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Bengal DCL Housing Development Company Ltd.

A Joint Enterprise of West Bengal Housing Board and DC Properties Ltd.

Registered Office : 24 Park Street, Kolkata 700016

City Office: Sree Manjari, 4

th

Floor,

8/1A Sir William Jones Sarani (Middleton Row) Kolkata 700016

Phone : (91) 33 40003333, 40003343, 40003307, 40003309

Fax: (91) 33 40003300

e-mail: sampoorna@bengaldcl.com

Visit us at www.bengaldcl.com

APPLICATION FORM

Serial Number

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/toBengal DCL Housing Development Company Ltd’s city office

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Sampoorna

Tritiya

INDIVIDUAL / JOINT APPLICATION FORM

Sole / First Applicant Joint Applicant

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

Any Other – Specify _________________________

6. Gross Annual Income Below 10,00,000.00 -Between 10,00,001.00 – 15,00,000.00 Above 15,00,000.00

Housewife Student

Any Other – Specify ________________________

6. Gross Annual Income Below 10,00,000.00 Between 10,00,001.00 – 15,00,000.00

Above 15,00,000.00

7. 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 ____________________________ Email ______________________

10. Correspondence address ________________________________________________________________________ (for Sole / First Applicant) City ______________________ State _________________ Country _______________ PIN/ZIP _______________________ Phone Home __________________ Phone Work ________________________ Mobile ______________________________ Fax ____________________________ Email ______________________

Affix Photograph

Affix Photograph

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Sampoorna

Tritiya

ADDITIONAL INFORMATION (NON-RESIDENT APPLICANTS ONLY)

Sole/First Applicant Joint Applicant

1. Nationality __________________________________________ _______________________________ 2. Native place in India ___________________________________ _______________________________ 3. Passport Indian Foreign Indian Foreign

4. No. , Place & Date of issue ___________ _____________ ______________ ________________ 5. Whether any property Yes No

held in India ?

Yes No

If yes, please specify _______________________________________________________________________ 6. Contact person in India :

Full Name ________________________________________________________________________________ Correspondence address ______________________________________________________________

City _______________________ State ______________________________ Pin _________________ Phone _______________ Mobile ________________ Fax _______________ Email ________________

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 ________________ ______________________

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 _______________ Email ________________

4. Name of authorized signatory with designation __________________________________________________________ _______________________________________________________________________________________________ 5. PAN No. __________________________________________________________________________________

Sampoorna

Tritiya

APARTMENT SELECTED Apartment No. ……………… Tower No. 1 2 3 4 5 (Tick one)

Please mention the category you are applying for

Duplex 3 Bed Room

(Please tick only one)

Parking Preferences (Ref Clause No. 7 of the GTC)

Type 1st Choice 2nd Choice 3rd Choice 4th Choice

Covered

Open

Stack Tier I

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) __________________________

PAYMENT DETAILS

Payment Plan Down Installment

Application Money Rs. ________________ (Rupees ___________________________________ only) Pay order / DD No. ________________________________________ dated ____________________ Drawn on ___________________________________________________________________________ In favour of “Bengal DCL – Sampoorna”.

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Sampoorna

Tritiya

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.

Signature of Sole/First Applicant Signature of Joint Applicant

Place : Place : Date : Date : 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 - Tritiya Apartment No. …………………Tower ………………. vide Pay Order / Draft No. …………. Rs. ………………….. (Rupees ………………only) dated …………………. drawn on ………………… Bank ………………Branch. Deposited by …………………

Sampoorna

Tritiya

BDCL 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 - Tritiya Apartment No. …………………Tower ……………vide Pay Order / Draft No. ……….. Rs. …………………(Rupees ……………… ..only) dated …………………. drawn on ………………… Bank ………………Branch. Deposited by …………………

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