1. Auto filled from the previous page (name of the claimant).

2. Select and Input one of the following: PAN Card, Aadhar Card, Passport Number etc.
3. Enter the correspondence address, where you want communication to be sent.
4. Auto filled from the previous page (name of the claimant)
5. Enter the total principal amount paid by you to Supertech ltd. for the unit. This amount
should be backed by Receipts/ Bank Account Statement.
6. It’s better to leave this blank as calculating it would be a pain. However, if you have
everything calculated you can fill it.

7. Enter the Principal Amount, in Payment Date enter the date you received Possesion of your
unit, rest all fields will be auto calculated.
8. You can specify any other expenses like in my case I mentioned 46000/- for additional 2 KVA
load increase.
9. Mention the documents that would be attached along with this Form CA that would act as
proofs of your entitlement of the unit and the payments made.
10. NA
11. NA
12. NA
13. Select Mrs. Anju Agarwal.

14. Input the Bank Account Details, where you wish the claim settlement to be made.

15. Attach all the Documents that would prove your entitlement and payment done to
Supertech Ltd.
 16. Print the Form CA and attach the same after self-attesting it.
17. Provide the note “My unit is completed and in my possession, I am waiting for Registry, I
want the registry for my unit and not looking for claim settlement as first choice.
The settlement should be done according to the attached Affidavit.”

Note: Make sure to attach the Affidavit duly attested by a Notary on a simple A4 size paper, the
format of the same is given below.

Affidavit

This to certify that I Himanshu Bajpai Son of P S Bajpai Resident of 124/5 A, Pardevanpurwa, Kanpur,
UP 201310 purchased the unit No. 46 in Villa at CZAR, Omicron-1, Greater Noida, UP as per the
allotment no. IN-DL04156013574421L dated 16th April 2013 and taken the possession of the Villa on
27th February 2016 In the absence of Occupation Certificate / Completion Certificate, the registry of
the above said flat is not done.

The total amount paid to M/s Supertech includes principal amount Rs. 5937172/- and the interest
for this principle @8% simple interest till today is Rs. 2884303/-

In future, if the registry of the flat will be done till the settlement date, in favor of Mr. Himanshu Bajpai,
the claim amount will be considered as Rs. 2884303/- which is only interest over the paid principle.
In future, if the registry of the flat will not be done till the settlement date, in favor of Mr. Himanshu
Bajpai, the claim amount will be considered as Rs. 8821475/- which is sum of the principle paid and
interest over the paid principle.