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Account Modification Form

The client is requesting to update their address, contact, bank, and demat account details with the brokerage firm. They provide their existing details and the new details to modify. The client declares that the updated information provided is true and correct to the best of their knowledge.

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Naveen

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0% found this document useful (0 votes)

65 views1 page

Account Modification Form

Uploaded by

Naveen

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

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DATE / / 20

AXISDIRECT ACCOUNT NO. :

CLIENT NAME:

..........................................................................................................................................................................................................................................

To,
AXIS Securities Limited
Solaris, 'C' Building, 6th Floor, Opp. L&T Gate No.6, Saki Vihar Road, Powai, Mumbai-400072
Dear Sir,
I/We request you to update the following details in your records for the above mentioned Client code
Address Details

Contact Details

Bank Details

DP Details

Income in Lac__________

ADDRESS MODIFICATION DETAILS

Modification requested in

Permanent or

Correspondence Address

Existing Details
Address ........................................................................................................................................

New Details
.....................................................................................................

........................................................................................................................................

.....................................................................................................

........................................................................................................................................

.....................................................................................................

City

...............................................................................Pin code...........................................

.....................................................................................................

State

.........................................................................................................................................

.....................................................................................................

Document:

Passport

Driving License

Voter Id

Bank Passbook

Ration Card

Telephone Bill

Electricity Bill

Rent Agreement

CONTACT DETAILS
Tel. No

Existing Details
....................................................................................................................................

New Details
....................................................................................................

Mobile No

..........................................................................Pin code............................................

...................................................................................................

Email ID

...................................................................................................................................

....................................................................................................

ADDITIONAL/ MODIFICATION OF BANK DETAILS

A/C No

Existing Details
.....................................................................................................................................

New Details
...................................................................................................

A/C Type

....................................................................................................................................

..................................................................................................

Bank Name .....................................................................................................................................

..................................................................................................

Branch

............................................................................Pin code..........................................

...................................................................................................

MICR

...................................................................................................................................

...................................................................................................

....................................................................................................

..................................................................................................

...........................................................................................................................

...................................................................................................

IFSC Code (RTGS / NEFT) :

Branch Code :

ADDITIONAL/ MODIFICATION OF DP DETAILS

Existing Details

..............................................................................................................................

New Details
...................................................................................................

Second Holder .............................................................................................................................

....................................................................................................

Third Holder

..............................................................................................................................

...................................................................................................

DP ID

............................................................................Pin code.....................................

....................................................................................................

Client ID

..............................................................................................................................

....................................................................................................

First Holder

Document:

Copy of Holding statement

Client Master.& Duly executed Power of Attorney for Demat account

I/We hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I/We undertake to inform you of any changes therein immediately in writing.
Note: Addition or Change in Demat /SB account will be charged at Rs 100 + applicable service tax per request.

Place

DATE / / 20

Signature (Client)

Copies of the documents may be obtained after due verification and certification by the client with the originals thereof
NSE SEBI Registration Number Capital Market: -INB 231481632|BSE SEBI Registration Number Capital Market:-INB 011481638|MCX SX SEBI Registration Number Capital Market:INB 261481635 |NSE SEBI Registration Number Derivatives:-INF
231481632|MCX SX SEBI Registration Number Derivatives: - INF 261481635|NSE SEBI Registration Number Currency:-INE 231481632|MCX SX SEBI Registration Number Currency:- INE 261481635|ARN- 64610 CDSL-IN-DP-CDSL-396-2007Dealing office
address- Solaris, "C" Bldg., 6th floor, Opp.L&T Gate No. 6, Saki Vihar Road, Powai, Mumbai-400072, Tel No.-18001030808,Reg. off. address-Axis House, 8th Floor, Wadia International centre, Pandurang Budhkar Marg, Worli, Mumbai-400 025.

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Account Modification Form

Uploaded by

Account Modification Form

Uploaded by

DATE ____ / ____ / 20____

AXISDIRECT ACCOUNT NO. :

ADDRESS MODIFICATION DETAILS

ADDITIONAL/ MODIFICATION OF BANK DETAILS

Bank Name .....................................................................................................................................

IFSC Code (RTGS / NEFT) :

ADDITIONAL/ MODIFICATION OF DP DETAILS

Second Holder .............................................................................................................................

Copy of Holding statement

Client Master.& Duly executed Power of Attorney for Demat account

DATE ____ / ____ / 20____

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DATE / / 20

DATE / / 20