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I, Mrs. Girijs Purushothaman, aged 65years, jointly with Mr. C S Purushothaman aged 71 years, an
Indian inhabitant, presently residing at 233/ 6099, Lakshmi Darshan, Pantanagar, Naidu Colony,
Ghatkopar East, Mumbai 400 075 for the last 37 years , do hereby solemly affirm and declare as

I, Mrs. Girija Purushothaman, jointly with Mr. C S Purushothaman ar registered holders of the
Company holding ______shares under Folio No. ______________________________ of Rs.
_____________________ each

I, further confirm that any claim whatsoever received in future in respect of the said shars to the
issuer Company will be indemnified by us.

I, further confirm to register my current signature as undersigned as the specimen signature in the
records of the Company.

I am executing this declaration to be submitted to the concerned authorities of the company.


I hereby state that whatever is stated herein above is true to the best of my knowledge

Specimen Signature of the Share Holder

Solemnly affirmed at __________________

On this __________________day of ____________________ 2018

Identified by me Before me

Advocate Notary