UltraTech Cement Limited,

Accounts Department
Unit: Ginigera Cement Works

Sub: Intimation regarding Voluntary Provident Fund

a) I am a member of the UltraTech CemCo Provident Fund and I wish to contribute

Provident Fund Voluntarily @ ______% with effect from April / October
________.

Accordingly, I request you to make the necessary deductions from my salary /

wages from April / October __________.

Such Voluntary contribution is in addition to my regular contribution to the

Provident Fund

b) I am a member of the UltraTech CemCo Provident Fund and I was contributing

Provident Fund Voluntarily @ ____% till April / October ________.

Since I do not wish to contribute in the Volunatary Provident Fund, I request you
to kindly stop the deductions from my salary / wages starting from April / October
________

Name of the member :________________________________________

PS NO: ________________________________________

POORNATA ID : ________________________________________

Location : ________________________________________

Date: Signature of the Member.

MOBILE NO:

CC: UltraTech CemCo Provident Fund

Awarpur Cement Works
Dist: Chandrapur - 442 917