National Securities Depository Limited



(On the letterhead of the Company)

Application for admission as Bonds / Debentures in the Depository System

Note:-

1. Kindly ensure that all columns are properly filled and write “N.A.” wherever not applicable.

2. Ensure that each page of the form has to be stamped and signed by authorized signatory.

Date: DD/MM/YYYY

To,

The Managing Director

National Securities Depository Limited

4th floor, Trade World, A Wing

Kamala Mills Compound,

Senapati Bapat Marg,

Lower Parel,

Mumbai - 400 013

Dear Sir,

We are pleased to inform you that our company has decided to offer the following debt securities as eligible securities under the Depositories Act, 1996. We request you to take necessary steps to induct our security into your depository system.

Name of Company

Whether Company has already signed agreement with NSDL for Debt instrument or any other instrument?

|Yes / No |

| |

Security Details – Part A

Kindly indicate YES against relevant rows

|Sr. No. |Particulars |Indicate |Remark (if any) |

|1. |Type of Instrument |

| |Plain Vanilla Debentures | | |

| |Structured / Market Linked Debentures (MLDs) | | |

| |Municipal Bonds | | |

| |Green Debt Securities | | |

| |(As defined under SEBI Circular No. CIR/IMD/DF/51/2017 on Disclosure | | |

| |Requirements for Issuance and Listing of Green Debt Securities) | | |

| |Perpetual Debt Instruments | | |

| |Non-Convertible Debentures (Less than one year) | | |

| |Bonds (refer note) | | |

| |Others (Please specify) | | |

| |Note : To be ticked for Bonds other than (iii) (iv) and (v) |

|2. |Mode of Issue |

| |Public Issue | | |

| |Private Placement (through Electronic Book Mechanism) | | |

| |Private Placement (through Non-Electronic Book Mechanism) | | |

| |Bonus Issue | | |

| |Rights Issue | | |

| |Scheme of Arrangement | | |

| |Others, please specify | | |

|3. |Objects of the Issue |

| | |

|3.A |Details of the utilization of the Proceeds |

| | |

|4. |Whether Tax Free | | |

| |If Tax free, quote the section of The Income Tax, 1961 under which it is tax free |

| | |

|5. |Whether Bonds / Debentures fall under Infrastructure category as per Government | | |

| |notification | | |

|6. |Guarantee Details |

| |Whether Guaranteed |

| |Guaranteed | | |

| |Partially Guaranteed | | |

| |Not Guaranteed | | |

| |If Guaranteed, provide complete details regarding the Guarantee |

| |Name of Guarantor | |

| |Nature of Guarantee | |

| |Percentage of Guarantee | |

| |Other details about Guarantee | |

| |Guarantee or Ranking (indicates, in the case of the Issuers inability to settle, whether the debt issues is additionally secured) |

| |Guidelines: The values Senior, Senior Subordinated, Junior and Junior Subordinated may only be used for unsecured securities. |

| |Negative may only be used for unsecured securities that are neither senior nor Junior; Unsecured may be used only if one of these |

| |codes does not apply to the relevant security. |

| |Government / State Guarantee | | |

| |(the debt instrument is guaranteed by a federal, state, (semi) – government, | | |

| |sovereigns, agencies) | | |

| |Joint Guarantee | | |

| |(the debt instrument is guaranteed by an entity (e.g. corporation) other than | | |

| |the issuer; not a federal or state government) | | |

| |Secured | | |

| |(debt issue against which specific assets are pledged to ensure the obligation, | | |

| |e.g. mortgage or receivables) | | |

| |Unsecured / Unguaranteed | | |

| |(the direct obligation of the issuer rest solely on its general credit) | | |

| |Negative Pledge | | |

| |(the borrower agrees not to pledge any assets if such pledging would results in | | |

| |less security for the agreement’s bondholders) | | |

| |Senior | | |

| |(applies to senior debts that are placed before senior subordinated, junior and | | |

| |junior subordinated in the ranking in the event of liquidation) | | |

| |Senior subordinated | | |

| |(applies to senior subordinated debts that are placed before junior and junior | | |

| |subordinated in the ranking in the event of liquidation) | | |

| |Junior | | |

| |(applies to junior debts that are placed before junior subordinated in the | | |

| |ranking in the event of liquidation) | | |

| |Junior subordinated | | |

| |(applies to junior subordinated debts in the ranking in the event of | | |

| |liquidation) | | |

| |Supranational | | |

| |(organization defined as being beyond the scope or borders of any one nation | | |

| |such as two or more central banks or two or more central governments. Examples | | |

| |of supranational includes the United Nations, the European Union, the European | | |

| |Investment Bank and the World Bank) | | |

| |If Secured, provide complete details regarding the assets Secured/Hypothecated/Mortgaged etc. |

| |Asset Type |

| |Details of Security (Please mention Security Clause against each Asset type separately.) |

| |Remarks if any |

| | |

| |Immovable Assets |

| | |

| |  |

| | |

| |Movable Assets |

| | |

| |  |

| | |

| |Current Assets |

| | |

| |  |

| | |

| |Book Debts / Receivables |

| | |

| |  |

| | |

| |Intangible Assets |

| |  |

| |  |

| | |

| |Tangible Assets |

| |  |

| |  |

| | |

| |Trust & Retention Account /Escrow Accounts |

| |  |

| |  |

| | |

| |Non-Current Investments |

| |  |

| |  |

| | |

| |Others, Please Specify |

| | |

| |  |

| | |

| |Details of Asset Coverage (Tick as applicable) |

| | |

| |  |

| |Principal |

| |Principal + Interest |

| | |

| |Asset Coverage |

| |  |

| |  |

| | |

| | |

| | |

| | |

| | |

| |Asset Cover (%) |

| |  |

| | |

| | |

|7. |Credit Enhancement Details |

| |Whether Securities are Credit Enhanced | | |

| |If Yes, Details of Credit Enhancement |

| |Nature of Credit Enhancement | |

| |Amount of Credit Enhancement | |

| |Other Details of Credit Enhancement | |

|8. |In the form of Promissory Note | | |

|9. | Type of Convertibility |

| |Part A | | |

| |Fully Convertible | | |

| |Partially Convertible | | |

| |Non-Convertible | | |

| |Part B |

| |Optionally Convertible | | |

| |Compulsory Convertible | | |

| |Not Applicable | | |

| |If Convertible, kindly provide following details | | |

| |Conversion Instrument Name | | |

| |Conversion Ratio | | |

| |Other Details | | |

|10. |Type of Interest / Coupon Basis |

| |Fixed Rate | | |

| |Variable Rate | | |

| |Index Linked | | |

| |Equity Linked | | |

| |Commodity Linked | | |

| |Mibor Linked | | |

| |Inflation Linked | | |

| |G-Sec Linked | | |

| |Credit Linked | | |

| |Bank MCLR Linked | | |

| |Others (please specify) | | |

| |Zero Rate | | |

| |Payment in Kind | | |

| |(pays interest using other assets instead of cash) | | |

| |Cash Payments | | |

|11. A |Coupon Rate | |

| |If aforesaid coupon rate is variable, please provide details under applicable fields below |

| |Underlying/ Reference/ Benchmark Index | |

| |Initial Fixing Date | |

| |Initial Fixing Level | |

| |Final Fixing Date | |

| |Final Fixing Level | |

| |Observation date(s) | |

| |Underlying Performance / Pay off | |

| |Participation Rate: PR | |

| |Coupon Payout formula | |

| |+/- Spread | |

| |Base rate | |

| |Cap rate | |

| |Floor Rate | |

| |Additional Details (If any) | |

|11. B |Coupon Reset Process Details | |

|11. C |Frequency of Interest Payment with Specific Dates | |

|11. D |Default Interest Rate Details | |

|12. |Coupon Type |

| |Simple | | |

| |Compounding | | |

| |(If compounding, provide the compounding frequency details) | | |

|13. |Record Date and Holiday Convention Details |

| |Record Date for Principal Payment | |

| |Holiday Convention for making Principal payment | |

| |Record Date for Interest Payment | |

| |Holiday Convention for making Interest payments | |

| |Business Day Convention | |

| |Holiday Convention Interest calculation – Additional Interest | |

| |Undertaking for calculating Day Count Convention |Actual/Actual |

|14. |Seniority in repayment |

| |Senior | | |

| |Subordinate – Tier 1 | | |

| |Additional Tier 1 | | |

| |Subordinate – Tier 2 | | |

| |Subordinate – Tier 2 Upper | | |

| |Subordinate – Tier 2 Lower | | |

| |Subordinate – Tier 3 | | |

| |Perpetual | | |

| |Unsubordinated | | |

|15. |Whether Step Up / Step Down coupon basis is available |

| |Step Up | | |

| |Step Down | | |

| |Provide the details of Step Up / Step Down along with details of coupon reset value/s and date/s of reset |

| |Step Up Coupon: |

| |Type of Step Up (Single/Multiple/Both) |Reset Date |Reset Value |Reason for Step Up |

| | | | | |

| | | | | |

| |Additional Details if any: |

| |Step Down Coupon: |

| |Type of Step Down (Single/Multiple/Both) |Reset Date |Reset Value |Reason for Step Down |

| | | | | |

| | | | | |

| |Additional Details if any: |

|16. |Put and Call Option Details |

| |Whether Put option available (Yes / No) | |

| |(If Yes, please provide following details) | |

| |Put Option with Specified Dates | |

| |Put Notice Deadline Date | |

| |Put Notification Time | |

| |Whether Put Option will be exercised at; | | |

| |Discount | | |

| |Premium | | |

| |Par | | |

| |Put Option Details | |

| |Whether Call option available (Yes / No) | |

| |(If Yes, please provide following details) | |

| |Call Option with Specified Dates | |

| |Call Notice Deadline Date | |

| |Call Notification Time | |

| |Whether Call Option will be exercised at; | | |

| |Discount | | |

| |Premium | | |

| |Par | | |

| |Call Option Details | |

|17. |Maturity Amount basis | |

|18. |Maturity Type |

| |Fixed Maturity | | |

| |(The redemption amount is repaid in full at maturity) | | |

| |Fixed maturity with call feature | | |

| |(The issue may be called for redemption prior to the fixed maturity date) | | |

| |Fixed maturity with put feature | | |

| |(The holder may request the reimbursement of his bonds prior to the maturity | | |

| |date) | | |

| |Fixed maturity with Put and Call | | |

| |Amortization Plan | | |

| |(Reduction of principal by regular payments) | | |

| |Amortization plan with call feature | | |

| |Amortization plan with put feature | | |

| |Amortization plan with put and call feature | | |

| |Perpetual | | |

| |(The debt instrument has no fixed maturity date and is only due for redemption | | |

| |in the case of the Issuer’s liquidation) | | |

| |Perpetual with call feature | | |

| |(The issue may be called for redemption at some time in the feature) | | |

| |Perpetual with put feature | | |

| |(The issue may be puttable for redemption at some time in future) | | |

| |Extendible | | |

| |Others (please specify) | | |

|19. A |Redemption Type |

| |Full Redemption | | |

| |Partial Redemption | | |

| |(including details, if redemption is due to exercise of call or put option) | | |

| |By Face Value Redemption | | |

| |By Quantity Redemption Lot Basis | | |

| | By Quantity Redemption Pro Rata Basis | | |

|19.B |Details of Partial Redemption | | |

| |Date |Face Value to be redeemed |Quantity to be redeemed |

| | | | |

| | | | |

|20. |ISIN required for Letter of Allotment (LOA)* | | |

|21. |Indicate whether Partly Paid | | |

| |(If Yes, specify the Paid Up value ( in Rs.) | | |

|22. |Following details are applicable only to Structured instruments (with Capital Protection) |

| |(Only one option can be selected from the given options in each group) |

| |Type |

| |Capital protection certificate with participation | | |

| |(Minimum redemption at expiry equivalent to the capital protection is defined as| | |

| |a percentage of the nominal amount (e.g.100%); capital protection refers to the | | |

| |nominal amount only, and not to the purchase price; the value of the product may| | |

| |fall below its capital protection value during its lifetime; participation is in| | |

| |the underlying price increasing above the strike) | | |

| |Capital protection convertible certificate | | |

| |(Minimum redemption at expiry equivalent to the capital protection; capital | | |

| |protection is defined as a percentage of the nominal price (e.g. 100%); capital | | |

| |protection refers to the nominal price only, and not to the purchase price; the | | |

| |value of the product may fall below its capital protection value during its | | |

| |lifetime; participation is in the underlying price increase above the conversion| | |

| |price; coupon payment is possible) | | |

| |Barrier capital protection certificate | | |

| |(Minimum redemption at expiry equivalent to the capital protection; capital | | |

| |protection is defined as a percentage of the nominal price (e.g. 100%); capital | | |

| |protection refers to the nominal amount only, and not to the purchase price; the| | |

| |value of the product may fall below its capital protection value during its | | |

| |lifetime; participation is in the underlying price increase above the strike up | | |

| |to the barrier; possibility of rebate payment once barrier is breached; limited | | |

| |profit potential) | | |

| |Capital protection certificate with coupons | | |

| |(Minimum redemption at expiry equivalent to the capital protection; capital | | |

| |protection is defined as a percentage of the nominal price (e.g. 100%); capital | | |

| |protection refers to the nominal amount only, and not to the purchase price; the| | |

| |value of the product may fall below its capital protection value during its | | |

| |lifetime; the coupon amount is dependent on the development of the underlying | | |

| |asset; periodic coupon payment is expected) | | |

| |Others (miscellaneous) | | |

| |Distribution (indicates the cash distribution provided by the structured instrument) |

| |Fixed interest payments | | |

| |Dividend payments (depending on strategy of the structured instrument) | | |

| |Variable interest payments | | |

| |No payments | | |

| |Others (miscellaneous) | | |

| |Repayment (indicates the repayment from provided by the structured instruments) |

| |Fixed cash repayment (only protected capital level) | | |

| |Variable cash repayment (protected capital level and additional performance | | |

| |capital depending on the underlying) | | |

| |Others (miscellaneous) | | |

| |Underlying assets (indicates that type of underlying assets in which the structured instrument participates) |

| |Basket (Group of securities that have been put together for a specific | | |

| |investment purpose) | | |

| |Equities | | |

| |Debt instruments | | |

| |Commodities | | |

| |Currencies (specify exchange rate) | | |

| |Indices (the performance of an index) | | |

| |Interest rates (specified amount based on the future level of interest rates) | | |

| |Others (miscellaneous) | | |

|23. |Following details are applicable only to Structured instruments (without Capital Protection) |

| |(Only one option can be selected from the given options in each group) |

| |Type |

| |Discount Certificate | | |

| |(should the underlying asset close below the strike on expiry, they underlying | | |

| |asset(s) and/or a cash amount is redeemed; discount certificates enable | | |

| |investors to acquire the underlying asset at lower price; it corresponds to a | | |

| |buy-write-strategy; it has reduced risk compared to a direct investment into the| | |

| |underlying asset; with higher risk levels multiple underlying assets (worst of) | | |

| |allow for higher discounts; limited profits opportunity (Cap)) | | |

| |Barrier discount certificate | | |

| |(The maximum redemption amount (Cap) is paid out if the barrier is never | | |

| |breached; barrier discount certificates enable investors to acquire the | | |

| |underlying asset(s) at a lower price; due to barrier, the probability of maximum| | |

| |redemption is higher; the discount, however, is smaller than for a discount | | |

| |certificate; if the barrier is breached the product changes in to a discount | | |

| |certificate; it has reduced risk compared to a direct investment in to the | | |

| |underlying asset; limited profit potential (Cap); with higher risk levels | | |

| |multiple underlying assets (worst-of) allow for higher discounts or a lower | | |

| |barrier) | | |

| |Reverse convertible | | |

| |(should the underlying asset close below the strike on expiry, they underlying | | |

| |asset(s) and/or a cash amount is redeemed; should the underlying asset close | | |

| |above the strike at expiry, the nominal amount plus the coupon is paid at | | |

| |redemption; the coupon is paid regardless of the underlying development; it has | | |

| |reduced risk compared to a direct investment in to the underlying asset; with | | |

| |higher risk levels, multiple underlying assets (worst-of) allow for higher | | |

| |coupons; limited profit potential (Cap)) | | |

| |Barrier reverse convertible | | |

| |(Should the barrier never be breached, the nominal price plus coupon is paid at | | |

| |redemption; due to the barrier, the probability of maximum redemption is higher;| | |

| |the coupon, however, is smaller than for a reverse convertible; if the barrier | | |

| |is breached the product changes into a reverse convertible; the coupon is paid | | |

| |regardless of the underlying development; it has reduced risk compared to a | | |

| |direct investment into the underlying asset(s); with higher risk levels multiple| | |

| |underlying assets (worst-of) allow for higher coupons or lower barriers; limited| | |

| |profits potential (Cap)) | | |

| |Express certificate | | |

| |(should the underlying trade above the strike on the observation date, an early | | |

| |redemption consisting of normal price plus an additional coupon amount is paid; | | |

| |it offers the possibility of an early redemption combined with an attractive | | |

| |yield opportunity; it has reduced risk compared to a direct investment into the | | |

| |underlying asset(s); with higher risk levels, multiple underlying assets | | |

| |(worst-of) allow for higher coupons or lower barriers; limited profits | | |

| |opportunity (Cap)) | | |

| |Others (miscellaneous) | | |

| |Distribution (indicates the cash distribution provided by the structured instruments) |

| |Fixed Interest Payment | | |

| |Dividend payments (depending on strategy of the structured instruments) | | |

| |Variable Interest Payments | | |

| |No Payments | | |

| |Others (miscellaneous) | | |

| |Repayment (indicates the repayment form provided by the structured instrument) |

| |Repayment in cash (depending on the underlying, if the barrier is not breached) | | |

| |Repayment in assets | | |

| |Repayment in assets and cash | | |

| |Repayment in assets or cash | | |

| |Others (miscellaneous) | | |

| |Underlying assets (indicates the type of underlying assets in which the structured instrument participates) |

| |Baskets (Group of securities that have been put together for a specific | | |

| |investment purpose) | | |

| |Equities | | |

| |Debt instruments | | |

| |Commodities | | |

| |Currencies (specified exchanged rate) | | |

| |Indices (the performance of an index) | | |

| |Interest rates (specified amount based on the future level of interest rates) | | |

| |Others (miscellaneous) | | |

|24. |Any other information (please specify) |

| | |

* Please note that one single ISIN is allotted for LOA and Secured Bond / Debenture. On conversion of an LOA into the security a separate letter in the format prescribed will have to be provided by the Issuer on receipt of which the ISIN description is changed in the system.

Security Details – Part B

|Sr. No. |Particulars |Details |

|1. |Name of the Instrument | |

|2. A |Series (if any) (Provide No.) | |

|2. B |Tranche (if any) (Provide No.) | |

|3. |Issue Price (in Rs.) (per security) | |

|4. |Face Value (in Rs.) (per security) | |

|5. |Allotment Date | |

|6. |Redemption Date / Last Conversion Date (if Convertible) | |

|7. |Tenure of the instrument at the time of Issuance |____ Years, ____ Months, ____ Days |

|8. |Allotment Quantity | |

|9. |Issue Size including Green Shoe Option, if applicable | |

| |Issue Size (Total allotment Quantity * face value) (Rs. in Crs.) | |

| |Green Shoe Option (Yes / No) | |

| |Amount Raised (Total allotment Quantity * Issue Price) (Rs. in Crs.)| |

|10. |Certificate / Distinctive Nos. From – To | |

|11. |Schedule Opening Date # | |

|12. |Schedule Closing Date # | |

|13. |Actual Closing Date # | |

|14. |Redemption Premium Details (if any) | |

|15. |Shut Period (for redemption) | |

|16. |Indicate whether instrument is rated (Yes / No) | |

# If applicable, mandatory in case of private placement and public issue.

Illustrative Cash Flow Details

|Sr. No. |

|Sr. No.|Name of Credit Rating Agency |Credit Rating |Rating Outlook |Date of Credit Rating |

|1. | | | | |

|2. | | | | |

|3. | | | | |

If rated by multiple credit rating agencies, include all such ratings

Registrar Details

|Sr. No.|Particulars |Details |

|1. |Name of Registrar | |

|2. |Registrar BP ID |IN |

|3. |Name of Contact Person | |

|4. |Designation | |

|5. |Address where physical securities is to be sent | |

Lead Manager / Arranger Details

|Lead Manager Details |Lead Manager 1 # |Lead Manager 2 # |

|Name of Organisation | | |

|Name of Contact Person | | |

|Designation / Department | | |

|Address | | |

|Tel No. | | |

|Mobile No. | | |

|Email Address | | |

|Website | | |

|Arranger Details |Arranger 1 # |Arranger 2 # |

|Name of Organisation | | |

|Name of Contact Person | | |

|Designation / Department | | |

|Address | | |

|Tel No. | | |

|Mobile No. | | |

|Email Address | | |

|Website | | |

# Attach Annexure, in case of more than 2 agencies

Address for submission of Tax exempted form by Investor

|Name of Organisation | |

|Name of Contact Person | |

|Designation / Department | |

|Address | |

|Tel No. | |

|Mobile No. | |

|Email Address | |

|Website | |

Debenture Trustee Details

|Particulars |Debenture Trustee 1 # |Debenture Trustee 2 # |

|Name of Organisation | | |

|Name of Contact Person | | |

|Designation / Department | | |

|Address | | |

|Tel No. | | |

|Mobile No. | | |

|Email Address | | |

|Website | | |

# Attach Annexure, in case of more than 2 agencies

Stock Exchange Details

|Sr. No.|Listed / Proposed to be | Name of Stock Exchange # |Date of Listing (if |Permitted to Trade |Stock Exchange Security Code (if|

| |listed / Unlisted | |listed) |(() |any) |

|2. | | | | | |

# Please start with Primary Stock Exchange

Default History Information

(Whether there have been any defaults/delays in servicing any other debt security issued. If yes, please provide details as below)

|ISIN |Nature of the |Issue Size (Rs. in |Due date of Interest / Redemption |Actual Payment Date |Default Details |

| |Issue |Crs.) |on (DD/MM/YYYY) |(DD/MM/YYYY) | |

| | | | | | |

We hereby certify that;

1. The above information is correct to the best of our knowledge and that we have attached all the enclosures mentioned above.

2. All relevant guidelines that are applicable or any applicable directions, rules and regulations that may be applicable for the issuance of Debt Securities have been complied with.

We hereby also declare that on redemption of this Security we will extinguish the securities from the Investors account.

Place: ____________________ __________________________________

Date: DD/MM/YYYY Signature of Authorised Signatory

Stamp: Name: ____________________________

Designation: ______________________

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