ACCOUNT DETAILS ADDITION / MODIFICATION / DELETION REQUEST FORM
FINVASIA SECURITIES PVT. LTD.
SEBI REGN. NO. : IN-DP-317-2017 • DP ID 12084300 Corporate Office: Finvasia Centre D-179, Phase - 8B (Sector74) Mohali 160055, Punjab (India) Phone: 0172-6670000, Fax: 0172-6670070, E-Mail: [email protected] Registered Office: # 1108, Sector- 21 B, Chandigarh -160022 (India)
Application No. Date D D M M Y Y Y Y Please fill all the details in Block Letters in English.
DP ID 1 2 0 8 4 3 0 0 Client ID
Account Holder's Details Name of Sole/First Holder Name of Second Holder Name of Third Holder
I/We request to carry out the change of address / signature in the Demat account. I/We request to carry out the change of address / signature in the KRA and Demat account. I/We request you to make the following additions / modification / deletions to my/our account in your records. I/We request you to add my/our POA account in your records.
DETAILS (Pl. specify change Addition / Modification Existing Details New Details of address, bank details, Deletion (Pl. Specify) telephone number etc.)
Attach an Annexure (with signature(s)) if the space above is found insufficient.
First/Sole Holder Second Holder Third Holder
Name
Signature
Depository Participant Seal and Signature
(1)
POWER OF ATTORNEY
TO ALL TO WHOM THESE PRESENTS SHALL COME I/We______(name of the BO), residing at______India, Indian inhabitant/Non-resident SEND GREETINGS.
Whereas I/ we hold beneficial owner account number DP ID 12084300 Client Id ______with Central Depository Services (India) Limited, through Finvasia Securities Pvt Ltd registered with Securities and Exchange Board of India (SEBI) and Trading Code ______with Finvasia Securities Pvt Ltd, Trading member of Bombay Stock Exchange Ltd. And National Stock Exchange of India Ltd having its registered address # 1108 Sector 21 B, Chandigarh -160022. India.
And Whereas I/ we am/ are desirous to buy and sell securities through Finvasia Securities Pvt Ltd who is a stock broker registered with SEBI and member of recognized stock exchange/s.
And Whereas I/ we am/ are desirous of appointing Finvasia Securities Pvt Ltd as my/our constituted attorney to operate my/ our beneficial owner account on my/ our behalf for a limited purpose in the manner hereinafter appearing and subject to conditions as provided herein.
Now know you all and these presents witness that I/ we do hereby nominate, constitute and appoint Finvasia Securities Pvt Ltd (hereinafter referred to as “the stock broker”) as my true and lawful attorney and authorize it to perform the following functions on my behalf: i. To transfer securities held in my/our aforementioned beneficial owner account(s) or any other account informed me in writing to the stock broker from time to time to the demat account nos.
Account Holder Name Demat Account No CM ID DP Name ACCOUNT TYPE Finvasia Securities Pvt Ltd 1208430000000085 4043 Finvasia Securities Pvt Ltd BSE Principle account Finvasia Securities Pvt Ltd 1208430000000070 M51912 Finvasia Securities Pvt Ltd NSE Pay-In Account Finvasia Securities Pvt Ltd 1100001100020191 M51912 NSCCL Early Pay-In Ac NSE Finvasia Securities Pvt Ltd 1100001000024014 4043 ICCL Early Pay-In Ac BSE of stock broker maintained for the purpose of settlement obligations arising out of trades executed by me/us on any recognized stock exchange through the stock broker. However, the said power will be restricted to only transfer of securities to the Clearing Member ID allotted to the stock broker by any existing or future exchange that the stock broker has joined/ will join as a member or to any demat accounts linked to the said Clearing Member ID provided that I/we have executed a Client Member Agreement with the stock broker for such exchanges. ii. To pledge the securities in favor of Finvasia Securities Pvt Ltd in below margin accounts for the limited purpose of meeting my/our margin requirements in connection with the trades executed by me/us on any recognized stock exchange through the Finvasia Securities Pvt Ltd.
Account Holder Name Demat Account No CM ID DP Name ACCOUNT TYPE Finvasia Securities Pvt Ltd 1208430000167234 M51912 Finvasia Securities Pvt Ltd CM-Client Securities Margin Pledge Account iii. To re-pledge the securities pledged by me as stated in Para ii above in favor of the clearing member/clearing corporation as the case may be." iv. To return to me/us, the securities or funds that may have been received by the stock broker erroneously or those securities or funds that the stock broker was not entitled to receive from me/us; v. To apply for various products like Mutual Funds, Public Issues (shares as well as debentures), rights, offer of shares, tendering shares in open offers etc pursuant to oral/written/electronic instructions given by me/us to the stock broker.
I/We ratify the instructions given by the aforesaid stock broker to the depository participant named hereinabove in the manner specified herein.
I/We further agree and confirm that the powers and authorities conferred by this Power of Attorney shall continue until it is revoked (without notice) in writing by me and that the said revocation shall be effective from the date on which the revocation notice is received by the stock broker in his office at Finvasia Centre, D179, Phase 8B, Sector 74, Mohali, Punjab: 160055 (India). SIGNED AND DELIVERED By the within named Beneficial Owner First/Sole Holder Second Joint Holder Third Joint Holder Name Specimen Signature
In the presence of: Details of the Witness : First Witness Second Witness Name of Witness Address of Witness
Signature of Witness X X
If HUF, Co-Parceners Signature :
1) For FINVASIA SECURITIES PVT. LTD.
I Accept 2) (Signature of Authorised Person) FINVASIA SECURITIES PVT LTD 3) Finvasia Centre D-179, Phase 8B, Sector – 74 Mohali, Punjab: 160055 (India) (2)
NOMINATION DETAILS Dear Sir/Madam, Nomination Regn. No. I/We the Sole Holder/ Joint Holder / Guardian (in case of minor) hereby declare that: Date D D M M Y Y Y Y I/We do not wish to nominate any one for this demat account.
[Strike out what is not applicable] [Signatures of all account holders should be obtained on this form] I/We nominate the following persons who are entitled to receive security balances lying in my/our account, particulars whereof are given below, in the event of the death of Sole holder or the death of all the Joint Holders. BO ACCOUNT DETAILS DP ID 1 2 0 8 4 3 0 0 Client ID Name of the Sole / First Holder
Name of the Second Holder
Name of the Third Holder
NOMINATION DETAILS NOMINEE 1 NOMINEE 2 NOMINEE 3 Nominee Name
First Name*
Middle Name
Last Name*
Address*
City* State* PIN* Country* Telephone No. Fax No. PAN No. UID Email ID Relationship with the BO* Date of Birth* (Mandatory if Nominee is a Minor) Name of the Guardian of Nominee (if the nominee is minor) First Name*
Middle Name
Last Name*
Address of the Guardian of nominee* City* State*
First / Sole Holder Signature Second Holder Signature Third Holder Signature
(3)
PIN* Country* Age Telephone No. Fax No. E-mail Id Relationship of the Guardian with the Nominee Percentage of allocation of securities*
Residual Securities [please tick any one nominee.* If tick not marked default will be first nominee]
Note : Residual securities: incase of multiple nominees, please choose any one nominee who will be credited with residual securities remaining after distribution of securities as per percentage of allocation. If you fail to choose one such nominee, then the first nominee will be marked as nominee entitled for residual shares, if any.
*Marked is Mandatory field This nomination shall supersede any prior nomination made by me / us and also any testamentary document executed by me / us. Note : One Witness shall attest signature(s) / Thumb Impression(s).
Details of the Witness
Name of Witness
Address of Witness
Signature of Witness
I/We confirm that I/We have received and read the copy of Rights & Obligations document and terms & conditions and agree to abide by and be bound by the same and by the Bye Laws as are in force from time to time. I / We declare that the particulars given by me/us above are true and to the best of my/our knowledge as on the date of making this application. I/We agree and undertake to intimate the DP any change(s) in the details / Particulars mentioned by me / us in this form. I/We further agree that any false / misleading information given by me / us or suppression of any material information will render my account liable for termination and suitable action.
First / Sole Holder or Second Holder Third Holder Guardian (in case of Minor)
Name
Signatures
Depository Participant Seal and Signature
(4)