Advance receipt
Received from the Investor Education and Protection Fund Authority the sum of Rs. -------- and No. of Shares ----------- being the amount and shares payable to me from the Investor Education and Protection Fund as Dividend on equity Dividend on accrued on Dividend credited to IEPF under Companies Act, 1956 or Companies Act, 2013/ Dividend credited to General Revenue Account under Companies Act, 1956 which was originally due from ---------------------------------------------LIMITED
Signature of claimant
Signature of witness:
1. Signature with date
Name
Address
2. Signature with date
Name
Address
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