Office Address: 3rd Floor, House No.
9, Magnet Corporate Park, Near Zydus
Hospital, B/H Intas Pharma, Sola Bridge, S.G. Highway, Ahmedabad - 380 054. |
Tel: + 079-61909595 |
Email: ewplcompliance@[Link] | Website: [Link]
Account Details Addition / Modification Request Form (Trading & DP A/c)
Dear Sir / Madam, Date:
I / We request you to make the following additions / modifications to my / our Trading and Demat account in your records.
PLEASE FILL ALL THE DETAILS IN BLOCK LETTERS IN ENGLISH. Please mark ( ) on the appropriate column.
Account Holder’s Details PAN NO.
CDSL DP ID - BO ID Trading Code
Annual Income Upto 1 Lac 1-5 Lac 5-10 Lac 10-25 Lac 25-50 Lac 50-1cr 1cr & above Networth as on Date
1. Bank & Dividend Details Existing Details (As per DP Account) New Details (This bank will be updated as default bank for PAYOUT)
Addition Bank Name & Branch: Bank Name & Branch:
A/c No.: A/c No.:
Modification A/c Type: A/c Type:
MICR (Mandatory for DP): MICR (Mandatory for DP):
2. Address Details Existing Details New Details
Address: Address:
Modification
Correspondence
Permanent City: State: City: State:
Country: Pin Code: Country: Pin Code:
3. Contact Details Existing Details New Details
Addition Tel.: Mob. Tel.: Mob.
Modification
Email ID: Email ID:
4. ECN activation and other electronic communication for Trading and Demat account: Yes No
I / We hereby give our consent and authorize you to send digital contract notes, bills, ledgers, statement of funds and securities, transaction statements,
Monthly / Quarterly demat statement of accounts / holding statement(s) / bills or other reports, Statement(S), related notices, Circulars, amendments and
such other correspondence, documents, records by whatever name called (hereafter referred to as “statement (s)” issued from time to time, at the above
mentioned new email id:
5. Signature Existing New
Modification
Reason for Change in Signature
KRA: I/We wish to update the above changes in KRA / Demat / Trading Account.
6. DP Details for Trading A/c Pay - in Payout
DP Name: DP ID: Client ID:
7. Others (Pls Specify) Existing New
Declaration: I/We hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief. In case any of the
above mentioned information is found to be false or untrue or misleading or misrepresenting, I am/we are aware that I/we may be held liable for it.
Client Name First / Sole Holder Second Holder Third Holder
Signature
Any one Proof Required from the following list (Self attested by client and all joint holders, if any) :
Bank details: Copy of cheque with name printed, copy of bank passbook, copy of bank statement of accounts duly attested by bank authorities not older than 4 months with cancelled cheque.
Address details: Copy of Ration card, Passport, Voter ID card, Driving license, Electricity bill / Land line Telephone bill (not more than 3 months old), Duly filled KRA form. DP details: Latest
transaction statement / holding statement / CML copy. Income Updation: Last 3 months Salary Slips, Form 16, ITR, Audited Annual Accounts, Bank account statement for last 6 months, Net-
worth Certificate from CA.
ACKNOWLEDGMENT RECEIPT
We hereby acknowledge the receipt of the your instruction for modification of the following Account subject to verification:
DP ID: Client ID: Trading Code:
Modification request for
(Specify reason) Annual Income Bank Address Contact Details ECN Signature DP Addition Others
EWPL Seal and Signature