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

LAPL Automotive Ltd

Symbol: LAPL

APPLICATION NUMBER 5000006

*5000006*

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

Priya Patel

PAN Card Number

PRYPT5678B

Category of Applicant

RETAIL INDIVIDUAL INVESTOR (RII)

2. DEPOSITORY PARTICIPANT (DEMAT) ACCOUNT DETAILS

Depository:

NSDL CDSL

DP ID (NSDL)

IN301549

Client ID (NSDL)

10234567

3. BID DETAILS & BLOCK AMOUNT DETAILS

Bid Option	Bid Quantity (Shares)	Bid Price (₹)	Total Bid Amount (₹)
Bid 1 (Retail)	1200 (1 Lots)	₹94.00	₹112,800.00
Bid 2	[N/A]	[N/A]	[N/A]

Amount in Words: Rupees One Lakhtwelve Thousandseight Hundred Only

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

Bank Name

HDFC Bank

IFSC Code

HDFC0000001

Branch City

MUMBAI / ONLINE

ASBA Bank Account Number (to be Blocked)

987654321098

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

LAPL Automotive Ltd

APPLICATION NUMBER

5000006

Applicant Name	Priya Patel	PAN	PRYPT5678B
Demat ID	NSDL: 10234567	Block Amount	₹112,800.00
Bank Account No	987654321098	Bank & IFSC	HDFC Bank (HDFC0000001)

* 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