Name of the Target Company (TC)

Number

% w.r.t.total share/voting capital wherever applicable

% w.r.t. total diluted share/voting capital of the TC (**)

Name(s) of the acquirer and Persons Acting in Concert (PAC) with the acquirer

Whether the acquirer belongs to Promoter / Promoter group

Name(s) of the Stock Exchange(s) where the shares of TC are Listed

Details of the acquisition / disposal as follows

Before under the acquisition consideration, holding of:

a) Shares carrying voting rights

) Shares in the nature of encumbrance (pledge/ lien/ non-disposal undertaking/ others)

) Voting rights (VR) otherwise than by shares b c

Warrants/convertible securities/any other instrument that entitles the acquirer to receive shares carrying voting rights in the TC (specify holding in each category)

Total (a+b+c+d) d) e)

Details of acquisition / sale

Shares carrying voting rights acquired / sold a)

b) VRs acquired /sold otherwise than by shares

c) Warrants/convertible securities/any other instrument that entitles the acquirer to receive shares carrying voting rights in the TC (specify holding in each category) acquired/sold

Shares encumbered / invoked / released by the acquirer Total (a+b+c+/-d) d) e)

After the acquisition / sale, holding of:

a) Shares carrying voting rights acquired

b) Shares encumbered with the acquirer

c) VRs otherwise than by shares

d) Warrants / convertible securities / any other instrument that entitles the acquirer to receive shares carrying voting rights in the TC (specify holding in each category) after acquisition

e) Total (a+b+c+d)

Mode of acquisition / sale (e.g. open market/off-market / public issue / rights issue / preferential allotment / inter-se transfer etc).

Date of acquisition / sale of shares / VR or date of receipt of intimation of allotment of shares, whichever is applicable

Equity share capital / total voting capital of the TC before the said acquisition / sale

Equity share capital/ total voting capital of the TC after the said acquisition / sale

Total diluted share/voting capital of the TC after the said acquisition

Place:
Date:

Signature of the acquirer / seller / Authorised Signatory