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Equity - Kyc Modification Format

This document is an account details addition/modification/deletion request form for Nirmal Bang Securities Pvt. Ltd. It contains fields for client details like name, address, bank account details, and contact information. The client can request changes to their existing details by filling in the new details. It requires signatures of all holders to authorize the changes. Supporting documents like ID/address proof and bank statements may be needed depending on the type of change requested.

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santosh kumari
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© © All Rights Reserved
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141 views1 page

Equity - Kyc Modification Format

This document is an account details addition/modification/deletion request form for Nirmal Bang Securities Pvt. Ltd. It contains fields for client details like name, address, bank account details, and contact information. The client can request changes to their existing details by filling in the new details. It requires signatures of all holders to authorize the changes. Supporting documents like ID/address proof and bank statements may be needed depending on the type of change requested.

Uploaded by

santosh kumari
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Nirmal Bang Securities Pvt. Ltd.

B/101 Khandelwal House, 1st floor, Poddar Road,


Near Poddar Park, Malad (East), Mumbai-400097.
__________________________________________________________________________________________________________________________________________________________________________________________________________________

ACCOUNT DETAILS ADDITION / MODIFICATION / DELETION REQUEST FORM


Application No. Date D D M M Y Y Y Y
Please fill all the details in Block Letters in English
DP ID No. CLIENT ID TRADING CODE
Name of the First / Sole Holder
Name of the Second Holder
Name of the Third Holder
I / we request to make the following additions / modifications / deletions to my / our account in your records.
Holder Details
EXISTING DETAILS NEW DETAILS

Address

City
Pin Code (Mandatory)
State
Country
Telephone No. ISD STD ISD STD
Mobile No.
Email ID

Bank Account(s) Details


Addition
EXISTING DETAILS NEW DETAILS
Default
Bank Name

Bank Address

Bank Account No.


MICR Code
Bank Account Type Saving Current Cash Credit Saving Current Cash Credit
IFSC Code

Further I / We hereby give my mandate to issue Contract Notes (For the transaction carried on by me/us) and Statement of Funds and Securities in
Digital format at the above mentioned Email ID. The above provided information is true.

First Holder Signature Second Holder Signature Third Holder Signature


Individual / Corporate Individual / Corporate Individual / Corporate

Note: - 1) For change of Address, Identity & Address proof of all the holders required.
2) For change of Bank detail Original Cheque leaf & photocopy of Bank passbook or Bank statement required.
============================================================================================= (Please Tear Here) =============================================================================================

Acknowledgement Receipt
Received Account details Addition / Modification / Deletions request as per details given below:
Application No. Date D D M M Y Y Y Y
DP ID No. CLIENT ID TRADING CODE
Name of the First / Sole Holder
Name of the Second Holder
Name of the Third Holder
Modification request for: (Specify reason)

Company Seal and Signature

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