Form ISR – 1

(see SEBI circular No. SEBI/HO/MIRSD/MIRSD_RTAMB/P/CIR/2021/655 dated November 03, 2021 on Common
and Simplified Norms for processing investor’s service request by RTAs and norms for furnishing PAN, KYC
details and Nomination)

REQUEST FOR REGISTERING PAN, KYC DETAILS OR CHANGES / UPDATION THEREOF

[For Securities (Shares / Debentures / Bonds, etc.) of listed companies held in physical form]

Date: / /

A. I / We request you to Register / Change / Update the following (Tick  relevant box)

□ PAN □ Bank details □ Signature

□ Mobile number □ E-mail ID □ Address
B. Security Details:
Name of the Issuer Company Folio No.:
Name(s) of the Security holder(s) 1.
as per the Certificate(s) 2.
3.
Number & Face value of
securities
Distinctive number of securities From To
(Optional)

C. I / We are submitting documents as per Table below (tick as relevant, refer to the
instructions):
Document / Instruction / Remark
Information
/ Details
1 PAN of (all) the (joint) holder(s)
PAN

Whether it
is Valid PAN shall be valid only if it is linked to Aadhaar by March 31, 2022*
(linked to For Exemptions / Clarifications on PAN, please refer to Objection Memo in page
Aadhaar): 4
 Yes No
2 Demat
Account
Number Also provide Client Master List (CML) of your Demat Account, provided by the
Depository Participant.

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 3 Proof of Any one of the documents, only if there is change in the address;
Address of
the first
□
Client Master List (CML) of your Demat Account, provided by DP.
Valid Passport/ Registered Lease or Sale Agreement of Residence / Driving
holder
License / Flat Maintenance bill.
□ Utility bills like Telephone Bill (only land line), Electricity bill or Gas bill -
Not more than 3 months old.
□ Identity card / document with address, issued by any of the following:
Central/State Government and its Departments, Statutory / Regulatory
Authorities, Public Sector Undertakings, Scheduled Commercial Banks, Public
Financial Institutions.
□ For FII / sub account, Power of Attorney given by FII / sub-account to the
Custodians (which are duly notarized and / or apostilled or consularised) that
gives the registered address should be taken.
□ The proof of address in the name of the spouse

4 Bank details Account Number:

Bank Name:
Branch Name:
IFS Code:
Provide the following:
original cancelled cheque with name of security holder printed on it or Bank
Passbook or Bank Statement attested by the Bank #
5 E-mail
address #
6 Mobile
#
* or any date as may be specified by the CBDT (DP: Depository Participant)
# In case it is not provided, the details available in the CML will be updated in the folio

Authorization: I / We authorise you (RTA) to update the above PAN and KYC details in my / our folio (s)
, ,(use Separate Annexure if extra space is required) in which I / We are the holder(s)
(strike off what is not applicable).
Declaration: All the above facts stated are true and correct.
Holder 1 Holder 2 Holder 3
Signature ✓

Name ✓
Full address ✓

PIN
✓
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 Form ISR – 2
(see circular No. SEBI/HO/MIRSD/MIRSD_RTAMB/P/CIR/2021/655 dated November 03, 2021 on Common and
Simplified Norms for processing investor’s service request by RTAs and norms for furnishing PAN, KYC details
and Nomination)

Confirmation of Signature of securities holder by the Banker

1. Bank Name and Branch

2. Bank contact details

Postal Address
Phone number
E-mail address

3. Bank Account number

4. Account opening date

5. Account holder(s) name(s) 1)

2)

3)

6. Latest photograph of the account holder(s)

1st Holder 2nd Holder 3rd Holder

7. Account holder(s) details as per Bank Records

a) Address

b) Phone number
c) Email address
d) Signature(s)

1) 2) 3)

Signature verified as recorded with the Bank

Seal of the Bank

(Signature)
Place: Name of the Bank Manager
Employee Code
Date: E-mail address
 Form ISR - 3
Declaration Form for Opting-out of Nomination
by holders of physical securities in Listed Companies
(see SEBI circular No. SEBI/HO/MIRSD/MIRSD_RTAMB/P/CIR/2021/655 dated November 03, 2021 on Common
and Simplified Norms for processing investor’s service request by RTAs and norms for furnishing PAN, KYC
details and Nomination)

[Under Section 72 r/w Section 24 (1) (a) of Companies Act, 2013 r/w Section 11(1) and 11B
of SEBI Act, 1992 and Clause C in Schedule VII and Regulation 101 of SEBI (Listing Obligations
and Disclosure Requirements) Regulations, 2015)]

Name of the Company :

Registered Address of the Company:

I / we ……………………… the holder(s) of the securities particulars of which are given

hereunder, do not wish to nominate any person(s) in whom shall vest, all the rights in
respect of such securities in the event of my /our death.
PARTICULARS OF THE SECURITIES (in respect of which nomination is being opted out)

Nature of Folio No. No. of Certificate No. Distinctive No.

Securities Securities

I/ we understand the issues involved in non-appointment of nominee(s) and further are

aware that in case of my / our death, my / our legal heir(s) / representative(s) are required
to furnish the requisite documents / details, including, Will or documents issued by the
Court like Decree or Succession Certificate or Letter of Administration / Probate of Will or
any other document as may be prescribed by the competent authority, for claiming my / our
aforesaid securities.

Name(s) and Address of Security holders(s) Signature(s)

Sole / First Holder Name

Second Holder Name

Third Holder Name

Name and Address of Witness Signature

 Form No. SH-13

Nomination Form

[Pursuant to section 72 of the Companies Act, 2013 and rule

19(1) of the Companies (Share Capital and Debentures) Rules
2014]
To

Name of the company:

Address of the company:

I/We …………………………………….. the holder(s) of the securities

particulars of which are given hereunder wish to make nomination and
do hereby nominate the following persons in whom shall vest, all the
rights in respect of such securities in the event of my/our death.

(1) PARTICULARS OF THE SECURITIES (in respect of which

nomination is being made)

Nature of Folio No. No. of Certificate Distinctive

securities securities No. No.

(2) PARTICULARS OF NOMINEE/S —

(a) Name:

(b) Date of Birth:

(c) Father’s/Mother’s/Spouse’s name:

(d) Occupation:

(e) Nationality:

(f) Address:
 (g) E-mail id:

(h) Relationship with the security holder:

(3) IN CASE NOMINEE IS A MINOR--

(a) Date of birth:

(b) Date of attaining majority

(c) Name of guardian:

(d) Address of guardian:

Name:

Address:

Name of the Security

Holder (s) Signature Witness with

name and address