| A. I / We request you to Register / Change / Update the following (Tick
relevant box) |
| PAN |
Bank details |
| Signature |
Mobile number |
| E-mail ID |
Address |
| B. Security Details: |
| Name of the Issuer Company |
|
| Folio No. |
|
| Name(s) of the Security holder(s) as per the Certificate(s) |
1.
2.
3.
|
| Number & Face value of securities |
|
| Distinctive number of securities (Optional) |
From: To: |
| C. I / We are submitting documents as per Table below (tick as relevant,
refer to the instructions): |
| PAN of (all) the (joint) holder(s) |
PAN
Whether it is Valid (linked to Aadhaar): Yes No
|
| Demat Account Number |
Also provide Client Master List (CML) of your Demat Account, provided by the Depository
Participant.
|
| Proof of Address of the first holder |
Any one of the documents, only if there is change in the address:
Client Master List (CML) of your
Demat Account, provided by DP.
Valid Passport/ Registered Lease or Sale
Agreement of Residence / Driving License / Flat Maintenance bill.
Utility bills like Telephone Bill (only land
line), Electricity bill or Gas bill - Not more than 3 months old.
Identity card / document with address,
issued by any of the following: Central/State Government and its Departments, Statutory /
Regulatory Authorities, Public Sector Undertakings, Scheduled Commercial Banks, Public
Financial Institutions.
For FII /
sub
account, Power of Attorney given by FII / sub-account to the Custodians (which are duly
notarized and / or apostilled or consularised) that gives the registered address should be
taken.
The proof of address in the name
of the spouse.
|
| Bank details |
Account Number:
Bank Name:
Branch Name:
IFS Code:
Provide the following:
original cancelled cheque with name of security holder
printed on it or Bank Passbook or Bank Statement attested by the Bank.
|
| E-mail address |
|
| Mobile |
|
Authorization: I / We authorize you (RTA) to update the above PAN and KYC details in my /
our folio(s) , (use Separate Annexure if extra space is required) in which I /
We are the holder(s) (strike off what is not applicable).
Declaration: All the above facts stated are true and correct.
|
| Holder 1 |
Signature: |
| Holder 2 |
Signature: |
| Holder 3 |
Signature: |
| Name |
|
| Full address |
|
| PIN |
|
