CDSL Sr. No. ‘BANK OF BARODA B ezrng nx nrc orcas BARODA SUN TOWER, GROUND FLOOR, BKC, MUMBAI-400054, Account Form Application No. L ease fil al the details in Block Letters in Engh DP ID 1[3]0]1]8{|7]0]0 | Cient1> . I/We request you to make the folowing ations / modifications / deletions to my/our account n your records. Details to be changed ‘Addition Modification Existing Details New Details (Please specify: Change of | /Deletion (Please specify) address; Bank details; ‘Telephone No. etc.) | PI. attach Proof > Change of Address > Telephone /Mobile Number > Bank Details and ‘account number > Others (please specify) | “Aiach an Areva (with Signature) the space above is found wsuficent. ~ ] First/Sole Holder ‘Second Holder ‘Third Holder ] . Name Signature Branch verfication/certificate: - 1) Verified 80s) Signature (s) For Bank of Baroda 2) Verified proof submitted for A/c modification 3) Recovered A/c modification charges, where applicable, (Branch) Participant Seal ‘Authorized Signatory Date: _ (Please Tear Here) ‘Acknowledgement Received Account Details Adltion / Modification / Deletions request as per details given below ‘pplication No. Date . DP ID 1|3|0/1/8/7|0\0 nt ID Tiame/s Of the Account Holder/s For Bank of Baroda (Branch) Participant Seal Authorized Signatory