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A firm) claiming certain receipts without deduction of tax I/We* *son/daughter/wife of resident of do hereby declare 1 Folio No. *that I am a Fixed Deposit holder in Ansal Properties & Infrastructure Ltd, 115 Ansal Bhawan, 16 Kasturba Gandhi Marg, New Delhi-110001 *#that the sums, particulars of which are given in Schedule III below, stand in *my/our name and beneficially belong to *me/us, and the *interest in respect of such securities or sums and/or income in resp.

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