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Individual Modification Form

1) The document is a request from a client to modify details of their trading and demat account, including bank details, address details, contact details, and ECN activation. 2) It provides forms to fill in existing and new details for bank details, address, contact information, income/net worth details, and signatures. 3) The client declares that the provided details are true and correct, and agrees to provide necessary supporting documents for the modifications.

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Sanjay Bhargava
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88 views

Individual Modification Form

1) The document is a request from a client to modify details of their trading and demat account, including bank details, address details, contact details, and ECN activation. 2) It provides forms to fill in existing and new details for bank details, address, contact information, income/net worth details, and signatures. 3) The client declares that the provided details are true and correct, and agrees to provide necessary supporting documents for the modifications.

Uploaded by

Sanjay Bhargava
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
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Choice House, Shree Shakambhari Corporate Park, Chakravarti Ashok Co-op

CHOICE HSG Society, CTSNo.156/157/158 JB Nagar, Andheri E, Mumbai- 400099.


Nurturing Financial Excellence [email protected]:022-67079999
Please note that this form is only applicable of Resident clients only. Date- 2 0 1
Dear Sir / Madam,
I / We request you to make the following additions / modifications to my / our Trading and Demat account in your records.
Account Holder's Details: Please fill all the details in BLOCK Letters in English. Please mark ( √ )on the appropriate column.
DP ID 1 2 0 6 6 9 0 0 BO ID Aadhaar No.(if any):
Trading Code: Branch tag: Region Tag:
I - 1) First Holder Name: Title: Mr. Mrs. Other:__________.
Father’s/Spouse Name: Date of Birth:
Marital Status: Single Married Pan No:
2)Second Holder’s Name: Title: Mr. Mrs. Other:__________.
Father’s/Spouse Name: Date of Birth:
Marital Status: Single Married Pan No:
3) Third Holder’s Name: Title: Mr. Mrs. Other:__________.
Father’s/Spouse Name: Date of Birth:
Marital Status: Single Married Pan No:
II. BANK DEATILS EXISTING DETAILS NEW DETAILS
BANK NAME
BRANCH ADDRESS
BANK A/c No.
MICR No.
IFSC CODE
BANK TYPE Saving Current Other________ Saving Current Other________
III. ADDRESS DETAILS EXISTING DETAILS NEW DETAILS
Modification Address: Address:
Correspondence:

Permanent: City: City:


State: Pin code: State: Pin code:
IV. CONTACT DETAILS EXISTING DETAILS NEW DETAILS
Addition/Modification Mobile No Mobile No
Email Id:
V.ECN activation for Only Equity Trading and Demat Account: ( Yes, I require ECN for Trading and Demat Account)
I/We hereby give our consent and authorize you to send digital contract notes , bills , ledgers , transaction statement , Monthly / Quarterly demat statement of accounts /
holding statement(s) / bills or other reports, Statements (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 new Email Id.
VI. Gross Annual Income Details: Below 1 Lakh 1-5 Lakhs 5-10 Lakhs 10-25 Lakhs > 25 Lakhs
Or Net Worth in Rs.________________________________( *Net Worth should not be older than 1 year ) as on date ________//______//201______.
KRA : I/We wish to update the above changes in KRA / Demat / Trading Account. Tick which is applicable or All
SIGNATURE EXISTING SIGNATURE NEW SIGNATURE
MODIFICATION
( This is only applicable Were clients wants
to modify their signatures)
Plz sign below the Declaration which is a mandatory
requirement.

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 is
found to be false or untrue or misleading or misrepresenting, I am/we are aware that/we may be held liable for it.
Client Name First / Sole Holder Second Holder Third Holder

Signature
Plz sign here as this mandatory req.

Bank details: Copy of cheque with name printed, copy of bank passbook, copy of bank statement of accounts duly attested by bank authorities not older than 3 months
with cancelled cheque. Address details: Copy of Ration card, Passport, Voter ID card, Driving license, Bank passbook, Electricity bill / Telephone bill - Land line (not more
than 3 months OLD) / OTHERS(plz specify)________________________________Validity/Expiry date of the proof____/____/__________
Document No._______________________(Applicable for Passport/Aadhar/DL/Voter Id/Ration Card/Utility Bills).DP details: Latest transaction statement / holding statement / Client Mastercopy.
Signature In-Person Relationship with the Date of IPV
Verification done by Intermediary/Designation
IPV Details

------------------------------------------------------------------------------------------------------------------------------------------------------------------
ACKNOWLEDGEMENT RECEIPT DATE :_____________________
We hereby acknowledge the receipt of the your instruction for modification of the following Account subject to verification:
Dp ID 1 2 0 6 6 9 0 0 Client Id Trading Code: Pan No.:

Modification request for(Specify reason) Bank Modification Contact details Modification Address Modification ECN Registration ( Trading and DP account

Depository Participant Seal and Signature

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