(FORMAT OF APPLICATION FOR UNPAID DIVIDEND/INTEREST ON BONDS)

(Pursuant to SEBI Circular No.SEBI/HO/MIRSD/DOP1/CIR/P/2018/73 dated April 20, 2018)

Date: ___________________
The Company Secretary,
Bank of India,
Investor Relations Cell, Head Office,
Star House, East Wing, 8th Floor, C-5, G Block,
Bandra Kurla Complex, Mumbai 400 051
Telephone No.: (022) 6668 4490
E-mail: headoffice.share@bankofindia.co.in
Dear Sir/Madam,
Bank of India Equity Shares / Bonds – Request for Unpaid Dividend / Interest on Bonds
I/We __________________________________, Equity Shareholder(s) of the Bank request you to pay my/our
Unpaid Dividend / Interest on Bonds for the year __________________ and update my Accounts with the
following information with your Registrar and Share Transfer Agent for future dividends/correspondence, etc.
1. Security Holder’s Name
2. Folio No /DPID-Client ID/Client ID No.
3. Number of Shares / Bonds
4. E Mail id
5. Mobile Number / Phone Number (with STD code)
6. PAN Number (Income Tax)
7. Original Instrument No. / MICR No.
8. Payee’s Name (Same as Security Holder’s Name)
9. Payee’s Bank Account Number and Type of
Account for getting Dividend
10. Name of the Bank and Branch
11. IFSC Code (Given on the Cheque Leaf)
12. MICR Code (Given on the Cheque Leaf)
13. Reason for Revalidation / Reissue of Dividend Request
The Shareholders should also enclose a copy of (i) Cancelled Cheque Leaf and (ii) PAN Card.

Thanking you,
Yours faithfully,

Signatures of All Shareholders

Name:
Address:
Note: Shareholders holding Shares in Physical form get the shares converted into Demat Form before 05.12.2018
as shares in physical form will not be transferred thereafter pursuant to SEBI Gazette Notification dt.08.06.2018.

Our Registrar and Transfer Agent: M/s. Bigshare Services Pvt. Ltd.,
1st Floor, Bharat Tin Works Building, Opp. Vasant Oasis,
Makwana Road, Marol, Andheri (East), Mumbai 400 059
Tel.No.022-62638200/8222/8223 E-mail: investor@bigshareonline.com

For Office Use Only:

Dividend Paid on Amount Year UTR No. / Transaction Ref. No