Gabriel India : Nomination Form

Form No. SH-13

Nomination Form

[Pursuant to section 72 of the Companies Act, 2013 and rule 19(1) of the Companies (Share Capital and Debentures) Rules 2014]

TO

Name of the company:

Address of the company:

I/We …………………………………….. the holder(s) of the securities

particulars of which are given hereunder wish to make nomination and do hereby nominate the following persons in whom shall vest, all the rights in respect of such securities in the event of my/our death.

1. PARTICULARS OF THE SECURITIES (in respect of which nomination is being made)

Nature of	Folio No.	No. of	Certificate	Distinctive
securities		securities	No.	No.

1. PARTICULARS OF NOMINEE/S -
2. 1. Name:
   2. Date of Birth:
   3. Father's/Mother's/Spouse's name:
   4. Occupation:
   5. Nationality:
   6. Address:

1. 1. E-mailid:
   2. Relationship with the security holder:
2. IN CASE NOMINEE IS A MINOR--
3. 1. Date of birth:
   2. Date of attaining majority
   3. Name of guardian:
   4. Address of guardian:

	Name:
	Address:
Name of the Security
Holder (s)	Signature	Witness with
		name and address