Dematerialisation Request Form

8/4/2019 Dematerialisation Request Form

http://slidepdf.com/reader/full/dematerialisation-request-form 1/1

DEMATERIALISATION REQUEST FORM (CDSL)Please fll all the details in Block Letters in English (FILL UP ISIN WISE SEPARATE DRF FOR FREE SECURITIES AND LOCKED-IN SECURITIES)

I/We request you to dematerialise the enclosed certifcates registered in my/our name into my / our demat account.

Details of Securities Free Securities Locked-in-Securities

Name of the Company

ISIN

Type of Security Equity Debentures Bonds Units Other (Specify)

Account No. 1 3 0 1 9 3 0 0

Date DRN (to be lled by DP) Application Slip/Ref. No. /DRF No.

D D M M Y Y Y Y

Folio No. Certicate No. Distinctive No. Quantity

From To From To

Total

Number of Certicates (In words) Face Value of Securities Rs.

Quantity to be

Dematerialised

(In Figures)

(In words)

(If the space above is found to be insufcient, an annexure containing the certicate details duly signed in the same format may be attached.)

In case of Locked-in Securities ll up a separate DRF for Locked - in Securities having different release dates.

Lock-in Reason

Lock-in Release Date

The Original Certicates / documents are hereby surrendered by me / us for dematerialisation and the same are free from any lien or charge or encumbrance

and represent the bona de securities of the Issuer Company to the best of my / our knowledge and belief.

Names

Signature with DP

Signature with RTA/Issuer/Co.

First / Sole Holder Second Holder Third Holder

Participant Authorisation (From DP to RTA)We have received the above mentioned securities bearing ISIN No.___________________ for Dematerialisation. The application form is veried with the

Certicates / Documents surrendered for dematerialisation and we certify that the application form is in accordance with the details mentioned in the enclosed

certicates / documents. It is also certied that the Holder(s) of securities have a beneciary account with us in the name (s) and order of name(s).

Signature veried

Name&SignatureofAuthorisedBankOfcial

Acknowledgement(DPTOBO)

Application No. CDSL

We hereby acknowledge the receipt of the following securities for dematerialisation subject to verication :

Account No. 1 3 0 1 9 3 0 0Sole/FirstHolderName

Name of the Company

Type of the Security Equity Debentures Bonds Units Other Specify)

ISIN No. of Securities No. of Certicates

I N

Branch Stamp & Signature

Branch Name:

Branch Code:

State Bank of India

DP Centralised Processing Cell, CMC House, C-18, Bandra-Kurla Complex, Bandra (East), Mumbai 400 051.

•HelpDesk:1800220488(Toll free for MTNL/BSNL users)/Ph.:022-26592123•Fax:022-26592127•Email:[email protected]

State Bank of IndiaDP Centralised Processing Cell, CMC House, C-18, Bandra-Kurla Complex, Bandra (East), Mumbai 400 051.

•HelpDesk:1800220488(Toll free for MTNL/BSNL users)/Ph.:022-26592123•Fax:022-26592127•Email:[email protected]

INDOC No.

DP ID No. : 13019300

SebI Rgn. No.: IN-DP-CDSL-80-2000

DP ID No. : 13019300

SebI Rgn. No.: IN-DP-CDSL-80-2000