AEROFLEX AEROFLEX-5434-142257- KIRTI NCM

 ELECTRONICS MART INDIA LIMITED - INITIAL PUBLIC OFFER - R FOR RESIDENT INDIAN INVESTORS INCLUDING
COMMON BID CUM Registered Office: D. No: 6-1-91, Shop No. 10, Ground Floor, Next to Telephone Bhavan, Secretariat Road, Saifabad, Hyderabad – 500 004, RESIDENT QIBs, NON-INSTITUTIONAL BIDDERS,
Telangana, India; Tel: +91 40-2324 2512
APPLICATION FORM Corporate Office: 6-3-666/A1 to 7, 3rd and 4th Floors, Opposite NIMS Hospital, Punjagutta Main Road, Hyderabad – 500 082 Telangana, India; RETAIL INDIVIDUAL BIDDERS AND ELIGIBLE NRIs
Tel: +91 40 2323 0244; Contact Person: Rajiv Kumar, Company Secretary and Compliance Officer; Tel: +91 40 4875 1125
E-mail: cs@bajajelectronics.in; Website: www.electronicsmartindia.com; Corporate Identity Number: U52605TG2018PLC126593 APPLYING ON A NON-REPATRIATION BASIS
TEAR HERE

To, 100% BOOK BUILT ISSUE Bid cum

The Board of Directors ISIN: INE02YR01019
ELECTRONICS MART INDIA LIMITED LEI: 335800HOFDU9X5L32I07
Application
Form No.
77787256
MEMBERS OF THE SYNDICATE STAMP & CODE REGISTERED BROKER/SCSB/CDP/RTA STAMP & CODE 1. NAME & CONTACT DETAILS OF SOLE / FIRST BIDDER
PENTAGON STOCK BROKERS AXIS CAPITAL LTD
JM FINANCIAL
PRIVATE LIMITED JM FINANCIAL
01/6105
Mr. /Ms./M/s. R A K H I K I R T I K U
01/0325-0
BSE-6646 01/0325-0 M A R J A I N
SUB-BROKER’S / SUB-AGENT’S STAMP & CODE SCSB BRANCH STAMP & CODE
Address B94 JOGESHWARI SOC2 RAJENDRAPARK,
ODHAV, AHMEDABAD
193840 382415 Email
BANK BRANCH SERIAL NO. SCSB SERIAL NO. Tel. No. (with STD code) / Mobile 9 9 9 8 8 4 2 8 4 6
2. PAN OF SOLE / FIRST BIDDER

A H E P J 4 1 4 7 N
3. BIDDER’S DEPOSITORY ACCOUNT DETAILS NSDL CDSL 6. INVESTOR STATUS
Individual(s) - IND
1 2 0 3 3 3 0 0 0 0 7 2 3 0 9 1 Hindu Undivided Family - HUF*
Bodies Corporate - CO
For NSDL enter 8 digit DP ID followed by 8 digit Client ID / For CDSL enter 16 digit Client ID Systemically Important NBFCs
Banks & Financial Institutions - FI
4. BID OPTIONS (ONLY RETAIL INDIVIDUAL BIDDERS CAN BID AT “CUT-OFF”) 5. CATEGORY Mutual Funds - MF
National Investment Fund - NIF
No. of Equity Shares Bid (In Figures) Price per Equity Share (`)/ “Cut-off” Retail Insurance Funds - IF
(Bids must be in multiples of (Price in multiples of ` 1 only) (In Figures only) Individual Insurance Companies - IC
Bid Bid Lot as advertised) Bidder Venture Capital Fund - VCF
Options Bid Price Retail Discount Net Price “Cut-off” Alternative Investment Fund - AIF
8 7 6 5 4 3 2 1 4 3 2 1 3 2 1 4 3 2 1 (Pleasetick) Non- Other QIBs - OTH
Institutional Non Resident Indian - NRI
(Non repatriation basis)
Option 1 1 3 0 Bidder
All entities other than QIBs, Bodies
Corporates and Individuals - NOH
(OR) Option 2 Please Specify__________________
QIB
PLEASE FILL IN BLOCK LETTERS

*HUF should apply only through Karta (Application by

(OR) Option 3 HUF would be treated on par with individual).

7. PAYMENT DETAILS [IN CAPITAL LETTERS] PAYMENT OPTION : FULL PAYMENT 

Amount blocked (` in figures) 1 4 0 4 0 (` in words) _____________________________________________________________________
FOURTEEN THOUSAND FORTY ONLY
ASBA 2 0 1 4 1 0 1 1 0 0 0 1 5 2 9
Bank A/c No.
BANK OF INDIA , CTM AHMEDABAD
Bank Name & Branch _____________________________________________________________________________________________________________________________
OR
UPI ID (Maximum
45 characters)
I/WE (ON BEHALF OF JOINT BIDDERS, IF ANY) HEREBY CONFIRM THAT I/WE HAVE READ AND UNDERSTOOD THE TERMS AND CONDITIONS OF THIS COMMON BID CUM APPLICATION FORM, THE
ATTACHED ABRIDGED PROSPECTUS AND THE GENERAL INFORMATION DOCUMENT FOR INVESTING IN PUBLIC OFFERS (“GID”) AND HEREBY AGREE AND CONFIRM THE ‘BIDDER’S UNDERTAKING’ AS GIVEN
OVERLEAF. I/WE (ON BEHALF OF JOINT BIDDERS, IF ANY) HEREBY CONFIRM THAT I/WE HAVE READ THE INSTRUCTIONS FOR FILLING UP THE COMMON BID CUM APPLICATION FORM GIVEN OVERLEAF.
8B. SIGNATURE OF ASBA BANK ACCOUNT HOLDER(S) MEMBERS OF THE SYNDICATE / SUB - SYNDICATE
8A. SIGNATURE OF SOLE/ FIRST BIDDER MEMBER / R E G I S T E R E D B R O K E R / SCSB / CDP /
(AS PER BANK RECORDS) RTA / AGENT STAMP (Acknowledging upload of
I/We authorise the SCSB to do all acts as are necessary to make the application in the Issue. Bid in Stock Exchange system)
1)

2)

Date : ________________, 2022 3)

2023
TEAR HERE
ELECTRONICS MART Acknowledgement Slip for Bid cum
INDIA LIMITED Members of the Syndicate / Sub-Syndicate
Member / Registered Broker /
Application
Form No.
77787256
INITIAL PUBLIC OFFER - R SCSB / CDP / RTA / Agent
PAN of Sole / First Bidder
DP ID
/ 1 2 0 3 3 3 0 0 0 0 7 2 3 0 9 1 A H E P J 4 1 4 7 N
CL ID

Amount blocked (` in figures) 14040 ASBA Bank A/c No./UPI ID 201410110001529 Stamp & Signature of SCSB Branch
Bank Name & Branch BANK OF INDIA , CTM AHMEDABAD

Received from Mr./Ms./M/s. RAKHI KIRTIKUMAR JAIN

Telephone / Mobile 9998842846 Email
Printed by : Orient Press Ltd.

TEAR HERE
Stamp & Signature of Members of the Syndicate / Sub-Syndicate Name of Sole / First Bidder 193840
Option 1 Option 2 Option 3
INDIA LIMITED - INITIAL

Member / Registered Broker / SCSB / CDP / RTA / Agent

ELECTRONICS MART

RAKHI KIRTIKUMAR JAIN

PUBLIC OFFER - R

No. of Equity Shares 130

TEAR HERE

Bid Price (`) AHEPJ4147N 1203330000723091

Amount Blocked (` in figures) 14040 Acknowledgement Slip for Bidder

201410110001529
ASBA Bank A/c No./UPI ID _____________________________________________________________________________________ Bid cum
Application
77787256


Bank Name & Branch BANK OF INDIA , CTM AHMEDABAD Form No.
Important Note : Application made using third party UPI ID or ASBA Bank A/c are liable to be rejected. ELECTRONICS MART INDIA LIMITED 1
AEROFLEX-5434-142257- KIRTI NCM
 AEROFLEX AEROFLEX-5434-142258- KIRTI NCM
 ELECTRONICS MART INDIA LIMITED - INITIAL PUBLIC OFFER - R FOR RESIDENT INDIAN INVESTORS INCLUDING
COMMON BID CUM Registered Office: D. No: 6-1-91, Shop No. 10, Ground Floor, Next to Telephone Bhavan, Secretariat Road, Saifabad, Hyderabad – 500 004, RESIDENT QIBs, NON-INSTITUTIONAL BIDDERS,
Telangana, India; Tel: +91 40-2324 2512
APPLICATION FORM Corporate Office: 6-3-666/A1 to 7, 3rd and 4th Floors, Opposite NIMS Hospital, Punjagutta Main Road, Hyderabad – 500 082 Telangana, India; RETAIL INDIVIDUAL BIDDERS AND ELIGIBLE NRIs
Tel: +91 40 2323 0244; Contact Person: Rajiv Kumar, Company Secretary and Compliance Officer; Tel: +91 40 4875 1125
E-mail: cs@bajajelectronics.in; Website: www.electronicsmartindia.com; Corporate Identity Number: U52605TG2018PLC126593 APPLYING ON A NON-REPATRIATION BASIS
TEAR HERE

To, 100% BOOK BUILT ISSUE Bid cum

The Board of Directors ISIN: INE02YR01019
ELECTRONICS MART INDIA LIMITED LEI: 335800HOFDU9X5L32I07
Application
Form No.
77787257
MEMBERS OF THE SYNDICATE STAMP & CODE REGISTERED BROKER/SCSB/CDP/RTA STAMP & CODE 1. NAME & CONTACT DETAILS OF SOLE / FIRST BIDDER
PENTAGON STOCK BROKERS AXIS CAPITAL LTD
JM FINANCIAL
PRIVATE LIMITED JM FINANCIAL
01/6105
Mr. /Ms./M/s. K I R T I K U M A R R A
01/0325-0
BSE-6646 01/0325-0 J K U M A R J A I N
SUB-BROKER’S / SUB-AGENT’S STAMP & CODE SCSB BRANCH STAMP & CODE
Address B94 JOGESHWARI SOC2 RAJENDRAPARK,
ODHAV, AHMEDABAD
193840 382415 Email
BANK BRANCH SERIAL NO. SCSB SERIAL NO. Tel. No. (with STD code) / Mobile 9 9 9 8 8 4 2 8 4 6
2. PAN OF SOLE / FIRST BIDDER

A D X P J 4 4 7 5 E
3. BIDDER’S DEPOSITORY ACCOUNT DETAILS NSDL CDSL 6. INVESTOR STATUS
Individual(s) - IND
1 2 0 3 3 3 0 0 0 0 7 2 3 0 8 5 Hindu Undivided Family - HUF*
Bodies Corporate - CO
For NSDL enter 8 digit DP ID followed by 8 digit Client ID / For CDSL enter 16 digit Client ID Systemically Important NBFCs
Banks & Financial Institutions - FI
4. BID OPTIONS (ONLY RETAIL INDIVIDUAL BIDDERS CAN BID AT “CUT-OFF”) 5. CATEGORY Mutual Funds - MF
National Investment Fund - NIF
No. of Equity Shares Bid (In Figures) Price per Equity Share (`)/ “Cut-off” Retail Insurance Funds - IF
(Bids must be in multiples of (Price in multiples of ` 1 only) (In Figures only) Individual Insurance Companies - IC
Bid Bid Lot as advertised) Bidder Venture Capital Fund - VCF
Options Bid Price Retail Discount Net Price “Cut-off” Alternative Investment Fund - AIF
8 7 6 5 4 3 2 1 4 3 2 1 3 2 1 4 3 2 1 (Pleasetick) Non- Other QIBs - OTH
Institutional Non Resident Indian - NRI
(Non repatriation basis)
Option 1 1 3 0 Bidder
All entities other than QIBs, Bodies
Corporates and Individuals - NOH
(OR) Option 2 Please Specify__________________
QIB
PLEASE FILL IN BLOCK LETTERS

*HUF should apply only through Karta (Application by

(OR) Option 3 HUF would be treated on par with individual).

7. PAYMENT DETAILS [IN CAPITAL LETTERS] PAYMENT OPTION : FULL PAYMENT 

Amount blocked (` in figures) 1 4 0 4 0 (` in words) _____________________________________________________________________
FOURTEEN THOUSAND FORTY ONLY
ASBA 2 0 1 4 1 0 1 0 0 0 2 6 5 1 1
Bank A/c No.
BANK OF INDIA , CTM AHMEDABAD
Bank Name & Branch _____________________________________________________________________________________________________________________________
OR
UPI ID (Maximum
45 characters)
I/WE (ON BEHALF OF JOINT BIDDERS, IF ANY) HEREBY CONFIRM THAT I/WE HAVE READ AND UNDERSTOOD THE TERMS AND CONDITIONS OF THIS COMMON BID CUM APPLICATION FORM, THE
ATTACHED ABRIDGED PROSPECTUS AND THE GENERAL INFORMATION DOCUMENT FOR INVESTING IN PUBLIC OFFERS (“GID”) AND HEREBY AGREE AND CONFIRM THE ‘BIDDER’S UNDERTAKING’ AS GIVEN
OVERLEAF. I/WE (ON BEHALF OF JOINT BIDDERS, IF ANY) HEREBY CONFIRM THAT I/WE HAVE READ THE INSTRUCTIONS FOR FILLING UP THE COMMON BID CUM APPLICATION FORM GIVEN OVERLEAF.
8B. SIGNATURE OF ASBA BANK ACCOUNT HOLDER(S) MEMBERS OF THE SYNDICATE / SUB - SYNDICATE
8A. SIGNATURE OF SOLE/ FIRST BIDDER MEMBER / R E G I S T E R E D B R O K E R / SCSB / CDP /
(AS PER BANK RECORDS) RTA / AGENT STAMP (Acknowledging upload of
I/We authorise the SCSB to do all acts as are necessary to make the application in the Issue. Bid in Stock Exchange system)
1)

2)

Date : ________________, 2022 3)

2023
TEAR HERE
ELECTRONICS MART Acknowledgement Slip for Bid cum
INDIA LIMITED Members of the Syndicate / Sub-Syndicate
Member / Registered Broker /
Application
Form No.
77787257
INITIAL PUBLIC OFFER - R SCSB / CDP / RTA / Agent
PAN of Sole / First Bidder
DP ID
/ 1 2 0 3 3 3 0 0 0 0 7 2 3 0 8 5 A D X P J 4 4 7 5 E
CL ID

Amount blocked (` in figures) 14040 ASBA Bank A/c No./UPI ID 201410100026511 Stamp & Signature of SCSB Branch
Bank Name & Branch BANK OF INDIA , CTM AHMEDABAD

Received from Mr./Ms./M/s. KIRTIKUMAR RAJKUMAR JAIN

Telephone / Mobile 9998842846 Email
Printed by : Orient Press Ltd.

TEAR HERE
Stamp & Signature of Members of the Syndicate / Sub-Syndicate Name of Sole / First Bidder 193840
Option 1 Option 2 Option 3
INDIA LIMITED - INITIAL

Member / Registered Broker / SCSB / CDP / RTA / Agent

ELECTRONICS MART

KIRTIKUMAR RAJKUMAR JAIN

PUBLIC OFFER - R

No. of Equity Shares 130

TEAR HERE

Bid Price (`) ADXPJ4475E 1203330000723085

Amount Blocked (` in figures) 14040 Acknowledgement Slip for Bidder

201410100026511
ASBA Bank A/c No./UPI ID _____________________________________________________________________________________ Bid cum
Application
77787257


Bank Name & Branch BANK OF INDIA , CTM AHMEDABAD Form No.
Important Note : Application made using third party UPI ID or ASBA Bank A/c are liable to be rejected. ELECTRONICS MART INDIA LIMITED 1
AEROFLEX-5434-142258- KIRTI NCM