FORM FOR NOMINATION/CANCELLATION OF NOMINATION
(TO BE FILLED IN BY INDIVIDUAL APPLYING SINGLY OR JOINTLY) M Mandatory
Account Details
DP ID: 12088600 Client ID:
Trading Code:
Name of Sole/First Holder: RAGHAVENDRA RATHNAPPA LAMANI
Name of Second Holder:
Name of Third Holder:
A. Nomination Option
Please tick the relevant option below:
I/We wish to make a nomination
I/We wish to cancel the nomination made by me/us on (DDMMYY __________________ ) and consequently all rights and
liabilities in respect of the beneficiary ownership in the securities held by me/us in the said account shall vest in me/us
(Strike off nomination details in B below)
I/We [sole holder/joint holders/Guardian (in case of minor)] wish to make a nomination and do hereby nominate the following person(s) who
is/are entitled to receive security balances lying in my/our account, particulars whereof are given above, in the event of the death of the Sole
holder or the death of all the Joint Holders.
B. Nomination Details
Nominee 1 Nominee 2 Nominee 3
*Photograph of the Nominee &
Signature across the photo
*Name of the Nominee
*Relationship with the Applicant (if any)
*Address of the Nominee
*City/Town/Village
*State
*Country
*Pin Code
Telephone/Mobile No.
Fax No.
Email Id
PAN
Aadhar No.
*Proof of Identity
*Percentage of allocation of securities
*Residual Securities
*Please tick.(If tick not marked default
will be first nominee)
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If the Nominee is a minor
Nominee 1 Nominee 2 Nominee 3
*Photograph of the Nominee &
Signature across the photo
*Name of the Nominee
*Relationship with the Applicant (if any)
*Address of the Guardian of the Nominee
*Relationship of the Guardian with the
Nominee
*City/Town/Village
*State
*Country
*Pin Code
*Age
Telephone/Mobile No.
Fax No.
Email Id
PAN
Aadhar No.
*Proof of Identity
*Percentage of allocation of securities
*Residual Securities
*Please tick.(If tick not marked default
will be first nominee)
Note: Residual securities: In case 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.
Sole/First Holder Second Holder Third holder
RAGHAVENDRA RATHNAPPA LAMANI
Name
S T
Signature
Place
Date
Details of Witness First Witness Second Witness
Name
Address
Signature
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Instructions:
a. The nomination can be made only by individuals holding beneficiary owner accounts on their own behalf (singly or jointly). Non-
Individuals including society, trust, body corporate, partnership firm, Karta of Hindu Undivided Family, holder of power of attorney
cannot nominate. If the beneficiary owner account is held jointly, all joint holders will sign the nomination form.
b. A minor can be nominated. In that event, the name and address of the Guardian of the minor nominee shall be provided by the beneficial
owner.
c. A nominee shall not be a society, trust, body corporate, partnership firm, Karta of Hindu Undivided Family or a power of attorney holder. A
non-resident can be a nominee, subject to Exchange controls in force, from time to time.
d. Nomination in respect of the beneficiary owner stands rescinded upon closure of the beneficiary owner account. Similarly, the
nomination in respect of securities shall stand terminated upon transfer of securities.
e. Transfer of securities in favour of a nominee shall be valid discharge by the Depository and the Participant against the legal heir.
f. The cancellation of nomination can be made by individuals only holding beneficiary owner accounts on their own behalf singly or jointly
by the same persons who made the original nominations. Non-Individuals including society, trust, body corporate, partnership firm,
Karta of Hindu Undivided Family, holder of power of attorney cannot cancel the nomination. If the beneficiary owner account is held
jointly, all joint holders will sign the cancellation form.
g. On cancellation of the nomination, the nomination shall stand rescinded and the Depository shall not be under any obligation to transfer
the securities in favour of the nominee.
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