Name & Address: ______________________________

______________________________

______________________________

Date: _________________________

To,

Old Name New Name

Reason

Thanking You,

First / Sole Holder Second Holder Third Holder

Signature

Dear Sir,

I/We hereby request you to kindly name change in my Demat & Trading Account

Sub: Name Change in DP & Trading

DP & KYC DepartmentArch Finance Limited81, Darya Ganj, 1st Floor,New Delhi-110002Ph: 8595233233 | Fax: 011-43710055Email : care@archfin.com Web: www.archfin.com

This is inform you that I/We have operating demat & Trading account vide DP ID : IN303403 /& 12050500 Client ID _____________with Depository Participant Arch finance Limited and Trading account vide Client Code ________with Arch Finance Limited

01

Please fill in ENGLISH and in BLOCK LETTERSApplication No. :

A. Identity Details (please see guidelines overleaf)

1. Name of Applicant (As appearing in support identification document).

Name

Father’s/Spouse Name

Mother’s Name

2. Gender Male Female B. Marital Status Single Married C. Date of Birth d d m m y y y y

3. Nationality Indian Other (Please specify)

4. Status Please tick () Resident Individual Non Resident Foreign National (Passport Copy Mandatory for NRIs & Foreign Nationals)

PHOTOGRAPH

Please affixthe recent passportsize photograph and

sign across it

5. PAN Please enclose a duly attested copy of your PAN Card

Aadhaar Number

6. Proof of Identity submitted for PAN exempt cases Please Tick ()

UID (Aadhaar) Passport Voter ID Driving Licence Others (Please see guideline ‘D’ overleaf

B. Address Details (please see guidelines overleaf)

1. Address for Correspondence

City/Town/Village

State

Pin Code

Country

City/Town/Village

State

Pin Code

Country

2. Contact Details

Tel. (Off.)

Mobile

E-Mail Id.

(ISD)

(ISD)

(STD)

(STD)

(ISD)

(ISD)

(STD)

(STD)

Tel. (Res.)

Fax

4. Permanent Address of Resident Applicant if different from above B1 OR Overseas Address (Mandatory) for Non-Resident / Foreign Nationals Applicant

3. Proof of address to be provided by Applicant. Please submit ANY ONE of the following valid documents & tick () against the document attached.

Passport Ration Card Registered Lease/Sale Agreement of Residence Driving License Voter Identity Card *Latest Bank A/c Statement/Passbook

*Latest Telephone Bill (only Land Line) *Latest Electricity Bill *Latest Gas Bill Others (Please Specify)

*Not more than 3 Months old. Validity/Expiry date of proof of address submitted d d m m y y y y

DECLARATION SIGNATURE OF APPLICANTI hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am/we are aware that I/we may be held liable for it.

Place Date

Application Form (For Individuals Only)Know Your Client (KYC)ARCH FINANCE LTD.Regd. Office: 81, Darya Ganj, 1st Floor, New Delhi-110002Ph.: 8595233233 | Fax: 011-43710055E-mail : care@archfin.com | Website : www.archfin.com

(02)

DECLARATION1. Ownership Declaration - Contact Detail (s)

A. E-mail-I hereby declare that the E-mail ID given by me belongs to Me or my family in case of family, the owner of E-mail ID is my Spouse Dependent children Dependent Parent

B. Mobile- I hereby declare that the Mobile given by me belongs to Me or my family in case of family the owner of Mobile is my Spouse Dependent children Dependent Parent2. Declaration for Electronic Communication Yes No

I wish to receive all future communication to me including but not limited to Contract note, Bills and Statement of Accounts to be sent to the above mentioned ID

Original Verified, Self Attested Documents & Certified copies received

ATTESTATION / FOR OFFICE USE ONLY

In person Verification (IPV) Details / KYC Verification Carried out by :Name of the person who has done the IPV:

Designation: Employee ID:

Name of the Organization: ARCH FINANCE LTD.

Date of IPV:Signature of the person who has done the IPV

Seal/Stamp of the Intermediary

Signature of the Authorised Signatory

Name of Sub-Broker/Authorised Person

Emp. Branch _______________________

Date D D M M Y Y Y Y

TM