Only for shares held in Physical form From Name Address of Shareholder GRASIM INDUSTRIES LIMITED Share Department Birlagram Nagda 456331 MP Dear Sir Re Deletion of nam ID: 947028
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C:Name deletion form.doc REQUEST LETTER FOR DELETING NAME OF THE DECEASED SHAREHOLDER (Only for shares held in Physical form) From (Name & Address of Shareholder) GRASIM INDUSTRIES LIMITED Share Department Birlagram, Nagda 456331 [M.P.] Dear Sir, Re: Deletion of name of the deceased shareholder. I/We, the undersigned being the joint holder(s) with Mr./Mrs./Miss …………………………… ………………………………(deceased) who has expired on ………………… hereby request you to delete his/her name from the Register of Members of the Company in respect of the …………………… Shares, share certificates for which are sent herewith for the purpose along with the Certified copy of the Death Certificate. I/We, give hereunder particulars regarding surviving holder / joint holder(s) as would be required by you for your records. Certificate No. Distinctive No. Sl. No. Full Name of Surviving holder(s) Father’s/ Husband’s Name Occupation From To From To No. of Shares 1. 2. 3. Complete Address of Sole Survivor/ Ist Holder Signature of Surviving holder(s) 1. 2. 3. (To be filled by Share Department) Regn. No. New Folio No. Approved on Signature