Physical ASBA Form

💡 ASBA Physical Form Preview: Below is the generated physical copy of your application. Click Print Physical Form to print it, or save it to PDF. Take the printed copy and submit it to any branch of your bank to authorize the bid amount block.

Current Submission Status: Printed

ASBA BID-CUM-APPLICATION FORM

Gaja Alternative Asset Management Ltd

Symbol: GAJA

APPLICATION NUMBER 5000012

*5000012*

Broker / Syndicate Member Stamp & Code

IQ-MEMBER-CODE: 11092

SCSB Bank Branch Stamp

[Bank Branch Stamp on Receipt]

1. APPLICANT DETAILS

Sole / First Applicant's Name

Mohit Solanki

PAN Card Number

LMOPD8659N

Category of Applicant

RETAIL INDIVIDUAL INVESTOR (RII)

2. DEPOSITORY PARTICIPANT (DEMAT) ACCOUNT DETAILS

Depository:

NSDL CDSL

Demat Account Client ID / BO ID (16-Digit CDSL)

1201090012345679

3. BID DETAILS & BLOCK AMOUNT DETAILS

Bid Option	Bid Quantity (Shares)	Bid Price (₹)	Total Bid Amount (₹)
Bid 1 (Retail)	93 (1 Lots)	₹160.00	₹14,880.00
Bid 2	[N/A]	[N/A]	[N/A]

Amount in Words: Rupees Fourteen Thousandseight Hundred And Eighty Only

4. BANK ACCOUNT DETAILS FOR BLOCKING OF FUNDS (ASBA)

Bank Name

State Bank of India

IFSC Code

SBIN0000456

Branch City

MUMBAI / ONLINE

ASBA Bank Account Number (to be Blocked)

123456789123

DECLARATION: I/We hereby declare that I/we am/are eligible to apply under Retail category and have not applied for more than ₹2,00,000 across applications. I/We authorize the bank to block the bid amount in the account details supplied above. In case of allotment, transfer the shares to my DP account and release the funds to the issuer bank.

Sole / First Applicant

Second Account Holder (if joint)

Bank Account Holder(s) (Authorizing block)

ACKNOWLEDGEMENT SLIP FOR BANK TELLER

Gaja Alternative Asset Management Ltd

APPLICATION NUMBER

5000012

Applicant Name	Mohit Solanki	PAN	LMOPD8659N
Demat ID	CDSL: 1201090012345679	Block Amount	₹14,880.00
Bank Account No	123456789123	Bank & IFSC	State Bank of India (SBIN0000456)

* Teller Note: Please verify applicant name matches Bank record. Block the funds and upload bids on the BSE/NSE IPO terminal. Provide stamp & receipt to client.

Bank Teller Stamp & Sign