UCO Bank UCO Bank ESPS-2019

(A Govt of India Undertaking) Application Form

Head Office: 10 BTM Sarani, Number- 58150
Kolkata-700001

Issue of Equity shares upto 20,00,00,000 of UCO Bank having face value of Rs. 10/- each to the eligible UCO Bank Employees ('Eligible Employees') at a discounted price of
Rs. 14.25 under UCO Bank Employee Share Purchase Scheme (UCO-ESPS-2019).

1). Emp No. 58150 2). Name (as in DEMAT A/c) SAURAV BHATTACHARJEE
3). Scale 2 4). Designation MANAGER
5). Date of Joining 19-MAY-2014 6). Present Place of Posting 2676 (CHAK BARBARIA)
7). Address1 MAJHERGAON,FLAT NO 1S, BLOCK Address2 233, BADU ROAD,OPPOSITE : NSG
14 HUB, MADHYAMGRA
Address3 MADHYAMGRAM Address4 WEST BENGAL
Pin code 700129 8). PAN AOGPB4182C
9). Mobile Number 7603027876 10). Mail Id bhattacharjeesaurav29@gmail.com
11). Name of DP NSDL DP Id 302847
Client Id 10197028 12). No. of equity share tentative 13000
offered
13). No. of equity share applied for 4900 14). Price per Share (B) 14.25
(A)
15). Application Amount (C=A x B) Rs. 69,825.00 Sixty-Nine Thousand Eight Hundred Twenty-Five only.
16). Payment Mode (Online payment/Fund Transfer/Direct Debit to Direct Debit to employee's account.
employee's account
17). Bank Account Details(For Lien/Debit with an amount equal to Sl. Saving A/c No. 28250110006481
No. 15) IFSC Code UCBA0000675

I hereby confirm that I have read and understood all the instructions for filing up this Application Form, terms and conditions including
Disclaimer etc. in Circular No. CHO/SUA/19/2018-19 dated 08-03-2019. I also hereby confirm , certify and give the following undertakings:
1. that I am an Eligible Employee of the bank as per above said Circular and consequently am eligible to participate in the UCO Bank Employees Share Purchase Scheme-
2019.
2. that I have made the payment from my own account.
3. that I am not in possession of or have access to any 'unpublished price sensitive information',as defined in the SEBI(Prohibition of Insider Trading) Regulations, 2015 and
the UCO Bank Code of Conduct for Prevention of Insider Trading (available on the Bank's website)etc. Further, I undertake to file the requisite Disclosures as required under
the said UCO Bank Code of Conduct, SEBI's Regulations and other applicable provisions/Government Guidelines.
4. that the information provided by me in this Application Form is true and accurate in all respects.
5. that I have authorised UCO Bank to deduct TDS from my salary for the purpose of tax on the value of perquisite arising out of this scheme.

I hereby authorize UCO Bank to mark lien/debit my bank A/C No. 28250110006481 with an amount of Rs 69,825.00 towards my share application money for 4900 equity
shares applied by me under the UCO Bank ESPS 2019.

(System generated Signature)

Place____________________

Date_____________________ (Signature of Employee)