NOMINATION FORM FOR INDIVIDUALS ONLY (Demat & Trading Account)
BO Account Details: Trading Code:
I/We the Sole holder/Joint holders/Guardian (in case of minor) hereby declare that:
I/We do not wish to nominate any one for this Demat & Trading Account. I/We wish to cancel to nomination.
I/We nominate the following person who is entitled to receive security and fund balances lying in my/our account, particulars whereof are given
below, in the event of the death of the Sole holder or the death of all the Joint Holders.
NOMINEE-1 DETAILS NOMINEE-2 DETAILS NOMINEE-3 DETAILS
Name: ___________________________________ Name: ___________________________________ Name: ___________________________________
Address : _________________________________ Address : _________________________________ Address : _________________________________
_________________________________________ _________________________________________ _________________________________________
_________________________________________ _________________________________________ _________________________________________
City: ________________ State: _______________ City: ________________ State: _______________ City: ________________ State: _______________
Pin.______________ Country: ________________ Pin.______________ Country: ________________ Pin.______________ Country: ________________
Fax: _________________ Tel.: _______________ Fax: _________________ Tel.: _______________ Fax: _________________ Tel.: _______________
Mobile: __________________________________ Mobile: __________________________________ Mobile: __________________________________
E-mail ID: ________________________________ E-mail ID: ________________________________ E-mail ID: ________________________________
Relationship with BO (if any): ________________ Relationship with BO (if any): ________________ Relationship with BO (if any): ________________
DoB of Nominee: __________________________ DoB of Nominee: __________________________ DoB of Nominee: __________________________
IDENTIFICATION DETAILS OF NOMINEE
PAN: ____________________________________ PAN: ____________________________________ PAN: ____________________________________
Aadhar / UID: _____________________________ Aadhar / UID: _____________________________ Aadhar / UID: _____________________________
Others#: __________________________________ Others#: __________________________________ Others#: __________________________________
GUARDIAN DETAILS (If nominee is a minor)
As the, Nominee is a minor as on date, I/We appoint following person to act guardian and to receive the securities in this account on behalf of the
Nominee in the event of death of the Soleholder/all Joint holders.
GUARDIAN-1 DETAILS GUARDIAN-2 DETAILS GUARDIAN-3 DETAILS
Name: ___________________________________ Name: ___________________________________ Name: ___________________________________
Address : _________________________________ Address : _________________________________ Address : _________________________________
_________________________________________ _________________________________________ _________________________________________
_________________________________________ _________________________________________ _________________________________________
City: ________________ State: _______________ City: ________________ State: _______________ City: ________________ State: _______________
Pin.______________ Country: ________________ Pin.______________ Country: ________________ Pin.______________ Country: ________________
Fax: _________________ Tel.: _______________ Fax: _________________ Tel.: _______________ Fax: _________________ Tel.: _______________
Mobile: __________________________________ Mobile: __________________________________ Mobile: __________________________________
E-mail ID: ________________________________ E-mail ID: ________________________________ E-mail ID: ________________________________
Relationship with Nominee (if any): ____________ Relationship with Nominee (if any): ____________ Relationship with Nominee (if any): ____________
DoB of Guardian: _________________________ DoB of Guardian: __________________________ DoB of Guardian: __________________________
IDENTIFICATION DETAILS OF GUARDIAN
PAN: ____________________________________ PAN: ____________________________________ PAN: ____________________________________
Aadhar / UID: _____________________________ Aadhar / UID: _____________________________ Aadhar / UID: _____________________________
Others#: _________________________________ Others#: __________________________________ Others#: __________________________________
@Signature of Guardian @Signature of Guardian @Signature of Guardian
Nominee-1 Nominee-2 Nominee-3
Percentage of allocation of securities : % % %
*Residual Securities (Please tick if any) :
This nomination shall suspersede any prior nomination made by me/us and also any testamentary document executed by me / us.
@ @ @
FH SH TH
Name:_________________________ Name:_________________________ Name:_________________________
Details of Witness
Signature of First Witness Signature of Second Witness
______________________________________________________ ______________________________________________
Name _________________________________________________ Name _________________________________________
Address _______________________________________________ Address _______________________________________
(To be filled by DP)
Nomination accepted and registered vide Registration No. For SBICAP Securities Limited
Dated ________________ Authorised Signatory
*Residual Securities: Incase 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
fall to choose one such nominee, then the first nominee will be marked as nominee entitled for residual shares, if any.
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Any one of the following can provided as identification details of the nominee/guardian. Savings Bank Account Number Proof of Identity Demat Account ID
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