Account Details Addition/Modification Request Form

(Trading/Demat A/c)
Date: D D MM Y Y Y Y
CDSL DP ID 1 2 0 4 9 2 0 0 -
NSDL DP ID I N 3 0 4 2 9 5 - PAN

Dear Sir/Madam, TRADING Code

I/We request you to make the following addition/modification to my/our trading/Demat account in your records.
Please fill all the details in BLOCK LETTER in english & fill separate request for NSDL & CDSL (Please mark on the appropriate column)
ADDRESS & CONTACT DETAILS MODIFICATION
Correspondence Permanent / Registered

Address

Landmark City
PIN* State Country

Tel:
Mobile: Mobile No of Self Other than Self
Email ID: Email ID Owner of Self Other than Self

#Mobile No./Email ID is of "Other then Self", Please provide the following details:
Email ID /Mobile No Spouse Dependant Children Dependant Parent Authorised Signatory Director Trustee
Name of the person whose Mobile No / Email ID has been provided

BANK MODIFICATION Trading Demat [ Charge Bank Account Dividend Account# ]

*Bank Name

Bank A/c No. A/c Type

MICR No IFSC Code

Branch Address

# Demat Bank details for Dividend account (If different from above)

Bank Name

Bank A/c No. A/c Type

MICR No IFSC Code

Branch Address

DEMAT MODIFICATION (TRADING ACCOUNT) *Link #De-link

*DP ID #DP ID
*Demat Account Number #Demat Account Number

Note:
I/We the under mentioned Demat/Trading Account holders hereby agree, undertake and declare that the aforementioned services provided
by Axis Securities Limited are subject to the Terms and Conditions mentioned herein and as amended from time to time.
KRA : I/We Wish to update the above changes in KRA/CERSAI/DEMAT/TRADING

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 information is found to be false or untrue or misleading or misrepresenting, I/We am/are aware that I/We may be held liable for it.
I have also the read the term and condition mentioned on Page 2

Name Name Name

First /Sole Holder /Authorised Signatory Second Holder Signature Third Holder Signature

Dispatch details:
Account Modification - Operations
Axis Securities Limited, iRise Building, 1st Floor, Aurum Qparc, Thane-Belapur Road, Ghansoli, Navi Mumbai, Maharashtra – 400710

Axis Securities Limited, SEBI Single Reg. No.- NSE, BSE, MSEI, NCDEX, MCX INZ000161633, ARN-64610-AMFI-Registered Mutual Fund Distributor, SEBI-Research Analyst Reg. No. INH000000297, SEBI Portfolio Manager Reg. No.- INP000000654,
SEBI Depository Participant Reg. No. IN-DP-403-2019, SEBI Investment Advisor Reg No. INA000000615, Main/Dealing off.- iRise Building, 1st Floor|Aurum Qparc, Thane-Belapur Road| Ghansoli, Navi-Mumbai|Maharashtra - 400710,
Reg. off.- Axis House, 8th Floor, Wadia International Centre, Pandurang Budhkar Marg, Worli, Mumbai-400 025
 DOCUMENTATION REQUIRED FOR PROCESSING ACCOUNT MODIFICATION REQUESTS

Annexure – I : Documents Required

Supporting documents (applicable as per below matrix) must be
attested by Sole/all Joint Holders/ Authorized signatories as per mode of operations – For Non-Individual accounts
duly certified as ‘Verified with Original’ by Branch Official under branch stamp (with his/her Full Signature mentioning Name, Designation
and Employee code)
Trading Account Holder must be Sole/ First holder in Bank/ Demat Account to be linked with Trading Account
In case of availability of multiple Demat and/or Bank accounts in Trading account, newly linked/added Demat and/or Bank account shall be
marked as Default
The modification request form (alongwith applicable supporting documents) are required to be dispatched/ submitted to :

Account Modification - Operations

Axis Securities Limited,
iRise Building, 1st Floor, Aurum Qparc, Thane-Belapur Road
Ghansoli, Navi Mumbai, Maharashtra – 400710

A) Common Documents: B) Additional Documents: Change of Address

Application Form Duly Filled and signed by All Holders/ Proof of New Address –
Authorized signatories as per mode of operations – For Copy of any of the following documents
Non-Individual accounts 1) UIDAI (Unique Identification Authority of India)- Aadhaar Card
Proof of Identity (Of Sole Holder or either of Holders Visiting 2) Passport, which is valid
the Branch and with Identifiable Photograph)- Copy of any of 3) Voter ID Card
the following documents 4) Driving License which is valid
1) PAN Card 5) Bank Passbook/ Bank Statement (with transaction not older
2) UIDAI (Unique Identification Authority of India)- Aadhaar Card than three month)
3) Passport, which is valid 6) Electricity Bills (not more than three months old)
4) Voter ID Card 7) Residence Telephone Bills (not more than two months old)
5) Driving License which is valid 8) Leave and License Agreement I Registered Agreement for sale.

C) Additional Documents: Addition of Bank Details D) Additional Documents: Addition of Demat Details with
Trading Account
Proof of Bank Account (In the name of Sole/First Holder)-
Copy of any of the following documents consisting MICR Proof of Demat Account (In the name of Sole/First Holder)-
details: Copy of Client Master List (CML) / Holding Statement duly
1) Personalized Cancelled Cheque Leaf attested by issuing Depository
2) Bank Statement/ Passbook (with transaction not older than Power of Attorney (POA) - Duly executed on non-judicial
three month) stamp paper of Rs. 500/- or with franking of equivalent
3) Branch MICR confirmation letter with the bank details amount & signed by Client & all Joint holders in Demat account
to be linked with the Trading Account.
Power of Attorney (POA) (Applicable if to be linked with SMS Alert Facility must be enabled in New Demat Account to
Trading Account) Duly executed on non-judicial stamp paper be linked with Trading Account(Separate Request for enabling
of Rs. 500/- or with franking of equivalent amount & signed by SMS Alert facility needs to be obtained if already not activated)
Client & all Joint holders in Bank account to be linked with the
Trading Account

Annexure – II : Terms & Conditions for Requisition for DIS Booklet through Website/Tele Depository and
Transaction & Holding Statement Through Website and/or By e-mail
1. I/ We agree that delivery Instruction Slip (DIS) booklet requested through internet Banking depository/tele depository service should be
treated as are request given by me/us in terms of the NSDL/CDSL requirement entirely as to our risk and consequences. The DP shall be
absolved of its duties/liabilities if the DIS Booklet requested is dispatched at my/our registered address for communication as recorded in
above stated Demat Account (as intimated and recorded by the Axis Securities Limited from time to time) at application cost (if any) that
the DP may now or subsequently prescribe
2. I / We am / are aware that I / We will not receive the transaction statements in paper form.
3. I / We will take all the necessary steps to ensure confidentiality and secrecy of the login name & password of the internet / e-mailed
account.
4. I / We am / are aware that the transaction statement may be accessed by other entities incase the confidentiality / secrecy of the login
name and password is compromised. I / We take the entire responsibility of the same.
5. I / We agree that the transaction statements are sent by email, I / We shall immediately inform the DP about change in e-mail address, if
any.
6. I / We agree and aware that DP shall have the right to terminate such service provided a written notice is given atleast 10 days in advance
and vice versa.
7. I / We agree that the above terms and conditions are in addition to and not in contravention of the terms and conditions forming a part of
the “Rights and Obligations of the beneficial Owner and Depository Participant” signed by me / us at the time of opening the Demat
Account.