Payment Slip

[to be used only in case of payment through cheque/ demand draft]

From To
Name : Aditya Birla Fashion and Retail Limited
Address : Piramal Agastya Corporate Park,
Building ‘A’, 4th and 5th Floor,
Notice Number : Unit No. 401, 403, 501, 502,
PAN : L.B.S. Road, Kurla, Mumbai - 400 070

REMINDER NOTICE ON THE PARTLY PAID-UP EQUITY SHARES

[to be filled in by the shareholder]

DP ID / Client ID No. of Partly Paid-up Amount due and payable [in ₹]

Equity shares held as ₹ in number ₹ in words
on Record Date

Payment Details:
Money Due [in ₹] Cheque/ Demand Cheque/ DD No. Drawn on Date of payment Bank Serial No.
draft amount [in ₹] [Bank & Branch] [To be filled in by
the Bank]

Acknowledgment Slip

Reminder Notice

Received Cheque/DD No. ____________________ dated _________________for ₹ ____________________ drawn on

_________________________________________ [name of bank and branch] the amount aforesaid being the
payment towards the above equity shares. [Details to be filed by the shareholder]

Date :
Name of the First/ Sole Shareholder :
DP ID/ Client ID :
No. of partly paid-up equity shares :
Notice No. :

Note: Cheque subject to realization

Sign and Stamp of the
Registrar and Share Transfer Agent/ Axis Bank Limited

Date: