Sl. No.

Particulars

1.

Name of the Target Company (TC)

2.

Name of the acquirer(s)

3.

Confirmation that the acquirer(s) is/are promoter(s) of the TC as defined under regulation 2(s) and has been disclosed as promoter(s) of the TC in the latest filing with the stock exchanges

4.

Details of proposed acquisition

a.

Name of the entity/ entities from whom shares are proposed to be acquired

b.

Status of the entity/ entities whether it is a state level financial institution or whether it is a subsidiary or company promoted by a state level financial institution

c.

If, it is a subsidiary or company promoted by a state level financial institution, disclose the name of the holding/promoter company/institution and the relationship with the transferor.

d.

Date of agreement between transferor and promoter

e.

Date of proposed acquisition

f.

Number of shares proposed to be acquired from entity mentioned in 4(a) above

g.

Total shares proposed to be acquired as a % of diluted share capital of the TC

h.

Price at which shares are proposed to be acquired

b

Each Seller / Transferor

Before the proposed transaction

After the proposed transaction

No. of shares

% w.r.t total diluted share capital of TC

6.

Declaration by the acquirer that all the conditions specified under regulation 10(4)(e) with respect to exemptions has been duly complied with.

Place:
Date:

Signature of the Promoter / Authorised Signatory