Form No. Iepf-5
Form No. Iepf-5
(e) Email ID
Others, specify
(xi) 0
Total 0
Note: If applicant doesn't have any information on amount claimed then the related column above may be left
blank
* Number of claims
Nature of claim Amount of the Financial year to Nature of Folio No. / DP Category Reason for non-
(1) claim which it relates security / ID - Client ID - (6) receipt / non-
(2) (3) deposit Account encashment of the
(4) number instrument of
(5) payment
(7)
Declaration
I declare that all the requirements of Companies Act, 2013 and the rules made thereunder in respect of the subject matter of
this form and matters incidental thereto have been complied with. I further declare that all the information given herein above
is true, correct and complete including the attachments to this form and nothing material has been suppressed.
*I understand that I, am the claimant and after filing the refund claim in this form online, shall to send the attachments
prescribed below to Nodal Officer (IEPF) of the company at its registered office in an envelope marked “claim for refund
form IEPF Authority” for initiating the verification for claim
1. Print out of duly filled claim form with claimant signature
2. Copy of acknowledgement
3. Indemnity Bond (original) with claimant signature
9. Copy of Passport, OCI and PIO card in case of foreigners and NRI
Note: Attention is also drawn to provisions of Section 448 of Companies Act, 2013 which status that -
“Save as otherwise provided in this Act, if in any return, report, certificate, financial statement, prospectus, statement or other
document required by, or for, the purposes of any of the provisions of this Act or the rules made thereunder, any person makes a
statement,-