Date of Receipt:____________________

Date of realisation of Cheque / DD No:___________________________

We hereby apply for Deposit of Rs. __________________ (Rupees _______________________________ only) for a period of ……… years………. months ……… days at ……..% p.a. interest in the NHB Term Deposit Scheme for HFCs.

Interest Payable: Quarterly Yearly On Maturity

Please tick the choice : Fresh Renewal

If renewal, FDR No._______________ Date ______________

Amount Rs._________________________
Cheque / DD No.______________________ Date_________________
Amount Rs. ______________ drawn on ______________________________Bank

NAME, ADDRESS AND OTHER DETAILS OF THE HOUSING FINANCE COMPANY AS REQUIRED IN FD RECEIPT (IN BLOCK LETTERS)

Name of Company____________________________________________________________________________________

Address____________________________________________________________________________________________
___________________________________________________________________________________________________

City___________________ State___________________ PIN___________________

Tel. No_______________________________________________________________

Email ID__________________________________________________________

TAX STATUS: Exempt YES NO (If yes, please enclose exemption certificate)

PAN /GIR NO.

BANK DETAILS FOR THE PAYMENT OF INTEREST AND PRINCIPAL:

Bank Name:_________________________________________________

Branch ___________________________ RBI Code _________________

Bank A/c No. _______________________________________________

We hereby declare that the particulars given above are correct and complete.We have read and understood the terms and conditions of the NHB Term Deposit Scheme for HFCs and the same are acceptable to us. We also declare that above information is true to the best of our knowledge and belief.

For_____________________________________________________ Ltd

__________________________________________________________

Authorised Signatory Date:_____________________________ Place:_____________________________

Acknowledgement (to be filled by the Company)

Received from_________________________________________________________ Cheque* / Draft no. _____________________ dated__________ for Rs. ________________ drawn on _______________________ Bank ___________________ Branch, towards NHB Term Deposit Scheme for HFCs for a period of _______ months at _________ % p.a.

*valid subject to realisation of Cheque / Demand Draft.

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