Transcription of REMATERIALISATION REQUEST FORM - Karvy
1 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). Lot Type Requested (Please Tick) Market Lot / Jumbo Name of the Security Name of Issuing Company Face Value ISIN.
2 The rematerilisation REQUEST for locked shares: Yes / No Quantity : Lock In Reason : Lock in Release Date : Address : (to be filled only if change in address is to be recorded). Authorised Signatory (ies). Account Holder Account Holder's Name Signature First / Sole Holder Second Holder Third Holder DP Authorisation: Received the above mentioned securities for REMATERIALISATION from: Demat Account No: ISIN: Date: Remat REQUEST No.: Name of the first Holder: The application form is verified with the details of the beneficial owner's account and certify that the application form is in order. The account has sufficient balances to accept the REMATERIALISATION as requested. It is also certified that the beneficial owner's signatures are verified and found in order.
3 The other details of the beneficial owners as extracted from the records are enclosed. Forwarded by: for Karvy STOCK BROKING LTD. (DP Seal, Name & Signature). Note: To be submitted in duplicate for acknowledgement
