, Lord Sinha Road, Kolkata

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1 APPLICATION NO. APPLICATION FORM FOR ADVANCE REGISTRATION OF A FLAT AT Policy Holders' Housing Scheme 8, Lord Sinha Road, Kolkata

2 EASTERN ZONAL OFFICE, KOLKATA (To be filled in by the Applicant) APPLICATION FORM (NOT TRANSFERABLE) FOR ADVANCE REGISTRATION OF A FLAT AT 8, LORD SINHA ROAD, KOLKATA (Incomplete Forms / Forms not accompanied by registration fee are liable for rejection.) Photograph A. PARTICULARS OF THE APPLICANT First Applicant 1. a) Name (in Block letters) Mr / Mrs / Miss Mr / Mrs / Miss b) Mother's name c) Father's name d) Spouse's name Second Applicant (If any) e) Marital status [ ] Married [ ] Single [ ] Married [ ] Single f) Identity proof- Enclose copy of Pan Card & any other ID proof from the list. (PAN card/voter ID/Driving License/Passport copy) 2. a) Residential Address: (Attach Documentary evidence) (Passport/Bank A/C / Electricity bill/ration Card/Telephone bill) b) Office/Business Address : c) Telephone / Fax / ID: Office : Residence : Mobile No : FAX No. : ID : 3. Date of Birth & Age 4. Nationality of the Applicant

3 5. State whether Resident/Non-Resident Indian If Non resident Indian state the Country of resident 6. Name of the Nominee with full address and contract No. 7.. Whether there is any flat/house in the applicant/spouse name in the city of Kolkata (Please give details) 8. Bank Particulrs i) Account No. in full ii) iii) iv) IFC number MICR number Bank name & address In case any mis-happening to the applicant till flat is finally handed over( if successful on draw of lots) the nominee shall be contacted. B. OCCUPATION OF THE APPLICANT : a). If Employed i) Name/s and addres/es of the Employers ii) Designastion of the Applicant/s her/their total Monthly Emoluments b) If Self Employed i) Nature of Profession/Business ii) Gross Annual Income from Profession/Business c) Permanent Account Number (PAN) Allotted by the Income Tax Department

4 C. ORIENTATION OF FLATS BACK SIDE. N B-1,3,5,7,9 B-2,4,6,8,10 Total 18 Flats A-1,3,5,7,9 A-6,8,10 FRONT SIDE Allotment of flats will be done exclusively on the basis of lottery in presence of a presiding officer. No choice /preference of flat/ floor will be entertained. D. DETAILS OF IN FORCE LIC POLICIES HELD BY THE APPLICANT : Sl.No Policy No. Sum Assured (Rs.) Plan & term Date of commencement Mode of payment (Mly/Qtly/Hly/Yly Due date of last premium paid Name of Branch Office servicing the policy. Copies of latest premium paid receipt / certificate from servicing Branch / employer to the effect that the premiums have bee n received / deducted must be enclosed). E. PARTICULARS OF REMITTANCE OF REGISTRATION FEES :

5 Amount Rs. Bank Name UTR No. Date Drawn on F. BANK DETAILS OF APPLICANT / S FOR REFUND : Account No Bank / Branch Name & Place IFSC Code MICR Code (Enclose photo copy of one cheque leaf) Note: Particular in respect of both individual to be furnished in case of joint applicant. due to any circumstances Power of Attorney shall be submitted. 2 Keeping in view of absence of the applicant Signature of the Applicant with name & address D E C L A R A T I O N 1. I / We hereby declare and affirm that the particulars given in this application are t rue in all respects and that the above referred flat, if allotted as per terms & conditions of the brochure will be purchased for Residential use and occupation AND THAT THE herein b efore made affirmation shall form the basis for consideration of allotment of a flat to me / us by LIC of India and if any untrue averment is made by me / us herein the LICI is at liberty to cancel the allotment of the flat and also take such other action / actions a gainst me / us as deem fit and / or as may be advised by their Legal Advisers. 2. Further I / We, hereby declare that the initial deposit of Rs. 2,00,000/- (Rupees Two lac) only will be remitted by me / us to the LIC of India in terms of relevant provisions in relation thereto contain in the Brochure setting out the t erms and conditions for Sale of flats at 8 Lord Sinha Road, Kolkata I / We also agree that the allotment and Sale of the flat is subject to the terms and conditions set out in the Brochure. 3. I also agreed & confirmed that the flat allotted to me / us sha ll not be sold out within 3 (three) years from the date of registration of flat.

6 4. I/We further acknowledge and understand that there shall be a second phase of development on number of towers/blocks on the N orth side of the premises where an old two storied structure is existing at present. I/We also understand that main approach road and the road surrounding the Phase-I building outside the building line is common for Phase -I occupant & phase-ii occupant, LIC, Contractors & end users. (Phase-II building will be developed at later stage). 5. I/We further acknowledge that the infrastructure of fire fighting system i.e. under ground tank, pumps etc including open space above the under ground tank is common for Phase-I & II occupants. 6. I/We further acknowledge that after the development of Phase-II building the phase-ii occupants will become the member of the phase-i association and they will enjoy the same rights as phase -I association. 7. I/We further acknowledge and understand that all the necessary connections like water, electricity, sewerage, telephone for the second phase of development shall be laid through this common approach road area by the respective Statuary Body as per their norms. 8. I/We shall not claim any right, title or interest with respect to are as designated for common use by the occupants of the entire development of the premises. 9. I/We further acknowledge that LIC reserves the right to develop the second phase of the premises as and when all permits are obtained from the concerned authorities. 10. a) I/We further acknowledge that Life Insurance Corporation of India with an intention to develop the premises in two phases -Phase-I and Phase-II and for constructing a housing complex containing self-contained residential units with provisions for car parking spaces, etc and other facilities and amenities for sale to intending buyers has undertaken construction of phase -I having two blocks- Front block and Rear Block. b) I/We further acknowledge that in addition to the First Phase of construction plan, LIC is entitled to demolish the existing old structure on the northern side of the said plot of land measuring about 2 bighas 10 kottahs 11 chittaks and 27 Sq. ft. and to develop and construct phase-ii in the northern portion of the premises as per the sanction building plan from the Kolkata Municipal Corporation. c) I/We further acknowledge that the approach road to the entire premises is by common approach road from Lord Sinha Road for both Phase-I and Phase-II construction and the Phase-II residents will be entitled to use the said common approach road common with the phase-i & II residents without any obstruction or hindrance. LIC and their representatives including Contractors, suppliers will also be e ntitled to use the common approach & entrance for transporting the construction & other related materials till completion of the Phase -II construction. d) I/We further acknowledge that the Phase-I residents will have access and shall be entitled to use the common areas and common facilities

7 equally in common with the phase-ii residents after completion of the phase-ii of the project. e) The undivided share in land is usually the land underneath the building in which the flat is constructed. For Phase -I, the undivided share will be the land underneath the building of Phase-I. f) The approach road and adjoining the phase-i building will be used for construction/ development of phase-ii at later stage & phase-i resident will not create any obstruction/ hindrance to the construction associate during c onstruction of phase-i 11. I/We further acknowledge that I have inspected the site on which the said building is being developed including the present layout plan, location plan, ownership record of the said land and all other documents relating to the title, competency and all other relevant details and the allottee hereby confirms that the Allottee is fully satisfied in all respect including LIC s right, title and interest on the said Land on which the said Policy holders Housing scheme is being developed. 12. I/We further acknowledge that LIC has provided all the information and clarifications as required by the Allottee and that the Allottee has relied on its own judgment and investigation in deciding to enter into this Agreement and to purchase the said Apartment and has not relied upon and is not influenced by any architect s plans, advertisement, representations, warranties, statements or estimat es of any nature whatsoever whether written or oral made by the Corporation, its selling agents/ brokers or otherwise including but not limited to any representations relating to the description or physical condition of the said complex/ said Building/ Said Apartment. No oral or written representations or statements shall be considered to be a part of this Agreement a nd that this Agreement is self contained and complete in itself in all respects. 13. I/We further acknowledge and hereby confirms to the Corporation that I am signing this Agreement with full knowledge of all the laws, rules, regulations notifications, etc., applicable to the said Complex/ said Building and the terms and conditions contained in this Agreement and the Allottee has clearly understood its rights, duties, responsibilities, obligations under each and all of the clauses of this Agreement. I AND WHEREAS Corporation relying on the confirmations, representations and assurances of the Allottee to faithfully abide by all the terms, conditions and stipulations contained in this Agreement has accepted in good faith the Application to allot t he said Apartment and is now willing to enter into this Agreement on the terms and conditions appearing hereinafter. 14. I/We further acknowledge that I/We have read and am/are aware of the clauses related to second phase of the development as mentioned in the Brochure & Sale Deed. Dated at on the day of 2018/2019.

8 1. Signature of Witness Signature of Applicant / s Name: Address: Name: Address: 2. Signature of Witness Name: Address:

9 भ रत य ज वन ब म नगम LIFE INSURANCE CORPORATION OF INDIA CHIEF ENGINEER's OFFICE, Kolkata (To be filled in by the Applicant) APPLICATION NO. Application Acknowledgement Slip Applicant No: Date of Payment: Received from: Drawn from (Bank) Branch Address for Communication: Date of receipt: Signature & Stamp of LIC

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