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Dematerialisation Request Form

The document is a Dematerialisation Request Form for converting physical securities into electronic form with Paytm Money Limited. It requires details such as the DP ID, client ID, names of holders, ISIN, quantity of securities, and nature of securities. The form also includes sections for signatures and participant authorization to ensure compliance and verification of the request.

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250 views1 page

Dematerialisation Request Form

The document is a Dematerialisation Request Form for converting physical securities into electronic form with Paytm Money Limited. It requires details such as the DP ID, client ID, names of holders, ISIN, quantity of securities, and nature of securities. The form also includes sections for signatures and participant authorization to ensure compliance and verification of the request.

Uploaded by

Audit
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

Dematerialisation Request Form

 Normal Dematerialization  Transmission-cum- Dematerialization


 Transposition-cum-Dematerialization

Paytm Money Limited


The HUB, 3rd Floor, SY No. 8 & 8/2 Ambalipura Village, Varthur Hobli sarjapura Main Road, Bangalore, Karnataka,
560103. DP ID: 12088800
(To be filled up by the Depository Participant)

DRN Date D D M M Y Y Y Y
DRF No. Date D D M M Y Y Y Y

(To be filled by the BO. Please fill all the details in BLOCK LETTERS in English. Fill up a separate DRF for Free
securities and Locked – in securities. In case of locked - in securities fill up a separate DRF for different lock-in
reason / lock-in expiry dates.)

I / We request you to dematerialise the enclosed security certificate(s) registered in my / our name into my / our
demat account.

DP ID 1 2 0 8 8 8 0 0 Client ID
Name of First Holder
Name of Second Holder
Name of Third Holder
Name of the Company
ISIN I N
Quantity to be Dematerialized (In Figures)
(In Words)
Number Of Certificates (in words)
Nature of Securities  Free Securities  Lock-in Securities
Lock-in reason
Lock in Expiry Date D D M M Y Y Y Y

Details of Securities:
Type of Security  Equity  Debentures  Bonds  Units
 Other (Specify)
Face Value of Securities
From To From To From To
Folio No.
Certificate Numbers
Distinctive Numbers
Quantity

Attach an annexure (duly signed by account holder(s)) in the above format if the space is not sufficient.

The original certificates / documents are hereby surrendered by me / us for dematerialisation and the same are free
from any lien or charge or encumbrance and represent the bonafide securities of the Issuer Company to the best of
my / our knowledge and belief.

First / Sole Holder Second Holder Third Holder


Name

Signature with DP

Signature with RTA

Participant Authorization (From DP to RTA)

We have received the above-mentioned securities bearing ISIN for Dematerialisation. The
Application form is verified with the Certificates / Documents surrendered for dematerialisation and we certify that
the application form is in accordance with the details mentioned in the enclosed certificates / documents. It is also
certified that the Holder(s) of securities have a beneficiary account with us in the same name(s) and order of
name(s).

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