FORM ‘A’ – APPLICATION FORM

Rights Issue of 1,45,000 Equity Shares of Rs. 14.98/- each(including premium)

to the existing shareholders and others whose name appeared in the Register of
Members on 11/01/2023.
Dated: 18/01/2023
The Board of Directors
NUTRISOURCE INDIA PRIVATE LIMITED
FLOOR FL-2, 1/37/6 BIJOYGARH JADAVPUR, LP-55/3/2/5 JADAVPUR Kolkata WB
700032 IN

Dear Sir,
We NUTRISOURCE PTE LTD, Apply For Allotment Of Equity Shares Indicated
Below In Response To Your Letter Of Rights Offer Dated 11/01/2023 And
Subject To The Memorandum And Articles Of Association Of The Company.
WE, Hereby Agree To Accept The Shares As May Be Allotted To US On The
Terms Laid Down In The Letter Of Offer.

Name Nutrisource PTE LTD

Address 22-11 , International Plaza, 10 Anson Road,

Singapore 079903

Folio Number 03

No. of shares held 2500

No. of shares offered 72500

No. of shares applied for 72500

No. of additional shares applied 72500

for

Total number of shares applied 1,45,000

for

Amount payable @ Rs. 14.98 per 21,72,100

share

Income-tax Permanent Account

No.

Specimen signatures and Seal

……………………………………..
Signature of Shareholder