AccountDetailsModificationDeletionForm .pdf

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Original filename: AccountDetailsModificationDeletionForm.pdf
Title: Modification.cdr
Author: Nikhil Aralimatti

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Account details addition/modication/deletion request form
Zerodha
Zerodha Securities Private Limited
Zerodha Commodities Private Limited

Application number

Dated

Please ll all details in BLOCK LETTERS in English
12081600

DP ID

Client ID

Account holder details
First/sole holder

Second holder

Third holder

Name
Mother’s name
Aadhaar
PAN
I/We request to carry out the change of address/signature in the demat account.
I/We request to carry out the change of address/signature in the KRA and demat account.
I/We request you to make the following additions/modications/deletions to my/our account in your records.
Details: Please specify ‘Change of
address’, ‘Change of bank details’,
‘Change of telephone number’, etc.

Type of change: Please specify
if addition/modication/deletion

Existing details

New details

Attach an annexure (with signature(s)) if the space above is found insufcient.

F

First/Sole Holder
or Guardian
(in case of Minor)

S

Second Holder

T

Third Holder

FOR OFFICE USE ONLY
In Person Verication (IPV) Details:
Name of the Person who has done the IPV: ___________________________________________________
Designation: ____________________________________ Employee ID: __________________________
Name of the Organization: ZERODHA
Date of the IPV:

D

D

M

M

Y

Y

Y

Y

Signature of the Person who has done the IPV

Seal/Stamp of the Intermediary

Acknowledgement
We have received the account modication/addition/deletion request for the account with details below on D D M M Y Y Y Y
Application no.
DP ID
Client ID
First/sole holder
Third holder
Second holder
Account holder’s name
Modication request for
Seal & signature of
authorised signatory


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