AFFIDAVIT
NAME CONFIRMATION
To:
GNSA Infotech Limited
STA Department
Nelson Chambers, F Block, 4
th
Floor
No 115, Nelson Manickam Road,
Aminjikarai
Chennai – 600029
Dear Sir/Madam,
Unit :
Folio No:
Name as per Certificate Records Name as per Pan Card
--------------------------------- -----------------------------
I / we hereby confirm and declare that the name appearing in the share certificate no.__________________ as
_____________________________and name stated in the Pan Card Copy as ______________are one and same
person. Therefore my request for Transfer of shares in Folio No__________ may be considered.
This Affidavit is executed in favor of the company on my /our own volition and is in the form , As required by the
Company / its agent forwarded to me/us.
NAME:
DATE:
PLACE:
(Execute the same in Rs.100/- Stamp Paper–Authorized by the Notary Public)
