~ M.:t itajadhani Systems & Estates Pvt. LtdHI·TECH Regd. No.: 15-05778/99-2000~ Sister Concern ofR.I..::II HI-TECH ESTATES & PROMOTERS (PVT) LTD.ESTATES Corp. Off.: Al103, Saheed Nagar, Bhubaneswar-751007

•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••

NatO'Q .To, Fill the form in Block LettersThe Executive DirectorRajadhani Systems & Estates Pvt. LtdSir,I am interested to purchase a flat / house to be constructed Hi-Tech Plaza Annex Project at Mouza- Kantilo, Sundarapada, BhubaneswarI also agree with your Terms & Conditions.

APPLICATION FORM

M.R. No. ( ) Block NO.( ) Flat No. ( ) Super Builtup Area : ( )

Name: ( ) Age ~:(=========~)~~======~------------~======~--~========~~Date of Birth ( ) Marriage Date (If married) ( ) Caste ( ) Occupation ( )

Father's/Husband's Name( \ )~========================================~Address: Temporary AUPo ( )

[ ) PS :( )

Dist :( ) Pin ( ) Tel ( )

E-mail: ( )~--~================================================~Permanent At/Po ( )

[ ) PS :( )

Dist: ( ) Pin ( ) Tel ( )

Nominee :(~ ~)

Source of Finance: Bank Finance I SELF Monthly payment I Self as per Bank

Date: Place:

N.B.: all type of payments should be made by Cheque/D.o. in favour of Rajadhani Systems & Estates Pvt. Ltd, payable at Bhubaneswar.

M.R. No.( ) BOOKING AMOUNT. ( )W~ CHQ/DD NO. ( ) DRAWN ON ( )

~ TOTAL COST :( ) SCHEME ( )

tE INST. PATTERNRS. ( ) MONTH ( )

o BOOKING DATE: ( ) ALLOTMENT DATE: ( )a::ou.

Signature of the Customer

INTRODUCEDBY : VERIFIEDBY : SIGNATUREOF THEACCOUNTANT

••••••••••••••••••••••••••••••••••••••••••••••••••••••• ••••• ••