Private & Confidential – Not for Circulation

POWER FINANCE CORPORATION LTD.

(A Government of India Enterprise)
(A Maharatna Company)
Regd. Office: Urjanidhi, 1 Barakhamba Lane, Connaught Place, New Delhi- 110001 Application Number
APPLICATION FORM FOR NON-CONVERTIBLE, NON-CUMULATIVE, REDEEMABLE, SECURED, TAXABLE
BONDS, SERIES-VI WITH BENEFITS UNDER SECTION 54EC OF INCOME TAX ACT, 1961 20035531
Disclaimer : This Bond Issue is being made strictly on a private placement basis. It is not and should not be deemed to constitute an offer
to the public in general. It cannot be accepted by any person other than to whom it is directed.
(PLEASE CAREFULLY READ INFORMATION MEMORANDUM FOR PRIVATE PLACEMENT BEFORE FILLING UP THIS FORM)
Broker's Name & Code Sub Broker's Name & Code Bank Branch Serial No. & Stamp FOR USE BY COLLECTING BANK BRANCH
D D M M Y Y D D M M Y Y

P014-ICICI SEC Date of receipt of application

Date of credit of Cheque / DD in
PFC Account

Registrar’s Reference No. :

Dear Sirs,
I/We have read and understood the Information Memorandum for Private Placement. I/We bind myself/ourselves to their provisions and apply for allotment. Please place my/our name(s) on the register of Bondholder(s).
No. of Bonds (Minimum 2 Bonds / Maximum 500 Bonds) Bank A/c Number from
Cheque / Demand Draft Drawn on Cheque / Demand Draft
which investment is Dated
In Numbers 100 (Name of the Bank and Branch) / UTR No.
made
In Words ONE HUNDRED ONLY
Issue Price of Bond Rs. 10,000 per bond
Amount of Bonds [Amount Payable (Rs.) = No. of Bonds x Rs. 10,000 per bond]
Amount in Numbers (Rs.) 1000000
TEN LAKH ONLY
Amount In Words (Rs.)

I/We are applying as (Tick Any One whichever is applicable)

✔
Banks/Commercial RRB/ Financial NRI / Other Eligible Foreign Investor
Co-Operative Institution Company Mutual Fund Firm (Mention Country of Residence) Individual HUF Others (please specify)
FIRST/ SOLE APPLICANT'S NAME IN FULL ( Mr. / Ms. / M/s )
ANITA GUPTA
Date of Birth
(IF MINOR)
03-08-1962
SECOND APPLICANT'S NAME IN FULL (ONLY IN CASE OF INDIVIDUALS) ( Mr. / Ms. )
Not Filled
THIRD APPLICANT'S NAME IN FULL (ONLY IN CASE OF INDIVIDUALS) ( Mr. / Ms. )

Not Filled
FATHER'S NAME FOR FIRST / SOLE APPLICANT (APPLICABLE IN CASE OF INDIVIDUALS ONLY)

FIRST/SOLE APPLICANT'S CORRESPONDENCE ADDRESS IN FULL (DO NOT FILL IN NAME AGAIN)
71 CHARU CHANDRA SINHA LANE
SANDHYA BAZAR,
HOWRAH PIN
CITY
CODE*
711101
Mobile*^ 9830420280 Email* [email protected]
*Please do not keep these fields blank ^preferably Indian Mobile Number

BANK PARTICULARS OF FIRST / SOLE APPLICANT FOR PAYMENT OF INTEREST/REDEMPTION WARRANT (PLEASE ENCLOSE CANCELLED CHEQUE OF BELOW MENTIONED ACCOUNT NO.)
Bank Name : ICICI BANK Account No SB 627601146404
Branch Name / Address 15.PORTUGUSE CHURCH STREET, NEW HOWRAH Account Type
BRIDGE APPROACH ROAD , KOLKATA-700001 (Tick Any One) ✔ SB A/c Current A/C Cash Credit A/c NRO A/c

IFSC ICIC0006949 MICR Code

(Details of Bank Account will be used for payment of interest and/or principal on due date(s), only in case of the bonds held in Physical mode)
BOND CERTIFICATE MODE (TICK ANY ONE) DEMAT DETAILS (applicable in case applied in Demat mode)

Physical Mode Demat Mode DP ID No. Client ID No.

✔

P.T.O.

(Signature - First/Sole Applicant / Authorised Signatory) (Signature - Second Applicant / Authorised Signatory) (Signature- Third Applicant / Authorised Signatory)

…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

ACKNOWLEDGEMENT SLIP POWER FINANCE CORPORATION LIMITED Application Number

(To be filled in by the Sole/First Applicant) (A Maharatna Company)
PFC Capital Gain Tax Exemption Bonds
Regd. Office : Urjanidhi, 1, Barakhamba Lane, Connaught Place, New Delhi-110001
20035531
SERIES-VI

ANITA GUPTA No. of Bonds Amount (Rs.) Date Accepting Officer's

Received from Mr./Mrs./Ms / M/s………………………………………………………….……………………………… (Min 2, Max 500) Signature & Bank's Seal
In Numbers 100 1000000
Physical Mode / Demat Mode (Tick whichever is applicable)
In Words ONE HUNDRED ONLY
DPID & CLIENT ID
No. (if applicable)
71 CHARU CHANDRA SINHA LANE Cheque / DD No……………………………… dated………………………………..drawn on …………………………………………………………………. …………………………
Address……………………………………………………………………………………………………………………………..
SANDHYA BAZAR, HOWRAH
711101 for Rs………………………………………………………………………………… in words………………………….………………………………………………………………………………
………………………………………………………………………………………………………………………………………………
 INSTRUCTIONS FOR INVESTORS

1) Application Forms must be completed in BLOCK LETTERS IN ENGLISH. A blank space must be left between two or more parts of the name.

2) Minimum investment - 2 Bonds of Rs. 10,000/- each and Maximum investment - 500 Bonds amounting to Rs. 50 lakhs in a financial year.

3) a) Investors are required to submit the duly filled in Application Form along with necessary enclosures at the designated branches of collecting banks-
HDFC Bank, IndusInd Bank, YES Bank, ICICI Bank, Kotak Mahindra Bank and Canara Bank. Demand Draft or account payee Cheque should be drawn in favour
of "PFC Capital Gain Bonds". UTR details in case of investment by RTGS/NEFT/E-Payment, must be mentioned in the relevant box in the application form.
b) For details of designated bank branches, please refer Information Memorandum (IM) or visit our website: www.pfcindia.com.
c) Applicant should mention his name, address and application number on the reverse of the Cheque/ Demand Draft. Cash, Money Orders or Postal Orders will
NOT be accepted.
d) Investors are advised in their own interest to fill up complete details of their bank particulars along with a cancelled cheque. In absence of such information,
the interest & redemption warrants shall be mailed at given address at applicant's sole risk.
e) A copy of the Information Memorandum for the bond issue containing all the details of the issue is available at PFC’s website www.pfcindia.com

4) Application once submitted cannot be withdrawn and subscription amount will not be refunded.

5) The application should be submitted during banking hours at any of the Collection Branches of the banks to the bond issue as mentioned in the Information
Memorandum for the bonds. Outstation Demand Draft should be made payable at any of the designated collection centres mentioned in Information Memorandum.
Bank charges for such applications will be borne by applicants. PFC assumes no responsibility for any applications/ cheques / demand drafts lost in mail or late / short
credit of Application Money.

6) In case the investor has applied for and not yet been allotted the PAN, then he is required to furnish a copy of the acknowledged Form 49A and on subsequent
allotment of PAN, he should submit a copy of PAN to RTA. In case PAN has not been allotted he is required to furnish a declaration in Form 60.

7) In case of application under the Power of Attorney or by Limited Companies or other corporate bodies, a certified copy of the Power of Attorney or a copy of the
approval of the relevant authority, as the case may be should be submitted along with the Application Form.

8) In case a partnership firm makes investments, the application is required to be made in the name of the partnership firm and the application form can be signed by
any partner(s) authorised to do so in this behalf and affixing a rubber stamp of the firm.

9) The applications would be accepted as per the provisions of the IM of the issue & other applicable rules and regulations. Applicants are deemed to have read the IM
and are supposed to be well versed with terms and conditions of the offer. PFC is entitled, at its sole and absolute discretion, to accept or reject any application, in
part or in full, without assigning any reason. An application form that is not complete in all respects is liable to be rejected and would be returned by PFC to the
applicant along with invested amount (if any) without any interest.

10) It is advisable that investor mentions his/her mobile number, email ID in the application form as well as keeps a photocopy of the set of application form.

11) In case of Bonds allotted under Demat Mode, the demographic details will be picked up from the DP ID/ CLIENT ID, i.e Payment warrants would be prepared in
favour of sole/ first applicant and issued as per the details identified by the Bondholder's Demat Account. Bank details mentioned in the application form would
not be considered for making payment of interest and redemption of principal amount in case of bonds allotted in Demat Mode.

12) In case, where the investor applies for bonds under Physical Mode, all the Payment Warrants will be issued as per the details captured in the Register of
Bondholders and any discrepancy arising due to wrong information furnished in the application form shall be at the applicant's sole risk. As a matter of precaution
against possible fraudulent encashment of interest/redemption warrants due to loss/ misplacement, such applicants are requested to mention the full particulars
of their bank account, as specified in the Application Form and also attach a cancelled cheque of the account mentioned.

13) CERTAIN ISSUE HIGHLIGHTS :

(i) Rate of interest on the bond shall be as applicable on the date of credit of application money in PFC’s collection account. The applicable interest rate where
application money is credited in PFC’s collection account on 01.04.2022 is 5% p.a. payable annually on July 31st. Change in interest rate, if any, for application
money credited in PFC’s collection account thereafter shall be published on websites of PFC as well as of Registrar and Transfer Agent.
(ii) Lock in period of 5 (five) years (No transfer/premature redemption is permitted). The Bonds will automatically redeem after expiry of five years.
(iii) The Bonds are AAA rated by CRISIL, ICRA and CARE.

14) Interest/Redemption shall be paid by way of warrant/NECS/RTGS/NEFT payable at par at all locations to the bondholders by the bank. Interest is payable annually on
July 31st every year till date of redemption.

15) Tax will not be deducted at source for resident Indians as PFC has been exempted from deduction of TDS under section 193 (iib) of the Income Tax Act, 1961 (vide
Ministry of Finance’s notification no. 27/2018 dated 18th June 2018). However, TDS shall be deducted in case of NRI / Other eligible foreign investor. NRI / Other
eligible foreign investor must mention the name of the Country in the box appearing against the status of NRI overleaf.

16) PFC reserves the right to revise the coupon rate for future allotments and/or close the issue by giving a notice on its website www.pfcindia.com. Further, it is clarified
that coupon rate shall remain fixed during entire tenor of the allotted bonds.

17) For status of allotment/ servicing or any other details, please contact our RTA/ PFC Investors Services Cell.

18) PFC shall not be responsible for denial of benefit under Section 54EC of the Income Tax Act, 1961 to the investor and any consequences arising thereof.
ALL INVESTORS TO PROVIDE :

(I) Self-attested copy of PAN Card / PAN Allotment Letter for all clients (Individuals/Non-individuals), including Promoters/Partners/Karta/
Trustees/Whole time directors & persons authorized to deal in the Bonds on behalf of company/firm/others (In case of Joint application, self-
attested PAN copy of all the applicants)
(or)
Form 60 where bond application size is Rs. 50,000/- or more.

(II) Self-attested Photo Copy of a cancelled Cheque for NEFT/RTGS/E-Payment facility.

(III) Other Document(s) :

For Resident Indian Nationals For NRIs/ Other foreign eligible Investor

Officially Valid Documents in support of Name and Address as Proof of (copies attested by Gazetted Officer/ Notary Public / Overseas branches
Address (PoA) and Proof of Identity (PoI) - (Any one copy attested by of Scheduled Commercial Banks registered in India / Self Attested)
Gazetted Officer/ Notary / Self Attested in case of Individual only)
a) Passport; and
a) Aadhaar Card b) Driving License
b) Passport
c) Driving License For HUF
d) Voters Identity Card
e) Ration card with applicant’s Photo and Address Documents in support (copies attested by Gazetted Officer, Notary
f) Identity card/document with applicant’s Photo and Address issued Public, Manager of a Scheduled Commercial Bank)
by Central/State Government & its departments,
Statutory/Regulatory authorities, Public Sector Undertakings, a) PAN Card / PAN Allotment Letter of HUF and of Karta; and
Scheduled Commercial Banks, Public Financial Institutions, College b) Deed of Declaration of HUF / List of coparceners; and
affiliated to Universities, Professional Bodies (ICAI, ICWAI, ICSI, Bar c) Bank Pass-book / Bank Statement in the name of HUF; and
Council etc.) to their members d) Any officially valid document to identify the Karta and his
address (PoI and PoA)

For Partnership Firms For Trust & Foundations

Documents in support (copies attested by Notary Public) Documents in support (copies attested by Notary Public)

a) Certificate of Registration (for registered partnership firms only); a) Certificate of Registration (for registered Trust & Foundations only);
and and
b) Partnership Deed; and b) Trust Deed; and
c) Power of Attorney granted to a partner or an employee of the c) Power of Attorney granted to transact business on its behalf; and
firm to transact business on its behalf; and d) Any officially valid document :
d) Any officially valid document - to identify the Trustees, Settlors, Beneficiaries and their
- to identify the partners & their addresses (PoA and PoI); addresses (PoI and PoA); and
and - to identify the persons holding Power of Attorney,
- to identify the persons holding the Power of Attorney and Founders/ Managers/ Directors and their addresses (PoI and
their addresses (PoI and PoA); and PoA); and
e) Telephone Bill in the name of firm/partner(s) e) Resolution of the managing body of the Foundation/Association;
and
f) Telephone bill; and
g) PAN Card / PAN Allotment letter (otherwise exemption certificate
issued by Income Tax authorities)

For Corporate
Documents in support (copies attested by Company Secretary/
Director)

a) Certificate of Incorporation and Memorandum & Articles of

Association; and
b) Resolution of the Board of Directors for investment in bonds and
for those who have authority to operate; and
c) Power of Attorney granted to its managers, officers or employees
to transact business, on its behalf; and
d) PAN Card / PAN Allotment letter of the Corporate and its
authorised signatory(ies); and
e) Any officially valid document to identify the authorized person(s)
applying for the Bonds and his/their address(es) (PoI and PoA)

PoA = Proof of Address PoI = Proof of Identity