Membership Application Form*

Name #

E-mail #

Mobie #

Address 1

Address 2

No Of Shares held in FTIL

DP ID and Client ID #

# Marked Fields are Mandatory
*I hereby give my consent to become a member of SHAFT.*to oppose the proposed merger.

*I also hereby confirm that neither me/my family members/relatives/associates/group cos /subsidiary have any outstanding claims against NSEL*

*.Submitting the Application form doesn't guarantee membership of the Association which is subject to the absolute discretion of the governing body of the association.