HINDUSTAN PETROLEUM CORPORATION LIMITED

(A GOVERNMENT OF INDIA ENTERPRISE)

Registered Office : 17, Jamshedji Tata Road, Churchgate, Mumbai 400 020

Instructions :

  1. Please read the instructions carefully before filling in the form
  2. Shareholders can fill in the details on line and then take print out of the form, sign it and send it to the Company / Registrar by post / courier for further handling.
  3. Shareholders can also take print out of the blank form fill and sign it separately and then send it to Company / Registrar by post / courier for further handling

SHAREHOLDING IN PHYSICAL FORM / SHAREHOLDING IN DEMAT FORM
To
INTIME SPECTRUM REGISTRY LTD
UNIT: HINDUSTAN PETROLEUM CORP. LTD.
C-13, PANNALAL SILK MILLS COMPOUND,
L.B.S. MARG, BHANDUP (W),
MUMBAI - 400 078 / To be sent to
Your Depository Participant (DP)

Dear Sirs,

Sub.: ECS MANDATE / BANK MANDATE FOR DIVIDEND PAYMENT

Folio No.:______/ Client ID:______DP ID :______

I the sole/first shareholder holding shares of Hindustan Petroleum Corporation Limited at the above mentioned Folio / Client ID & DP ID number wish to receive dividend through Electronic Credit Services / Bank Mandate

I understand that Hindustan Petroleum Corporation Limited also reserves the right to send the dividend payable to me by a physical dividend warrant / draft, on account of any unforeseen circumstances beyond the control of Hindustan Petroleum Corporation Limited, that may affect the payment of dividend through ECS.

Particulars / Existing Bank Account Details / Changes to existing details, if any
Bank Name
Branch
(Name, Address & Telephone No.)
Bank City
Account No. (as appearing in cheque book)
Account Type
9 digit MICR No.
as appearing on the cheque
(Pleae enclose cancelled / photocopy of cheque)
PAN/GIR NO.

I hereby confirm that the particulars given above are correct and complete. If the transaction is delayed or not effected at all for reasons of incomplete or incorrect information, I would not hold Hindustan Petroleum Corporation Limited responsible. I also agree for printing of the bank details on the dividend warrant/DD if the payment of dividend is effected by warrant / DD.

______

Sole/First Shareholder

(Signature should be as per the specimen signature recorded with Hindustan Petroleum Corporation Limited)

Certification by the Bank
(This is required if cancelled cheque / photocopy of cheque is not enclosed)
Certified that the bank details furnished above are correct as per our records.
(Bank Stamp) Signature of authorized official
Date : of the bank