The Zerodha
153/154, 4th Cross, J.P Nagar 4th Phase,
Opp. Clarence Public School,
Bengaluru - 560078
Subject:- DRF (Dematerialized Request Form) for dematting of the physical (ICICI Bank
Limited) Bond in respect of Ms Kashmiri Devi
Dear Sir/ Madam
Kindly nd the enclosed DRF (Dematerialization Request Form) duly lled and signed in triplicate along
with the self-certi ed ID proof of Ms Kashmiri Devi, for your scrutiny and early execution of the request
so that Demat Request Number (DRN) may be raised at your end as advised by the RTA.
D/A:- i) Original Letter of Con rmation
ii) Filled & Signed DRF in triplicate
iii) Self-certi ed ID proof
Regards
Kashss s
Ms Kashmiri Devi
W/o Late Sh. Om Parkash
H.N. 1060, Sector-5
Urban Estate, Kurukshetra 136118
99101-30542, 9896773169
Email: Jitender.singh29@[Link]
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Annexure - B
(to circular no. SEBIHO/MIRSD/MIRSD_RTAMB/P/CIRI2022/8 dated January 25, 2022 on Issuance of Securities in
dematerialized form in case of Investor Service Requests)
RTA- 3i Infotech Limited, Tower No. 5, 3rd Floor, International Infotech Park, Vashi, Navi Mumbai 400703
Rof: 10C/BONDS/BAB/2519 Date: October 31, 2023
KASHMIRI DEVI
H NO 1060 SECTOR 5
URBAN ESTATE
KURUKSIHETRA
HARYANA
136118
Dear Sir/Madam,
LETTER OF CONFIRMATION
Sub: Issuance of Securilies in dematerialized form in case of Investor Service Requests
Name of the Company: ICICI Bank Limited ISIN: INEO90A08TB6
We refer to the request received from you for issuance of securities in your name. We would like to inform you that the
requcst has been approved as detailed below:
Name of rst holder & PAN KASHMIRI DEVI - BSJPDO693J
Joint holder 1 & PAN NA - NA
Joint holder 2 & PAN
NA-NA
Number of bond(s) 1
Folio Number 0092231
Certi cate number(s) 34542
Distinctive number (s) 34539- 34539
Lock-In Yes or No. No
Ifyes,lock-infrom _J till J (DD/MMIYYYY)
As you may be aware, SEBI vide Gazelte Noti cation no. SEBI/LAD-NRO/GN/2022/66 dated January 24, 2022, has
mandated that the bonds thal are issued pursuant to investor service request shall henceforth be issued in demat
modo only and hence the security certi cates (wherever applicable) are retained at our end.
Accordingly, within 120 days of this letter, please request your Depository Participant (DP) to demat these bonds using
the Dematerialization Request Form (DRF). Please ll the DRF with the details mentioned in this letter, sign it and present
this letter in original to your DP along with the DRF for enabling your DP to raise a Demat Request Number (DRN). In
casc you do not have a demat account, kindly open one with any DP. Please note that you can open Basic Service
Demat Account at minimal / nil charges.
Plcase nole thal this lelter is valid only for a period of 120 days from the date of its issue within which you have lo
raisc demat request with the DP as above. Any request tor processing demat after the expiry of aforesaid 120 days will
not be cntertained and as per the operating guldelines İssued by SEBI, the subject bonds shall be transferred to a
Suspense Escrow Demat Account of the company.
Thanking you,
Yours faithfully.
For 3i Infotech Limited (RTA)
l
Authorised Signatory
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Dematirialization request form has to be led in triplicate
One copy for Bene cial Owner| One copy for DP | One copy for Issuer/RTA N ZERODHA
Documents Required: Physical Share Certi cate and Sell-attested ID proof DP ID No.
DP SEBI Reg. No. IN-DP-431-2019
Zerodha Broking Ltd.
#153/154 4th Cross Dollars Colony. Opp. Clarence Public School, J.P Nagar 4th Phase, Bangalore - 560078
Halp Desk: 080 47181888 Email: support@[Link]
DEMATERIALISATION REQUEST FORM (CDSL)
Please fal all the details in Block Letters in English (FliL UP ISIN WSE. SEPARATE DRF FOR FREE SECURITIES AND LOCKED-IN SECURITIES)
Account
No. |20 |8|s|o496 6|P|5|2]
Date DRN (to be lled by DP) Applicalion Slip/Ref. No. DRF No
We request you to demateralise the enclosed certi cates reglstered In mylour name into my/ our demat account.
Details of Securities Bfree Securities DLocked-in-Securities
NameoftheCompany CICI BJnk Lmte
ISIN ONEOP|o40 TBG
Type of Security OEquity ODebentures BBonds DUnits Oother (Specify)
Folio No. Certifcate No. Distinctive No. Quantity
From To From To
O092231 34542 34539 - 34539
Total
Number of Certi cates (ln words) One Only Face ValueofSecuitiesRs.25. 000/. Rupee Tweoty hue thourns
Quantityto be(In Figures)
Dematerialised
(trn words)
on only
(If the space above is found to be insuf cient, an annexure containing the certiicate details duly signed in the same fomat may be attached.)
| In case of Loked-in Securities up a separate DRF for Locked - in Securitieshaving different release dates. NA
Lock-in Reason
Lock-in ReleaseDate
The Original Certi cates / documents are hereby surrendered by me /us for dematerialisation and the same are free from any lien or charge or encumbrance
and represent the bona de securitles of the Issuer Company to the best of myi our knowledge and belief.
Names KASHMIRI DEVI
Signature with DP
Signature with RTAssuer/Co.
Kanez D2
First /Sole Holder Second Hokder Third Holder
Participant Authorisation (From DP to RTA)
We have received the above mentioned securities bearing ISIN No. Dematerialisation. The applicabion form is veri ed with the
Certi cates Documents surrendered
for dematerialisaion andwe certy thattheapplicationform is in acordance with the detais mentioned in the endosed
certi cates / documents. It is also certi ed that the Holder(s) of securities have a bene ciary account with us in the name (s) and order of name(s).
Signature veni ed
Name & Signature of Authorised DP Of cial
Acknowledgement (DP TO BO) DP ID No. DP SEBI Reg. No: IN-DP-431-2019
Zerodha Broking Ltd.
#15/154, 4th Cross, Dol ars Cokony. Opp. Clarence Publc Schod, JP Nagar 4th Phase, Bangalore- 560078
Application No. CDSL
We hereby acknowedge the receipt of the following securities for dematerialisation subject lo veri cation:
Account No.
Sole / First Holder Name
Name of the Company
Type of the Security DEquity ODebentures OBonds OUnits Oother Specity)
ISIN No. of Securities No. of Cert cates
Branch Name:
Branch Stamp & Signature Branch Code:
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