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.