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2829069
Citizenship* Indian
Residential Status* INDIVIDUAL
Occupation Type* Student
Residence for Tax
Purposes In
Jurisdiction(s) Outside
India*
Country of Jurisdiction of
Residence*
Tax Identification
Number or Equivalent(If
issued by jurisdiction)*
Place/City of Birth*
Country of Birth*
2. Proof of Identity
Passport Number Passport Expiry Date
Voter ID Card
UID (Aadhaar)
Proof of Address*
Correspondence Address
Address Line 1* D/O Suresh Chandra Pandey 204/2 purani basti naubasta
Address Line 2 Kanpur Kanpur Nagar
Address Line 3
City/Town/Village* District*
Address Line 1*
D/O Suresh Chandra Pandey 204/2 purani basti naubasta
Address Line 2
Kanpur Kanpur Nagar
Address Line 3
4. Contact Details
Tel.(Off.) Tel.(Res.)
PAN NA
Voter ID Card
UID (Aadhaar)
Signature
CKYC Institution Code IN1100
Date
Client ID 1201910000770092
BRANCH
BRANCH CODE
I/We request you to open a depository account in my/our name as per the following details:
DATE
A) TYPE OF ACCOUNT
Type of Account Individual Resident
IFSC ESFB0017005
MICR Code 226756002
D) Service Request
Account statement requirement As Per SEBI Regulation
I/We instruct the DP to receive each and every credit in my / our account YES
I/We wish to receive dividend/interest directly into my/our Bank A/c through ECS
(If not marked, the default option would be 'Yes'. ECS is mandatory for locations YES
notified by SEBI from time to time.)
I/We request you to send Electronic Transaction-Cum-Holding Statement through E-mail YES
I/We would like to instruct the DP to accept all the Pledge instructions in my / our account
YES
without any other further instruction from my / our end.
I/We would like to share the E-mail ID with the RTA. YES
To register for easi,please visit website www.cdslindia.com[easi allow a BO view his ISIN balances, transactions and value of the
portfolio online.]
Option 1 (YES)
I/We require you to issue Delivery Instruction Slip(DIS) booklet to me / us immediately on opening my / our CDSL account though
I/we have issued a Power of Attorney(POA)/ executed PMS agreement in favour of / with Moneywise finvest Limited(name of the
attorney / Clearing Member / PMS manager) for executing delivery instructions for setting stock exchange trades[settlement related
transactions]effected through such Clearing Member / PMS manager.
Option 2
I/We do not require the Delivery Instruction Slip(DIS)for the time being, since I/We have issued a POA/ Executed PMS agreement in
favour of/with Moneywise Finvest Limited(name of the attorney / Clearing Member / PMS manager)for executing delivery
instructions for setting stock exchange trades[settlement related transactions]effected through such Clearing Member / PMS
manager. However, the Delivery Instruction Slip (DIS) booklet should be issued to me/us immediately on my/our request at any later
date.
Date: Place:
PAN
DOB (Mandatory in
case of minor)
Address of Nominee
Address Line 1*
Address Line 2
Address Line 3
City/Town/Village* State*
Phone Email
As the Nominee is a Minor as on Date, to receive the securities and fund in this account on behalf of the nominee in the
event of the death of the sole holder/all joint holders, I / We appoint following person to act as Guardian
Name of Guardian :
Mr./Mrs.
PAN
Address Line 1
Address Line 2
Address Line 3
City/Town/Village* State*
Phone Mobile
Relationship of
Email
Guardian with Nominee
PAN
DOB (Mandatory in
case of minor)
Address of Nominee
Address Line 1*
Address Line 2
Address Line 3
City/Town/Village* State*
Phone Email
As the Nominee is a Minor as on Date, to receive the securities and fund in this account on behalf of the nominee in the
event of the death of the sole holder/all joint holders, I / We appoint following person to act as Guardian
Name of Guardian :
Mr./Mrs.
PAN
Address Line 1
Address Line 2
Address Line 3
City/Town/Village* State*
Phone Mobile
Relationship of
Email
Guardian with Nominee
PAN
DOB (Mandatory in
case of minor)
Address of Nominee
Address Line 1*
Address Line 2
Address Line 3
City/Town/Village* State*
Phone Email
As the Nominee is a Minor as on Date, to receive the securities and fund in this account on behalf of the nominee in the
event of the death of the sole holder/all joint holders, I / We appoint following person to act as Guardian
Name of Guardian :
Mr./Mrs.
PAN
Address Line 1
Address Line 2
Address Line 3
City/Town/Village* State*
Phone Mobile
Relationship of
Email
Guardian with Nominee
Pledge Charges
Rs.20/-per transaction plus Depository Charges at actual
(Creation/closer/ConfirmationLQYRFDWLRQ)
Rematerialisation Charges Rs. 150/- per certificate plus depository charges at actual
Repurchase/Redemption Charges Rs. 25/- per transaction plus depository charges at actual
Securities Lending & Borrowing Charges Rs. 25/- per transaction plus depository charges
Rs. 50/- per request plus courier charges at actual. Rs. 500/- for foreign
Adhoc / Non-periodic statement charges
address
Note:
1. GSTwill be levied separately as applicable from time to time.
2. The Company reserves the right to review charges after one year with sufficient prior notice.
I/We have read the above tariff sheet and agree to pay the same.
Client Declaration
I hereby confirm that I have read and understood the contents of the form including declarations, authorization and have
also verified the information in the form. I hereby confirm that I have digitally signed the form including declarations,
authorizations and copy of documents at all places with inscription
‘Digitally Signed by: ’.
Address: पता :
शि पा डे य
D/O Suresh Chandra Pandey, D/O सुरशे च पा डे य, 204/2,पुरानी ब ती,
Shakti Pandey
ज म ित थ/DOB: 23/07/1996 204/2,purani basti, naubasta, नौब ता, कानपुर, कानपुर नगर,
मिहला/ FEMALE Kanpur, Kanpur Nagar, उ र देश, 208021
Uttar Pradesh, 208021