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REMATERIALISATION REQUEST FORM - Karvy

Karvy HOUSE 46, Avenue 4, Street No 1, Banjara Hills, Hyderabad - 500034. Tel: 040 23312454. REMATERIALISATION REQUEST form . RRF No.: RRN:_____ Date:_____. I/We hereby declare that the below mentioned account may be debited to the extent of my/our REMATERIALISATION REQUEST and equivalent certificates be issued for the same. I/We hereby declare that the below mentioned person(s) are the beneficial owners of the securities mentioned. IN300394 IN301557 IN301926 IN302470. Demat Account No. / Client Id: Account Holder Name(s): No. of Securities to be Rematerialized: (nos.). No. of Securities to be Rematerialized (in words).

“KARVY HOUSE” 46, Avenue 4, Banjara Hills Street No 1, , Hyderabad - 500034 Tel: 040–23312454 REMATERIALISATION REQUEST FORM

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