Application Form For Corporate For Pop Change

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Annexure CHO-3

Page 1

POP-CODE(5000273)

Application Form for Corporate for POP Change

(Please fill all the details in CAPITAL LETTERS & in BLACK INK only. All Fields mark with * are mandatory.)

Corporate Registration Number* :

Sir/Madam,

We hereby submit a request to change POP . The necessary details are provided below:

1. Name of the Corporate*:

2. Phone No. :

Mobile No.

STD Code

Phone Number

3. Details of POP Change:

Name of existing POP

: _______________________________________________________________

Existing POP registration no.

: _______________________________________________________________

Name of targeted POP

: ______________________________________________________________

Targeted POP registration no.

: _______________________________________________________________

We hereby declare and agree that we have read and understood the Offer Document, terms and condition. We further declare that the information supplied in

the application, is complete and true. And we will notify Central Recordkeeping Agency (CRA) immediately about any change in the information provided in the

application.

Signature of Authorized Signatory

Name : ___________________________________

Place : __________________

Designation : ________________________________

Date :

Corporate Head Office Seal

Department : ________________________________