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Sample - KYC Modification Form

This document is a request form to modify account details, including changing an address, signature, bank details, mobile number, or email. Section A and B on page 1 need to be filled out with the Trading Account Code, DP ID, Client ID, and account holder name. The form allows specifying details to add, modify, or delete, as well as providing existing and new details. A signature is required.

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Avinash Shukla
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
663 views2 pages

Sample - KYC Modification Form

This document is a request form to modify account details, including changing an address, signature, bank details, mobile number, or email. Section A and B on page 1 need to be filled out with the Trading Account Code, DP ID, Client ID, and account holder name. The form allows specifying details to add, modify, or delete, as well as providing existing and new details. A signature is required.

Uploaded by

Avinash Shukla
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
You are on page 1/ 2

Fill all the details on page

1Section A and B

UCC BO ID

Attach photo with


cross signature

Signature

Fill all the details on page 1


Section A and B
ACCOUNT DETAILS ADDITION / MODIFICATION / DELETION REQUEST FORM
CHANGE ACCOUNT DETAILS: ꪛ TRADING ꪛ DEMAT

TRADING ACCOUNT CODE: UCC DATE: Date


Please fill all the details in BLOCK Letters in English

DP ID 12088700 CLIENT ID : Last 8 digit of your BO ID


Account Holder details
NAME OF THE CLIENT Your name as per Groww Account
ꪛ I request to carry out the change of address/signature in the Demat account
ꪛ I request to carry out the change of address/signature in the KRA and Demat account
ꪛ I request you to make the following additions/modifications/ deletions to my / our account in your records

Details Addition / Existing Details New Details


(Please specify a change Modification /
of address, bank details, Deletion
mobile*, email*, etc) (Please Specify)

Details you wish Old Details New Details


to update

Attach an annexure (with signature(s)) if the space above is found insufficient.


Name of the client Your name as per Groww Account
Sole Holder Signature
Signature

FOR OFFICE USE ONLY


In-Person Verification(IPV Details):
Name of the person who has done the IPV:_____________________________________

Designatuon:________________________Employee:_____________________________
Name Of the Organization: NEXTBILIION TECHNOLOGY PRIVATE LIMITED

Date of IPV:_ _/_ _/_ _ _ _ Signature of the person who has done the IPV Seal/Stamp of the Intermediary

Acknowledgment
We have received the account modification/addition/deletion request for the account with details below on DATE:_ _ /_ _ /_ _ _ _

DP ID 12088700 CLIENT ID :

Name of the Account Holder

Modification request for

Seal & Signature of authorized signatory

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