ANAND RATHI SHARE & STOCK BROKERS LIMITED
CIN : U67120MH1991PLC064106
Processing Office: Plot no CYB-2, Cyber Park, Heavy Industrial Area, Near Jodhpur Dairy, Jodhpur 342003
Tel No 0291-6661001 E-mail: dp@[Link]
Regd. Office: Express Zone, A Wing, 10th Floor, Western Express Highway, Goregaon (East), Mumbai – 400063 Maharashtra
Account Details Addition / Modification Request Form Trading / DP A/c/Mutual Fund
Dear Sir / Madam Date :
I / We request you to make the following additions / modifications to my / our Trading / Demat / Comtrack / NERL / CCRL / Mutual Fund account in your records.
PLEASE FILL ALL THE DETAILS IN BLOCK LETTERS IN ENGLISH. Please mark ( ) on the appropriate column
Account Holder’s Details PAN :
CDSL DP ID Trading Code
1 2 0 1 0 6 0
Comtrack /NERL/CCRL Code :
Client Name :-
[Link] Income Up to 1 Lac 1-5 Lac 5-10 Lac 10-25 Lac 25-50 Lac 50-1cr 1cr & above
OR Net-Worth* Rs. as on Date / / 20 (*Net-worth should not be older than 1 Year)
[Link] Details: Existing Details New details
Primary Mob: Primary Mob:
Secondary Mob:* Secondary Mob:*
Primary Email: Primary Email:
Secondary Email: * Secondary Email*
[Link] Details: Existing Details New Details Check mark for default in Trading
Trading A/c Bank name & Branch Bank name & Branch
A/c No. : A/c No. :
Demat A/c A/c Type : A/c Type :
IFSC Code IFSC Code
Both MICR MICR
4. Address Details: Existing Details New Details
Address: Address:
Correspondence
Permanent City : State : City : State :
Country Pin Code: Country Pin Code:
5. Any Other Existing Details New Details
PAN / DOB /Occupation / Status /
Others etc.
KRA- I/We wish to update the above changes in KRA
6. ECN / E-Statement Consent :-
i. I/we aware that the Member has to provide physical contract note in respect of all the trades placed by me unless I/we our self want the same in the electronic form.
ii. I /we aware that the Member has to provide electronic contract note for my convenience on my request only.
iii. Though the Member is required to deliver physical contract note, I/we find that it is inconvenient for me to receive physical contract notes. Therefore, I/we/am/are voluntarily requesting for
delivery of electronic contract note pertaining to all the trades carried out / ordered by me/us.
iv. I/we have access to a computer and am a regular internet user, having sufficient knowledge of handling the email operations.
v. My email id has been created by me/us and not by someone else.
vi. I/we am/are aware that this declaration form should be in English or in any other language known to me/us.
vii. I/we am/are aware that non-receipt of bounced mail notification by the member shall amount to delivery of the contract note at the above e-mail ID.
The above declaration and the guidelines for ECN / E-Statement Consent have been read and understood by me/us. I/we am/are aware of the risk involved in dispensing with the physical contract
note , Reports and E-Statement and other communication, and do hereby take full responsibility for the same.
I / We hereby give our consent and authorize you to send digital contract notes, bills, ledgers, statement of funds and securities, transaction statements, Monthly/Quarterly demat statement of
accounts / holding statement(s) / bills or other reports, Statement(S), related notices, Circulars, amendments and such other correspondence, documents, records by whatever name called
(hereafter referred to as “statement (s)” issued from time to time, at the above mentioned email.
6. ECN/E-Statement activation and other electronic communication for Trading and Demat account : Yes No.
Declaration: - I/We hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief. In case any of the above mentioned 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.
-All other details available into my/our client master of trading and DP which are not modifying with this request form, are true and correct to the best of my/our knowledge and belief and I/We agree and responsible,
for any issue occurred due to not updated proper detail in my/our account.
- I/ We authorized you to reach out to me/ us for any confirmations like Order Verification, Delivery Confirmation, Trade Confirmation, Welcome call etc. through Call/ IVR , E-Mail/ SMS or other source of
communication on the Mobile no. recoded/ registered with us, irrespective of User's registration with DND registry of TRAI.
I/ We agree to auto-renew my/ us consent after every 180 days until I / We opt-out
I/ We AGREE, "I/We authorize Anand Rathi Share and Stock Brokers Limited to activate Income which I requested.
I / We agree to consider attached financial document proof as Current Annual Income Proof and I /we will submit my / Our Financial Statement Every Year.
* Secondary Email-ID will be update only into Demat Account.
Client Name First/Sole Holder Second Holder Third Holder
Signature
Any one Proof Required from the following list (All document must be Self attested by all joint holders): *Self Attested PAN CARD copy is mandatory. IPV/OSV seal & detail is mandatory
Bank details: Cancelled cheque with name printed/ copy of bank passbook/ latest bank statement of accounts duly attested by bank authorities.
Address details: Copy of Ration card, Passport, Voter ID card, Driving license, Bank passbook, Electricity bill / Land line Telephone bill (not more than 2 months old)
*'- Please strike off which are not applicable.
VERIFIED BY ……………………………… UPDATED BY ………………………………
ACKNOWLEDGMENT RECEIPT
We hereby acknowledge the receipt of the your instruction for modification of the following Account Subject to verification Date :
DP ID 1 2 0 1 0 6 0 Client ID: Trading Code: Comtrack/NCRL/CCRL :
Modification request for Annual Income Bank Address Contact Details ECN Dormant Other
(Specify reason)
Version : May - 2021 Depository Participant Seal and Signature
