APPLICATION FOR SHARES (PART “A”)

(Pursuant to Notice of offer of Rights shares dated August 20, 2022)

CAF NO .: 3145 Date: 20-08-2022

DP ID - Client ID / Folio No.: IN302679-32020369
Sole/First Holder name : SHYAM SUNDAR PALREDDY
Address: 59 71
JUBILEE HILLS PHASE III
HYDERABAD
500033
JT-1:
JT-2:
JT-3:

To: The Board of Directors,

Care Health Insurance Limited
5th Floor, 19, Chawla House,
Nehru Place, New Delhi-110019

Dear Sirs/ Madam,

I/We refer to the Notice of offer dated August 20, 2022, offering rights equity shares in proportion to One equity share for
every Thirty Four equity shares held by the shareholder.
I/We hereby apply for allotment to me _ equity shares of the Company having a face value of Rs 10/- per share
and premium of Rs. 100/- per share, as stated below in Column 4 of the below table. I/We have remitted the amount specified in
Column 5 in the below mentioned table being the amount payable on application @ Rs 110/- per equity share (including
premium @ Rs. 100 per share).
I/We agree to accept the equity shares applied for or such lesser number as may be allotted to us by the Company subject to the
terms and conditions set forth in the said Notice of offer and subject to the provisions of Foreign Exchange Management Act,
1999 (if applicable) and the Rules /Regulations/ Notifications /Guidelines issued by the Insurance Regulatory and Development
Authority of India (IRDAI), Govt. of India and Reserve Bank of India in this behalf, if any and the provisions of the Companies Act,
2013 and the Rules made thereunder and any other applicable Laws, Rules and Regulations and the provisions of the
Memorandum and Articles of Association of the Company, and the terms and conditions set out in this Application Form and
other documents as may be relevant/applicable, if any.
I/We undertake that I/we will comply with the aforesaid laws, rules and regulations as may be applicable to us from time to time
and will sign all such other documents and do all such other acts, deeds and things, if any, that may be necessary on our part in this
regard and to enable me/us to be registered as the holder(s) of the equity shares which may be allotted to me/us by the Company.
I/We authorize you to place my/our name(s) on the Register of Members of the Company as the holder(s) of Equity Shares
that may be so allotted to us.

Regd. DP Client ID (1) No. of equity No. of equity shares No, of equity shares Amount paid on application
shares held offered/Entitlement accepted @ Rs. 110/-per equity
( 2) (3) (4) share (including premium
of Rs. 100 per share) (5)

IN302679-32020369 34250 1007

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Amount paid (Currency and
also equivalent Rs. in Words)

Drawn on(Name
of Bank and Branch)
By Cheque / Draft / Dated

Payable at PAN:
(Name of Bank and Branch)
For refund order, if any details of Sole /First applicant
Saving/Current account Account number : Bank and branch address:

IFSC Code: Micr:

SIGNATURE

Specimen signature of applicant

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 LETTER OF DECLINE

Date:
The Board of Directors,
Care Health Insurance Limited
5th Floor, 19, Chawla House,
Nehru Place, New Delhi-110019

Subject: Non-acceptance of offer of Right Issue

Dear Sirs

I refer to the Notice of offer dated August 20, 2022, offering rights equity shares in proportion to One equity share for every
Thirty Four equity shares held by the shareholder. I do not intend to apply for new shares and the offer shall be deemed to have
been declined by me.

This is for your record and reference.

Signature

Name of Shareholder:

Address of Shareholder:

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 LETTER OF ACCEPTANCE / RENOUNCEMENT (Part “B”)

To,
The Board of Directors, Date:
Care Health Insurance Limited
5th Floor, 19, Chawla House,
Nehru Place, New Delhi-110019

Name of the Shareholder:

DP Client ID/Folio Number.:

No of Equity shares held:

No of equity shares offered:

1. On the basis of the Company’s Notice of offer dated August 20, 2022, offering___________ equity shares of Rs 110 each
including premium of Rs. 100/- per share for cash in the Rights Issue of shares by the Company, I/we hereby accept and
apply for allotment to me/us ___________ of Equity Shares out of the above offer.

2. I/ we hereby renounce ____________ equity Shares out of the offer in favour of residing at______________

3. I/We remit herewith a sum of Rs. /- by cheque in favor of ‘Care Health Insurance Limited Rights Issue
Account’ on , being a consideration value of Equity Shares at Rs.110/- per equity shares
(including premium of Rs. 100/- per share).

4. I/ We have remitted a sum of Rs. ___________/- through online R-WAP facility vide transaction No. ____________ dated
_____________. For details you may refer to Point 11 of Terms and Conditions of the CAF.

5. The prescribed application for equity Shares duly filled in and signed by me/us or renounce is enclosed.

*Strike out whichever is not applicable.

Signature of shareholder

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 CARE HEALTH INSURANCE LIMITED
CIN: U66000DL2007PLC161503
Registered Office: 5th Floor, 19, Chawla House, Nehru Place, New Delhi-110019
Phone: 0124 6141810 Email: [email protected]

To:
Mr/Mrs

Dear Shareholder
Sub: Offer of shares on Rights basis
Notice pursuant to Section 62(1)(a) of the Companies Act, 2013, is hereby given that the Board of Directors in their meeting
held on August 02, 2022, have resolved to issue and offer 2,72,72,727 equity shares of Rs. 10/- each at a premium of Rs. 100/-
each in the unissued equity capital of the Company to the existing shareholders on Rights basis in the ratio of 1 equity share for
every 34 equity shares held by a shareholder. The shares are being offered for cash at par on the following terms and
conditions:
Terms and conditions

1. The shareholder whose name is borne on the Register of Members or List of Beneficial Owners obtained from the
Depository as on 12.08.2022 shall be entitled to the Rights shares.

2. The offer shall open at 9.00 AM on Wednesday, August 24, 2022 and will close at 5 PM. on Thursday, September 22,
2022 (for a period of 30 days both days inclusive).

3. In case of fractional entitlement the number of shares offered shall be rounded of to nearest integer.

4. The shareholder may accept the offer and apply for the equity shares offered either in full or in part by filling in
accordingly the application form.

5. The shareholder may also renounce all or any of the equity shares to which he/she is entitled to in favour of any
person. Any renunciation from Resident to Non resident or vice versa is subject to the provisions of Insurance Act, 1938,
various circulars/ regulations, guidelines issued by IRDAI in this regard, Foreign Exchange Management Act 1999 and the
Regulations made thereunder and permission or approval if any, of Government of India or Reserve Bank Of India as may
be required, and a copy of such permission or approval, if any, must be attached to the application.

6. In the event of under subscription, any unsubscribed portion of the Rights Equity Shares, in full or in part, if any shall not
be allotted to any other shareholder. Any amount, if received from any of the Shareholders in excess of their Rights
Entitlements of this Rights Equity Shares offer shall be refunded within 15 days from the date of the closure of the offer.

7. Application should be made on the printed form accompanying this Notice of offer or by using the RWAP facility as
mentioned in point 11.

8. Full consideration amount i.e. Rs. 110/- (including premium Rs. 100) per equity share is payable on application.

9. Payment of consideration money should be made only by account payee local cheques or demand draft (payable at
Hyderabad) drawn in favour of “Care Health Insurance Limited Rights Issue Account” accompanying the application. The
consideration money along with application should be received by the Banker to the Issue on or before 5 PM on
September 22, 2022.

10. Application for Rights shares/ acceptance of offer/renouncement of shares along with the cheques / DDs shall reach or
be deposited at the collection centres of the banker to the Issue. List of collection centers is given at the end of CAF.

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11. Set out below is the procedure followed using the R-WAP:

a. Resident Investors should visit R-WAP (accessible at https://rights.kfintech.com) and fill the online Application Form
available on R-WAP in electronic mode. Please ensure to provide correct DP ID, Client ID, Folio number (only for resident
Eligible Equity Shareholders, who hold Equity Shares in physical form as on Record Date), PAN details and all other details
sought for while submitting the online Application Form.
b. Non-resident Investors are not eligible to apply in this Issue through R-WAP.
c. Only resident Investors are eligible to apply in this Issue through R-WAP.
d. The Investors should ensure that Application process is verified through the email / mobile number. Post due verification,
the Investors can obtain details of their respective Rights Entitlements and apply in this Issue by filling-up the online
Application Form which, among others, will require details of total number of Rights Equity Shares to be applied for.
Please note that the Application Money will be determined based on number of Rights Equity Shares applied for.
e. The Investors who are Renouncees should select the category of ‘Renouncee’ at the application page of RWAP and provide
DP ID, Client ID, PAN and other required demographic details for validation. The Renouncees shall also be required to
provide the required Application details, such as total number of Rights Equity Shares to be applied for.. Renounce are
advised to dispatched the application form to Registrar on or before closure date
f. Investors applying in the Issue through UPI facility should accept the debit/ payment request in the relevant mobile
application for which the UPI ID details were provided.
g. Prior to making an Application, the Investors should enable the internet banking or UPI facility of their respective bank
accounts and the Investors should ensure that the respective bank accounts have sufficient funds. If the funds available in
the bank account are less than total amount payable on submission of online Application Form, such Application shall be
rejected. Please note that R-WAP is a non-cash mode mechanism in accordance with the SEBI Rights Issue Circulars.
h. The Investors shall make online payment using internet banking or UPI facility from their own bank account only. Such
Application Money will be adjusted for either Allotment or refund. Applications made using payment from third party
bank accounts will be rejected.
i. Verification in respect of Application through Investors’ own bank account, shall be done through the latest
beneficial position data of our Company containing Investor’s bank account details, beneficiary account details provided to
the depository, penny drop, cancelled cheque for joint holder verification and such other industry accepted and tested
methods for online payment.
j. The Application Money collected through Applications made on the R-WAP will be credited to the Escrow Account,
opened by our Company with the Escrow Collection Bank.

12. If a member fails to apply for his entitlement on or before the appointed day, the offer shall be deemed to have been
declined and rescinded.

13. The shares / balance shares not taken up by the respective members will be disposed off by the Board/ Allotment
Committee in such manner as the Board/ Allotment Committee may deem fit and decide at its absolute discretion.

14. The applicants should state PAN details along with a copy of PAN attached to the application. Applicant(s) who do not
have PAN are required to provide a declaration in Form 60/61 prescribed under the IT.Act along with application.
Application without PAN/declaration will be considered incomplete and is liable to be rejected.

15. In case of application under power of attorney or by a body corporate or by a society, a certified true copy of the relevant
power of attorney or resolutions or authority to the signatory to make the investment under this offer and to sign the
application and a copy of the Memorandum and Articles of Association or bye laws of such body corporate or society
should accompany the application.

16. The form must be filled in English and in block capital as applicable/appropriate and delete whichever is not
applicable.

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17. The application for shares found incomplete with regard to any of the particulars required to be given therein and/ or
which are not complete in conformity with the terms of Notice of offer is liable to be rejected and money paid in respect
thereof shall be refunded without interest.

18. Eligible Equity Shareholders can obtain the details of their respective Rights Entitlements from the website of the Registrar
(i.e., https://rights.kfintech.com by entering their DP ID and Client ID or Folio Number (in case of Eligible Equity
Shareholders holding Equity Shares in physical form) and PAN. The link for the same shall also be available on the website
of our Company (i.e. www.careinsurance.com).

19. The Investors can visit following links for the below-mentioned purposes:

a) Frequently asked questions and online/ electronic dedicated investor helpdesk for guidance on the Application process
and resolution of difficulties faced by the Investors: https://rights.kfintech.com
b) Updation of Indian address/ email address/ mobile number in the records maintained by the Registrar or our Company:
https://rights.kfintech.com
c) Updation of demat account details by resident Eligible Equity Shareholders holding shares in physical form:
https://rights.kfintech.com

20. As the Equity Shares being allotted in demat form, the bank account details will be obtained from the information
available with the Depositories;
21. The Board reserves its full, unqualified and absolute right to accept or reject any application, in whole or in part, and in
either case without assigning any reason thereto.
22. The Notice of offer has been sent by Care Health Insurance Limited to the shareholders whose names appear in the
Register of Members/ List of Beneficial Owners as on Friday, 12th August, 2022 at the address provided by them to the
Registrar.
23. As per the new Rule 9A inserted to Companies (Prospectus and Allotment of Securities )Rules, 2017, with effect from 2nd
October 2018, an Unlisted public Limited Company can issue securities only in dematerialized form. Due to which all the
shares allotted under rights issue will be only in dematerialized form and no physical share certificates will be issued.
Hence the shareholders are requested to open a Beneficiary Account with any of the Depository participants and
mention the same clearly in the Application Form. No shares will be allotted to the shareholder who does not have a
Demat Account.
24. The shareholders may contact for any clarification or duplicate application form the following persons:
KFin Technologies Limited
Selenium Tower B, Plot No- 31 and 32, Financial District,
Nanakramguda, Serilingampally, Hyderabad, Rangareddi - 500 032,
Telangana, India
Tel: +91 40 6716 2222
Toll Free Number : 18003094001
Email: [email protected]
Investor Grievance Email: [email protected]
Website: www.kfintech.com
Contact Person: Mr. M. Murali Krishna/Williams R

On the basis of your existing holding you are entitled to apply for __________ equity shares of Rs. 10/- each at a premium
of Rs. 100/-each as stated in the attached Application Form. Accordingly, you may please return the enclosed application
form duly filled and signed along with the consideration money in full as aforesaid, on or before Thursday, September 22,
2022.

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 Please note that if the application along with application money is not received by the Registrar/Banker to the Issue
on or before Thursday, September 22, 2022 you shall be deemed to have declined to accept the offer and rescinded the
same and the Board shall proceed to dispose off the said equity shares forthwith as it may deem fit without further
notice.

BANKERS TO THE ISSUE-ICICI BANK LIMITED

APPLICATIONS WILL BE COLLECTED AT THE FOLLOWING BANK BRANCHES

City (COLLECTION CENTRES) Pincode
Agra ICICI Bank Ltd, No 6,8- 13,Ground Floor , Shanta Tower, Sanjay Place, Agra 282002
Ahmedabad ICICI Bank Ltd, Jmc House, Opp. Parimal Gardens, Off C.G.Road Ambawadi, Ahmedabad 380006
Amritsar ICICI Bank Ltd, 361, M.C International The Mall Amritsar, Punjab 143001
Bangalore ICICI Bank Ltd, 1, Shobha Pearl, Commissariat Road, Off M G Road, Ground Floor, Bangalore 560025
Belgaum ICICI Bank Ltd, 14, Khanapur Road, Rpd Cross, Tilakwadi, Belgaum 590006
Bharuch ICICI Bank Ltd, Blue Chip Sanitorium Compound, Sevashram Road, Panch Batti, Bharuch 392001
ICICI Bank Ltd, Plot No. 2569, Ground Floor, Ratnadeep Complex, Opp. Central Salt Research
Bhavnagar Institute, Waghawadi Road, Bhavnagar Gujarat 364002
Bhopal ICICI Bank Ltd, Alankar Palace, Plot No.Ii, Zone Ii, M P Nagar, Bhopal, Mp 462011
Bhubaneswar ICICI Bank Ltd, Bhanjaprava Building, Opp. Sriya Talkies, Unit 3, Janpath, Bhubaneshwar 751001
Chandigarh ICICI Bank Ltd, sco 27 sector 10D chandigarh 160017 160017
ICICI Bank Ltd, 110, Prakash Presidium, Utthamar Gandhi Salai, Nungambakkam High Road,
Chennai Chennai 600034
Ernakulam ICICI Bank Ltd, Emgee Square, M.G.Road, Ernakulam, Kochi 682035
Coimbatore ICICI Bank Ltd, Cheran Plaza, No.1090 Trichy Road 641018
Dehradun ICICI Bank Ltd, Ncr Plaza,24, New Cantt Road, Hathibarkala, Dehradun,Uttarakhand 248001
Faridabad ICICI Bank Ltd, Booth No. 104105, District Centre, Sector 16, Faridabad, Haryana 121007
Ghaziabad ICICI Bank Ltd, R1/88, Raj Nagar, Ghaziabad, Uttar Pradesh 201001
Guntur ICICI Bank Ltd, 5822, Pmg Complex, Lakshmipuram Main Road, Guntur Andra Pradesh 522002
ICICI Bank Ltd, Sco 18 19, Huda Shopping Centre, Sector14, Market Complex, Gurgaon,
Gurgaon Haryana 122001
Guwahati ICICI Bank Ltd, Ground Floor, Shanti Complex, G.S. Road, Bhangagarh, Guwahati 781005
Hubli ICICI Bank Ltd, Eureka Junction, Travellers Bungalow Road, Hubli 580029
ICICI Bank Ltd, 6-2-1012, Tgv Mansions, Opp. Institution Of Engineers, Khairatabad,
Hyderabad Hyderabad 500004
Hissar ICICI Bank Ltd, Plot No. 5760, Kamla Palace Road, Red Square Market, Hissar, Haryana 125001
Indore ICICI Bank Ltd, 4,Chhoti Khajrani, Malav Parisar, Indore 452008
Jaipur ICICI Bank Ltd, C99, shreeji Towers, Subhash Marg, Near Ahimsa Circle, C Scheme, Jaipur 302001
Jamshedpur ICICI Bank Ltd, Natraj Mansion, Main Road, Bistupur, Jamshedpur Jharkhand 831001
Jodhpur ICICI Bank Ltd, Plot No. 10,11, Refugee ColonySindhi Colony, Near Jaljog Circle, Jodhpur 342003
Kanpur ICICI Bank Ltd, 16/106, J.S.Towers, The Mall, Kanpur, Uttar Pradesh 208001
Kolhapur ICICI Bank Ltd, Vasant Plaza, Near Udyog Bhavan, Rajaram Road, Rajarampuri, Kolhapur 416001
Kolkata ICICI Bank Ltd, 22, Sir R.N. Mukherjee Road, Kolkata 700001
Lucknow ICICI Bank Ltd, Shalimar Tower, 31/54 M.G.Marg, Hazratganj, Lucknow 226001
Ludhiana ICICI Bank Ltd, Nehru Sidhant Kender Trust Building, Feroz Gandhi Market, Ludhiana, Punjab 141001
8
 Madurai ICICI Bank Ltd, No.21,22,23,North Chitrai Street, Madurai 625001

ICICI Bank Ltd, Capital Market Division, 163,Ground Floor, H T Parekh Marg, Backbay
Mumbai Reclamation, Churchgate - 400020 400020
Mysore ICICI Bank Ltd, 2950, Aishwarya Arcade, 9Th Cross, Kalidasa Road, V.V. Mohalla, Mysore 570002
Nagpur ICICI Bank Ltd, Shriram Tower, Ground Floor, S V Patel Marg, Near NIT Building, Sadar 440001
ICICI Bank Ltd, Unit NoG19, Utility Center,Opp To Rajiv Gandhi Bhavan, Sharanpur
Nashik Road,Nasik 422002
New Delhi ICICI Bank Ltd, 9A, Phelps Building, Connaught Place, New Delhi 110001
Noida ICICI Bank Ltd, K1, Senior Mall, Sec18, Noida, Uttar Prades 201301
ICICI Bank Ltd, 65, Sindur Business Centre, Swami Vivekanada Road, Opp. Passport Office,
Panaji Panaji Goa 403001
Puducherry ICICI Bank Ltd, 49 Mission Street, Puducherry 605001
Pune ICICI Bank Ltd, Satguru House 362/6, CTS. No. 30, Ground Floor, Bund Garden Road, Pune 411001
Rajkot ICICI Bank Ltd, Jai Hind Press Annexe, Opp. Shardabaug, Near Dharam Cinema, Rajkot 360001
Ranchi ICICI Bank Ltd, Arora Heights, P.P. Compound, Main Road, Ranchi 834001
ICICI Bank Ltd, Swarnambigai Plaza, S.F.No. 6/5, Block No. 7, WardC, Omalur Main Road,
Salem Near Bus Stand, Salem, Tamilnadu 636009
Surat ICICI Bank Ltd, Platinum Plaza, Opp. V.T. Choksi Law College, Athwalines, Surat 395007
Trichy ICICI Bank Ltd, New no - 58, West Bouleward Road, Sivapoorna complex, Trichy-620002 620002
Vadodara ICICI Bank Ltd, 42, Haribhakti Society, Nr. Chakli Circle, O.P. Road, Vadodara 390007
Vijayawada ICICI Bank Ltd, #401127,128 129, Murali Chambers, M.G.Road, Vijayawada 520010

Visakhapatnam ICICI Bank Ltd, 47-14-18, Isnar Satya Sri Complex, Dwarkanagar Main Road, Visakhapatnam 530016

Yours sincerely,

By order of the Board

For Care Health Insurance Limited

SD/-
Authorized Signatory

Date: August 20, 2022

Place: New Delhi