FORM ‘A’ — APPLICATION FORM. Rights Issue of 1,00,000 Equity Shares of Rs. 10 each to the existing shareholders whose name appeared in the Register of Members on 10/11/2021 Dated: 27/11/2021 ‘The Board of Directors Accudex Elastomers Private Limited Plot No. 14/15/16, GIDC, Visnagar-384315. Dear Sir, |, Alpaben Ashishkumar Patel apply for allotment of Equity shares indicated below in Fesponse to your letter of Rights Offer dated 10/11/2021 and subject to the Memorandum and Articles of Association of the Company. | hereby agree to accept the shares as may be allotted to me on the terms laid down in the letter of offer. Name Alpaben Ashishkumar Patel Address 37, Gulabpark Bungalows, Kansa, NA, Vistar, Visnagar-384315 Folio Number 1 No. of shares held No. of shares offered No. of shares applied for ‘No. of additional shares applied for Total number of shares applied for ‘Amount payable @ Rs. 10 per share Income-tax Permanent Account No Specimen signatures and Seal A.A ater Signature of Shareholder 20,000 10,000 10,000 ° 10,000 4,00,000 cZQPP39291.FORM ‘A’ - APPLICATION FORM. Rights Issue of 1,00,000 Equity Shares of Rs. 10 each to the existing shareholders whose name appeared in the Register of Members on 10/11/2021 Dated: 27/11/2021 The Board of Directors Accudex Elastomers Private Limited Plot No. 14/15/16, GIDC, Visnagar-384315. Dear Sir, |, Ashishkumar Dashrathbhai Patel apply for allotment of Equity shares indicated below in response to your letter of Rights Offer dated 10/11/2021 and subject to the Memorandum and Articles of Association of the Company. | hereby agree to accept the shares as may be allotted to me on the terms laid down in the letter of offer. Name Ashishkumar Dashrathbhai Patel Address 41, Gulabpark Bungalows, Kansa, NA Vistar, Visnagar-384315 Folio Number 1 No. of shares held 70,000 No. of shares offered 35,000 No. of shares applied for 35,000 No. of additional shares applied for o Total number of shares applied for 35,000 ‘Amount payable @ Rs. 10 per share 3,50,000 Income-tax Permanent Account No, BJBPP 12301 ‘Specimen signatures and Seal "ee Signature of ShareholderFORM ‘A’ — APPLICATION FORM. Rights Issue of 1,00,000 Equity Shares of Rs. 10 each to the existing shareholders whose name appeared in the Register of Members on 10/11/2021 Dated: 27/11/2021 ‘The Board of Directors Accudex Elastomers Private Limited Plot No. 14/15/16, GIDC, Visnagar-384315, Dear Sir, |, Brijesh Manubhai Patel apply for allotment of Equity shares indicated below in Fesponse to your letter of Rights Offer dated 10/11/2021 and subject to the ‘Memorandum and Articles of Association of the Company. | hereby agree to accept the shares as may be allotted to me on the terms laid down in the letter of offer. Name Bresh Manubhai Patel Address 22, Suraksha Society, MIN College Road Visnagar-384315, Folio Number 1 No. of shares held 20,000 No. of shares oftered 10,000 No. of shares applied for 10,000 No of addtional shares applied for ° Total number of shares applied for 10,000 Amount payable @ Rs. 10 per share 100,000 Income-tax Permanent Account No cSxPP96630 Specimen signatures and Seal on Signature of ShareholderFORM ‘A’ - APPLICATION FORM. Rights Issue of 1,00,000 Equity Shares of Rs. 10 each to the existing shareholders whose name appeared in the Register of Members on 10/11/2021 Dated: 27/11/2021 The Board of Directors Accudex Elastomers Private Limited Plot No. 14/15/16, GIDC, Visnagar-384315, Dear Sir, |, Chimanlal Shambhudas Patel apply for allotment of Equity shares indicated below in response to your letter of Rights Offer dated 10/11/2021 and subject to the Memorandum and Articles of Association of the Company. | hereby agree to accept the shares as may be allotted to me on the terms laid down in the letter of offer. Name Address Folio Number No.of shares held No. of shares offered No. of shares applied for No, of addtional shares applied for Total number of shares applied for ‘Amount payable @ Rs. 10 per share tncome-tax Permanent Account No Specimen signatures and Seal Be” Signature of Shareholder Chimanlal Shambhudas Patel B/19, Nataraj Benkars Society, Kheralu Road, Visnagar-384315, 1 6,000 3,000 3,000 ° 3,000 30,000 ‘ABNPP8B38PFORM ‘A’ — APPLICATION FORM. Rights Issue of 1,00,000 Equity Shares of Rs. 10 each to the existing shareholders whose name appeared in the Register of Members on 10/11/2021 Dated: 27/11/2021 The Board of Directors Accudex Elastomers Private Limited Plot No. 14/15/16, GIDC, Visnagar-384315, Dear Sir, |, Manishchandra Dhudalal Patel apply for allotment of Equity shares indicated below in response to your letter of Rights Offer dated 10/11/2021 and subject to the Memorandum and Articles of Association of the Company. | hereby agree to accept the shares as may be allotted to me on the terms laid down in the letter of offer Name Manishchandra Dhudalal Patel Address 8, Hinglaj Society, Radhanpur, Patan — 385340 Folio Number 1 No. of shares held 10,000 No. of shares offered 5,000 No. of shares applied for 5,000 No. of addtional shares applied for ° Total number of shares applied for 5,000 Amount payable @ Rs. 10 per share 50,000 Income-tax Permanent Account No. ‘AMBPP9914D ‘Specimen signatures and Seal AD Frey, Signature of Shareholder (wsnagar x srs:FORM ‘A’ — APPLICATION FORM Rights Issue of 1,00,000 Equity Shares of Rs. 10 each to the existing shareholders whose name appeared in the Register of Members on 10/11/2021 Dated: 27/11/2021 The Board of Directors Accudex Elastomers Private Limited Plot No. 14/15/16, GIDC, Visnagar-384315 Dear Sir, |, Pinakin Kamleshbhai Patel apply for allotment of Equity shares indicated below in response to your letter of Rights Offer dated 10/11/2021 and subject to the Memorandum and Articles of Association of the Company. | hereby agree to accept the shares as may be allotted to me on the terms laid down in the letter of offer. Name Pinakin Kamleshbhai Patel Address 11, Asopalav Society, Mahavimagar, Himmatnagar-383001 Folio Number 1 No. of shares hela No. of shares offered No. of shares applied for No. of additional shares applied for Total number of shares applied for ‘Amount payable @ Rs. 10 per share Income-tax Permanent Account No Specimen signatures and Seal ee Signature of Shareholder 20,000 10,000 10,000 0 10,000 4,00,000 EFIPP4O66LFORM ‘A’ — APPLICATION FORM. Rights Issue of 1,00,000 Equity Shares of Rs. 10 each to the existing shareholders whose name appeared in the Register of Members on 10/11/2021 Dated: 27/11/2021 ‘The Board of Directors Accudex Elastomers Private Limited Plot No. 14/15/16, GIDC, Visnagar-384315, Dear Sir, |, Sunnykumar Kanaiyalal Patel apply for allotment of Equity shares indicated below in response to your letter of Rights Offer dated 10/11/2021 and subject to the Memorandum and Articles of Association of the Company. | hereby agree to accept the shares as may be allotted to me on the terms laid down in the letter of offer. Name Sunnykumar Kaniyalal Patel Address 7, Shivam, Shahibag Society, Kansa N.A Visnagar-$84315 Folio Number 2 No. of shares held 54,000 No. of shares offered 27,000 No. of shares applied for 27,000 No. of adeitional shares applied for ° Total number of shares applied for 27,000 ‘Amount payable @ Rs. 10 per share 2,70,000 Income-tax Permanent Account No. BLNPPS7AGH Specimen signatures and Seal we Signature of Shareholder