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Account Details Modification Deletion Form

This document is an account details addition/modification/deletion request form for Zerodha Broking Limited. It requests changes to address, signature, or other details in a demat account or KRA. The form collects information like name, address, and photo ID details of the account holders. It also has a section for specifying the type of change requested and providing existing and new details. Once completed, an authorized signatory can process the request.

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402 views2 pages

Account Details Modification Deletion Form

This document is an account details addition/modification/deletion request form for Zerodha Broking Limited. It requests changes to address, signature, or other details in a demat account or KRA. The form collects information like name, address, and photo ID details of the account holders. It also has a section for specifying the type of change requested and providing existing and new details. Once completed, an authorized signatory can process the request.

Uploaded by

prabath_too
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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Account details addition/modication/deletion request form

Zerodha Broking Limited Application number Dated


Zerodha Securities Private Limited
Zerodha Commodities Private Limited

Please ll all details in BLOCK LETTERS in English


DP ID 12081600 Client ID

Account holder details


First/sole holder Second holder Third holder
Name
Mother’s name
Aadhaar
PAN
I/We request to carry out the change of address/signature in the demat account.
I/We request to carry out the change of address/signature in the KRA and demat account.

I/We request you to make the following additions/modications/deletions to my/our account in your records.
Details: Please specify ‘Change of Type of change: Please specify
address’, ‘Change of bank details’, Existing details New details
if addition/modication/deletion
‘Change of telephone number’, etc.

Attach an annexure (with signature(s)) if the space above is found insufcient.

First/Sole Holder
or Guardian
F (in case of Minor) S Second Holder T Third Holder

FOR OFFICE USE ONLY


In Person Verication (IPV) Details:
Name of the Person who has done the IPV: ___________________________________________________
Designation: ____________________________________ Employee ID: __________________________
Name of the Organization: ZERODHA SECURITIES PVT. LTD.
Date of the IPV: D D M M Y Y Y Y Signature of the Person who has done the IPV Seal/Stamp of the Intermediary

Acknowledgement
We have received the account modication/addition/deletion request for the account with details below on D D M M Y Y Y Y
DP ID Client ID Application no.
First/sole holder Second holder Third holder
Account holder’s name
Modication request for
Seal & signature of
authorised signatory
Know Your Client (KYC) Application Form - for Individuals
New Change Request (Please tick ✔ the appropriate box)
Please fill this form in English and BLOCK Letters
(Please tick the box on the left margin of the appropriate row where CHANGE/CORRECTION is required and provide the details in the corresponding window)

A IDENTITY DETAILS Photograph


1. Name of the Applicant Please affix your
recent passport size
photograph and
sign across it
2. Father's/Spouse's Name
F1

3a. Gender Male Female 3b. Marital Status Single Married 3c. Date of Birth D D M M Y Y Y Y
4a. Nationality Indian Other (Please Specify)_______________________________
4b. Status Resident Individual Non Resident Foreign National
5a. PAN
5b. Unique Identification Number (UID) / Aadhar, if any
6. Specify Proof of Identity Submitted Pan Card Other (Please Specify) _______________________________
B ADDRESS DETAILS
1. Residence/Correspondence Address

City/Town/Village Pin Code


State Country

2. Specify the Proof of Address Submitted for Residence / Correspondence Address: _____________________________

3. Contact Details
Telephone (Office) Fax
Telephone (Residence) Mobile No
Email ID

4. Permanent Address

City/Town/Village Pin Code


State Country
C DECLARATION
I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief
and I undertake to inform you of any changes therein, immediately. In case any of the above information is
found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.
Date : D D M M Y Y Y Y F2 Client Signature
FOR OFFICE USE ONLY
In Person Verification (IPV) Details:
Name of the Person who has done the IPV: __________________________________________________

Designation: ____________________________________ Employee ID: __________________________

Name of the Organization: ZERODHA SECURITIES PVT. LTD.

Date of the IPV: D D M M Y Y Y Y Signature of the Person who has done the IPV Seal/Stamp of the Intermediary

Originals Verified and Self-Attested Document Copies Received

Date Signature of the Authorized Signatory

1 Sign wherever you see

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