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Y declare that the particulars given above are correct and complete. Yours faithfully, (Signature of the 1st Registered holder as per the Specimen Signature lodged with the Company) Name : Address : Date : * In case you are not in a position to give a blank cancelled cheque or a photocopy thereof, then a certificate from your banker shall be furnished as under. Certificate of the Shareholder(s) Bank Certified that the particulars furnished above are correct as per our.

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