paid up value, on an application

made by the Bond holder, as under expiry of 60 months from the date of

application.

(ii) Bond holder will not be able to get redemption of the bond if he has

already opted for conversion.(iii) No interest will be payable for the period which pertains earlier or after the

date of the bond.

Particulars RedemptionAmount (in Rs.)

(a)Period in months 60Face Value of 02 Bonds 12000Redemption oncompletion of 60 months Rs. 15,500

(c) For any reason, if Bond Holder fails to pay regular installments upto 60 months

then that will be considered as partial payments and in such situation at the time

of redemption, payments will be made as per the calculation charts / table

available in the company and in such cases interest will be payable only on

maturity of the Bonds. In the interest of Bond Holders, the company may

consider pre-mature redemption under such circumstances.

4. Company will issue certificate of holding on demand by the bond holders and the

same will be sent to their address recorded with the company.

5. Nomination facility :

At the time of application for the bonds, the bond holders may nominate two persons

along with share of the redemption amount payable to them.

6. Dispute redressal/Arbitration

Any dispute or difference arising relevant to the bonds, the same shall be

settled through mutual discussion. In the event, the Parties fail to amicably

settle such dispute or difference within 7 days of consultation, such dispute

shall be resolved through arbitration. The venue of the arbitration shall be in

the city of Vadodara. The arbitration proceedings shall be governed under the

Arbitration and Conciliation Act, 1996. The arbitral Tribunal shall consist of a

sole Arbitrator appointed with mutual consent by both the parties. The award


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of the Arbitrator shall be a reasoned award and shall be final and binding on

the Parties. The Arbitration shall be conducted and the award shall be

rendered in English language. The Civil Courts at Vadodara shall have

exclusive jurisdiction in respect to try and entertain any proceeding arising

under or out of this Agreement. The laws of Republic of India shall govern this

Agreement.

GENERAL RULES

(a) Company may amend / modify any of the terms and conditions governing the

Bonds in future from time to time for any reason including changes as may be

notified by the Regulatory Authorities. Company will make any such

amendment/s by display on the Notice Board of the company or by

publication in the newspaper having circulation in the area where the

Registered Office of the company is situated or by any other means of

electronic communication etc.

(b) Company reserves the right to redeem the Bond pre-maturely without

assigning any reason/s whatsoever and in such event this decision of the

company will be binding to all the bond holders.

(c) In case of the signatures by thumb impression, the same will have to be

authorized by the authorized employee of the company or Manager of a

Nationalised Bank or Magistrate or Notary Public.

(d) Company will be free to issue other types of Bonds, to raise funds by any

other means including loans, without taking concurrence/consent of the

Bondholders.

(e) Register of Bondholders will be maintained as per provisions of Companies

Act, 1956.

(f) Any type of communication / instructions will be given to the bondholders as

per the address recorded in the Register of the company by way of Ordinary

Post / Courier.


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(g) Any individual / Karta of the HUF or a company who has association with any

of the company can apply for the Bonds.

(h) Date of realization of Cheque / Demand Draft will be considered as the date of

application.

(i) Applicant will be solely responsible for the contents filled in by him in the

application forms including that of signature and sources of fund.

(j) Payments will be made as per Income Tax Rules. Applicant will be required to

produce copy of PAN Card in case of investment of Rs.800/- or more per

month. In case applicant desires to have exemption from Tax, he will have to

lodge necessary declaration/certificate in the prescribed forms to the

company every year. Prescribed forms for this purpose are available from the

company.

(k) Under the order of appropriate Court, company reserves right to transfer

bonds to other company for its payment in case of merger, demerger,

amalgamation or any kind of arrangement leading to restructuring with other

company. In such situation the Bonds will be considered as if they have been

issued by the original company. This kind of instruction / communication will

be displayed on the Notice Board of the company or will be published in the

News papers where Registered Office of the company is situated.

DECLARATION

I / We,________________________________________________ with this application hereby

request and apply to the company to issue me optionally fully convertible unsecured

bonds equivalent to the payments being made by me.

I/We, _________________________________________________ hereby give my consent to

abide all the provisions of Memorandum & Articles of Association of the company as

well as all the terms, conditions and rules mentioned in this application forms and

any amendments as may be notified by the company from time to time.

I/We, __________________________________________________ hereby authorize you to enter

my name as a bondholder in the Register of bondholders maintained by your

company and in the event of exercising the option, I/We

________________________________ authorize you to enter my name in the Register as


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may be maintained by the company, after the bonds are converted into equity shares

and that such shares are allotted to me.

I/We __________________________________ authorize you and give consent that as per

Clause 8(k), will act as per the situation mentioned therein.

I/We __________________________________ declare that I am Indian Resident and I am

not nominating any person as nominee who is resident outside India.

I/We __________________________________ confirm that I/We ____________________ are

associated / related with Jeevansuraksha group.

I/We __________________________________ confirm that all the terms and conditions

given in this application form are understood by me in my language mother tongueand that I/We __________________________________ agree with the same.

__________________________________

Signature of the Applicant

(In case of minor, signature by the Guardian)

DECLARATION

I/We __________________________________ as a representative of the applicant hereby

confirm that I have explained all the terms and conditions of every columns of this

application form to the applicant in the vernacular language/his mother tounge which

he understands.

I/We __________________________________ confirm and declare that all the information /

declaration given by the applicant or by the undersigned are true and bonafied to the

best of my information and knowledge.

_______________________________________

Signature of Jeevan Associate

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Jeevan Usha