APPLICATION FORM Serial Number

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1 APPLICATION FORM Serial Number D Please fill in relevant portions of the APPLICATION FORM for Individual/ Joint or Other Entity. Strike out portions that are not applicable and deposit the APPLICATION FORM in full. Please deposit/mail the Application Form along with signed General Terms and Conditions at/to Bengal DCL Housing Development Company Ltd s city office Bengal DCL Housing Development Company Ltd. A Joint Enterprise of West Bengal Housing Board and DC Properties Ltd. Registered Office : 24 Park Street, Kolkata City Office: Sree Manjari, 4 th Floor, 8/1A Sir William Jones Sarani (Middleton Row) Kolkata Phone : (91) , , , Fax: (91) Visit us at

2 INDIVIDUAL / JOINT APPLICATION FORM Sole / First Applicant Joint Applicant Affix Photograph Affix Photograph Please fill in block letters 1. Full Name Mr./Ms. Mr. / Ms. 2. Relation to the First Applicant (Only for Joint Applicant) 3. Father / Husband s Name / Father / Husband s Name / Natural guardian (in case of minor) Natural guardian (in case of minor) 4. Date of birth D D M M Y Y D D M M Y Y 5. Occupation Doctor Lawyer Doctor Lawyer Engineer Engineer IT Professional Accountant IT Professional Accountant Business - Nature of business Business Nature of business H Housewife Student Housewife Student Any Other Specify Any Other Specify 6. Gross Annual Income Below 10,00, Between 10,00, ,00, Above 15,00, Gross Annual Income Below 10,00, Between 10,00, ,00, Above 15,00, Status Resident Indian Non Resident Indian Resident Indian Non Resident Indian 8. PAN NO. 9. Permanent address (for Sole / First Applicant) City State Country PIN/ZIP Phone Home Phone Work Mobile Fax 10. Correspondence address (for Sole / First Applicant) City State Country PIN/ZIP Phone Home Phone Work Mobile Fax

3 Sampoorna ADDITIONAL INFORMATION (NON-RESIDENT APPLICANTS ONLY) APARTMENT SELECTED Sole/First Applicant Joint Applicant 1. Nationality Apartment No. 2. Native place in India 3. Passport Indian Foreign Indian Foreign 4. No., Place & Date of issue Tower No (Tick one) Please mention the category you are applying for Duplex 3 Bed Room (Please tick only one) 5. Whether any property Yes No held in India? Yes No Parking Preferences (Ref Clause No. 7 of the GTC) If yes, please specify 6. Contact person in India : Full Name Correspondence address City State Pin Phone Mobile Fax Type 1 st Choice 2 nd Choice 3 rd Choice 4 th Choice Covered Open Stack Tier I 7. i. (a) NRE Account No. (b) Name of bank and branch ii. (a) FCNR Account No. (b) Name of bank and branch iii. (a) NRO Account No. (b) Name of bank and branch Stack Tier II How did you come to know of the project? (May tick more than one option, if applicable) Through news paper advertisement (Specify which one) From my relative/friend/colleague From Realtors Others (Please specify) OTHER ENTITY APPLICATION FORM Please fill in block letters 1. Name of the organization 2. Status Proprietorship Firm Partnership Company AOP/BOI Others 3. Registered / Head Office address City State Pin / Zip Phone Mobile Fax PAYMENT DETAILS Payment Plan Down Installment Application Money Rs. (Rupees only) Pay order / DD No. dated Drawn on In favour of Bengal DCL Sampoorna. 4. Name of authorized signatory with designation 5. PAN No.

4 Sampoorna BDCL COPY DECLARATION 1. I/We hereby solemnly declare that all the foregoing facts are true to the best of my/our knowledge and nothing relevant has been concealed or suppressed. I/We also undertake to inform Bengal DCL Housing Development Company Limited of any future changes, related to the information and details shown in this Application Form. 2. I/We declare that I/We have read and understood the terms and conditions of sale and other information / Payment conditions stated in the General Terms & Conditions including Area Schedules. I/We do hereby solemnly accept and agree to abide by them, and as also others as may be prescribed by Bengal DCL Housing Development Company Limited in future. I/We further agree to sign and execute the necessary documents as and when desired by Bengal DCL Housing Development Company Limited. 3. I/We being Non Resident Indians Foreign Citizen of Indian Origin do solemnly declare that I/We want the apartment (applied for), for residential purposes only. (strike out, if not applicable) 4. I/We hereby accord my/our irrevocable consent to become member of the Apartment Owners Association and execute necessary documents as and when called upon. PAY-IN-SLIP BENGAL DCL HOUSING DEVELOPMENT COMPANY LIMITED SAMPOORNA - TRITIYA Application No. D D M M Y Y Y Y Received from Mr./Ms. (in block letters).. For Sampoorna - Apartment No. Tower vide Pay Order / Draft No... Rs. (Rupees..only) Signature of Sole/First Applicant Signature of Joint Applicant Place : Place : Date : Date : dated. drawn on Bank Branch. Deposited by APPLICANT S COPY D D M M Y Y Y Y PAY-IN-SLIP BENGAL DCL HOUSING DEVELOPMENT COMPANY LIMITED SAMPOORNA- TRITIYA Application No. Received from Mr./Ms. (in block letters).. For Sampoorna - Apartment No. Tower. vide Pay Order / Draft No.. Rs... (Rupees only) dated. drawn on Bank Branch. Deposited by

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