Zerodha Broking Ltd.

153/154, 4th Cross, 4th Phase, JP Nagar, Dollars Colony,

Opp. Clarence School, Bangalore - 560078
Additional KYC Form for Opening a Demat Account
For Individuals
(To be filled by the Depository Participant)
Application No Date DP Internal Reference No
DP ID 12081600 Exchange NSE/BSE UCC Client ID
(To be filled by the applicant in BLOCK LETTERS in English)
I/We request you to open a demat account in my/ our name as per following details:-
Holder Details
Sole / First Holder’s Name PARIKH JIYANSHI ZANKAR
PAN EOVPP5250L UID 696239149867
Second Holder’s Name
PAN UID
Third Holder’s Name
PAN UID
*In case of Firms, Association of Persons (AOP), Partnership Firm, Unregistered Trust, etc., although the account is opened in the
name of the natural persons, the name of the Firm, Association of Persons (AOP), Partnership Firm, Unregistered Trust, etc.,
should be mentioned above.
Type of Account (Please tick whichever is applicable)
Status Sub – Status
Individual Individual Resident Individual-Director
Individual Director’s Relative Individual HUF / AOP
Individual Promoter Minor
Individual Margin Trading A/c (MANTRA) Others(specify)

NRI NRI Repatriable NRI Non-Repatriable

NRI Repatriable Promoter NRI Non-Repatriable Promoter
NRI – Depository Receipts Others (specify)
Foreign National Foreign National Foreign National - Depository Receipts Others (specify)

Details of Guardian (in case the account holder is minor)

Guardian’s Name POOJA ASHOKBHAI PODAR PAN BCEPP5791A
Relationship with the applicant FATHER
I / We instruct the DP to receive each and every credit in my / our account [Automatic Credit] Yes No
(If not marked, the default option would be ‘Yes’)
I / We would like to instruct the DP to accept all the pledge instructions in my /our account without Yes No
any other further instruction from my/our end (If not marked, the default option would be ‘No’)

Account Statement Requirement As per SEBI Regulation Daily Weekly Monthly Fortnightly
I / We request you to send electronic transaction-cum-holding statement at the following Yes No
Email ID [email protected]
I / We would like to share the email ID with the RTA Yes No
I / We would like to receive the Annual Report Physical Electronic Both Physical and Electronic
(Tick the applicable box. If not marked the default option would be in Physical)

12 Sign wherever you see

I/We would wish to avail the following facility:
Basic Service Demat Account facility (BSDA)
Yes No

Nomination details (Please tick the appropriate options)

I / We do wish to nominate (Fill Annexure 1A)
I / We do not wish to nominate

I/We wish to receive dividend/interest directly in to my bank account as given below through ECS. Yes No
(If not marked, the default option would be ‘Yes’) [ECS is mandatory for locations notified by SEBI from time to time ]
Bank Details [Dividend Bank Details]
Account type Saving Current Others (specify)
Bank Code (9 digit MICR code) IFS Code (11 character)
Account number
Bank Name
Branch Name
Bank Branch Address
City State
Country PIN code
(I) Photocopy of the cancelled cheque having the name of the account holder where the cheque book is issued, (or)
(ii) Photocopy of the bank statement having name and address of the BO
(iii) Photocopy of the passbook having name and address of the BO, (or) (iv) Letter from the Bank.
*In case of options (ii), (iii) and (iv) above, MICR code of the branch should be present/mentioned on the document.

Other Details
Gross Annual Income Details (please specify): Income Range per annum
Below Rs 1 Lakh 1-5 Lakh 5-10 Lakh 10-25 Lakh >25 Lacs
12/05/2022 500000
Or Net-worth as on ________________date___________________ (Net worth should not be older than 1year)
student
Occupation :_______________________________________________________________________________________
Please tick, if applicable: Politically Exposed Person (PEP) Related to Politically Exposed Person (RPEP)
Any other information:________________________________________________________________________________

SMS Alert Facility 9377366667

MOBILE NO. +91 _____________________________
Refer to Terms &
Conditions given in [Mandatory, if you are giving Power of Attorney (POA)]
Annexure - 2.4 (if POA is not granted & you do not wish to avail of this facility, cancel this option).

Transactions Using I wish to avail the TRUST facility using the Mobile number registered for SMS Alert Facility. I have
Secured Texting Facility read and understood the Terms and Conditions prescribed by CDSL for the same.
(TRUST). Refer to Terms I/We wish to register the following clearing member IDs under my/our below mentioned BO ID
and Conditions registered for TRUST
Annexure – 2.6
Yes No
Stock Exchange Name/ID Clearing Member Name Clearing Member ID (Optional)

To register for easi, please visit our website www.cdslindia.com. Easi allows a BO to view his
ISIN balances, transactions and value of the portfolio online.

13 Sign wherever you see

 Zerodha Broking Ltd.
153/154, 4th Cross, 4th Phase, JP Nagar, Dollars Colony,
Opp. Clarence School, Bangalore - 560078

Schedule-A Tariff Structure

For individuals/HUF/corporates
Details POA Clients
Option-1
Stamp charges payable upfront Rs.50/-
Annual Maintenance Charges (charged quarterly)
a. Individuals/Non Individual (except Corporate) Rs.300/- + GST
b. Non Individual - Corporate Rs.1000/- + GST
Transaction Charges : (Market Trades)
Buy(Receive) / Sell (Debit) Nil / Rs.8/- + Rs 5.50/- (CDSL Charges)
Transaction Charges : (Off-Market Trades)
Buy(Receive) / Sell (Debit) Nil / 0.03% or Rs.25/- whichever is higher
Demat (Per certificate) Rs. 150/- per certificate
Rs. 150/- per certificate
Remat (Per certificate)
+ CDSL Charges
Courier charges per Demat/Remat/Demat Rejn./CMR Rs. 100/-
Pledge Request Rs. 20/- + Rs. 12 per request (CDSL Charges)
Unpledge Request Rs. 20/- + Rs. 12 per request (CDSL Charges)
Pledge invocation Rs. 20/-
Margin Pledge Rs. 9 + Rs. 5 per request (CDSL Charges)
Margin Unpledge Rs. 9 + Rs. 5 per request (CDSL Charges)
Margin Repledge Rs. 2/- (CDSL charges)
Periodic Statement
By Email / Physical Free / Rs. 50/- (+Courier charges at actual)
Adhoc / Non Periodic Statement Requests
a. By Email Rs.10/- per request
Rs. 50 per request upto 10 pages. Every additional page
b. Physical
at Rs. 5 (+Courier charges at actual)
Delivery instruction
a. First Delivery Instruction Book Free (10 Leaves)
b. Every Addl Booklet (10 Leaves) Rs.100/-
Cheque Bounce Charges Rs. 350/-
Failed Transactions Rs. 50 per ISIN
Modification in CML Rs. 25/- per request
KRA Upload / Download Rs. 50/-
NOTE :
For all purposes the bill date shall be construed as the date demand and the bills will be considered as the bill cum notice for
payment and Zerodha Broking Ltd. reserves the right to freeze depository account for debit transaction in case of non
payment of charges after two days from the bill date.
The above tariff is subject to change. Changes if any will be intimated 30 days in advance Annual Maintenance Charge
(AMC) is non refundable. GST is applicable on all above charges except stamp charges.

First/Sole Holder
or Guardian
F11 (in case of Minor) S1 Second Holder T1 Third Holder

14 Sign wherever you see

Date : 12/05/2022
D D M M Y Y Y Y
To,
Zerodha Broking Ltd.
153/154, 4th Cross, Dollars Colony, 4th Phase, JP Nagar, Opp. Clarence Public School, Bangalore - 560078.

Dear Sir,
Sub : Requesting for bill/transaction/holding statement through email.

I/We request you to send me/us bill, transaction and holding statement of my CDSL Demat account no. 12081600__________
[email protected]
________at following email address: ____________________________________________________________________
I/We fully agree and are aware of following Terms and Conditions mentioned below.
(a) that I/We will not receive the bill, transaction and holding statements in paper form.
(b) that I/We will take all the necessary steps to ensure confidentiality and secrecy of the login name and password of the
internet/email account.
(c) that I/We am/are aware that the bill, transaction and holding statements may be accessed by other entities in case the
confidentiality /secrecy of the login name and password is compromised.
(d) that I/We in case bill, transaction and holding statements are sent by email, I/We will immediately inform the Zerodha
Broking. about change in email address, if any.
In case, the Zerodha Broking is not able to provide bill/transaction statement to its Clients by email or on website due to any
reason (including bounced emails), Zerodha Broking Ltd. will ensure that the transaction statement is provided to me/us in
paper form as per the time schedule stipulated in the Bye Laws & Business Rules of CDSL.

I/We hereby request you to send the statements:

Daily Fortnightly Weekly Monthly

Yours faithfully,

First/Sole Holder
or Guardian
F12(a) (in case of Minor) S2(a) Second Holder T2(a) Third Holder

I, the sole holder, or we, the Joint Holders confirm that we would like to designate the First Demat Account Holder (who
is a Resident Indian Individual) of our account to receive the CDSL TPIN (or any such other similar PIN as required by any
or all Depositories to transact as per the e-DIS facility offered by such Depository) on his/her mobile/email address for
execution/permission of all such transactions & ancillary facilities to be availed via such mechanism from any or all
Depositories.
Declaration
I/We have received and read the Rights and Obligations documents and terms & conditions and agree to abide by and be bound
by the same and the Bye Laws as are in force from time to time. I/We declare that the particulars given by me/us above are true
to the best of my/our knowledge as on the date of making this application.
I/We agree and undertake to intimate the DP of any change(s) in the details/particulars mentioned by me/us in this form.
I/We further agree that any false/misleading information given by me/us or suppression of any material information will render
my account liable for termination and suitable action.

First/Sole Holder
or Guardian
F12(b) (in case of Minor) S2(b) Second Holder T2(b) Third Holder

15 Sign wherever you see

Annexure E

Option form for issue of DIS booklet Voluntary

Date : D D M M Y Y Y Y
DP ID Client ID
First Holder Name
Second Holder Name
Third Holder Name

To,
Zerodha Broking Ltd.
153/154, 4th Cross, Dollars Colony, 4th Phase, JP Nagar, Opp. Clarence Public School, Bangalore - 560078.
Dear Sir,
I/We hereby state that: [select one of the option given below]
Option 1:
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) in favour of Zerodha Broking Ltd. for executing delivery instructions for
settling stock exchange trades (Settlement related transactions) effected through such Clearing Member.

Option 2: OR
I/We do not require the Delivery Instruction Slip(DIS)for the time being. However, the Delivery Instruction Slip (DIS)
booklet should be issued to me / us immediately on my / our request at any later date.

I/We hereby select Option 1 Option 2

First/Sole Holder
or Guardian
F15 (in case of Minor) S5 Second Holder T5 Third Holder

Client E-mail ID Optional

Client Mobile Number

Declaration
I hereby declare that the mobile no./email ID mentioned in the Account opening form/ request for change in mobile no./email
ID is my own
Request letter for registration of mobile no./email ID of person belonging to the client's family

Please note that the mobile no./email id/both mentioned in the Account opening form/ request for change in mobile no./email ID
belongs to Mr/Mrs./Ms. ______________________________________________________________________ who is my
______________________________ [relationship with the client]

First/Sole Holder
or Guardian
F16 (in case of Minor)

[Only the mobile no./email id of your spouse, dependent children and dependent parents can be registered in your demat account]

1 Sign wherever you see

 Nomination Details - Annexure 1A
Zerodha Broking Limited Date
Zerodha Commodities Private Limited

I/We wish to make a nomination and do hereby nominate the following person(s) who
shall receive all the assets held in my / our account in the event of my / our death.
Name UCC Demat ID
Nomination Details
Up to 3 nominations can be made Details of 1st Nominee Details of 2nd Nominee Details of 3rd Nominee
Name of the nominee(s) (Mr./Ms.) zankar rajendra parikh Manan rajendra parikh
pravina rajendra parikh
Share of each nominee Distribute equally
[If not equally shared,
please specify %age] Any odd lot after division shall be transferred to the rst nominee mentioned in the form.
Relationship With the Applicant (if any) father uncle grand mother
Address of nominee(s)

plot no 164, sector : plot no 164, sector : plot no 164, sector :

8, gandhinagar : 8, gandhinagar : 8, gandhinagar :
382007 382007 382007
gujarat gujarat gujarat

Mobile/Telephone no. of nominee(s) 9377366667 9824223106 9408054111

Email ID of nominee(s) advanceengconsultant@ya advanceengconsultant@ya advanceengconsultant@ya
hoo.co.in hoo.co.in hoo.co.in
Proof of identity submitted

Fill below details only if the nominee is a minor

Date of birth
Name of the guardian zankar rajendra pooja podar
parikh
Address of guardian(s)
plot no 164, sector : plot no 164, sector :
8, gandhinagar : 8, gandhinagar :
382007 382007
gujarat gujarat

Mobile/Telephone no. of guardian(s) 9377366667 9408054111

Email ID of guardian(s) advanceengconsultant@ya [email protected]
hoo.co.in
Relationship of guardian with nominee
Proof of identity submitted

First/Sole Holder
or Guardian
F17 (in case of Minor) S6 Second Holder T6 Third Holder

Note:
• This nomination shall supersede any prior nomination made by the account holder(s), if any.
• The Trading Member / Depository Participant shall provide acknowledgment of the nomination form to the account
holder(s).
 Zerodha Broking Ltd.
153/154, 4th Cross, 4th Phase, JP Nagar, Dollars Colony,
Opp. Clarence School, Bangalore - 560078
Date : D D M M Y Y Y Y
Declaration form for opting out of nomination (Annexure 1B)
To,
Zerodha Broking Ltd.
153/154, 4th Cross, Dollars Colony,
4th Phase, JP Nagar, Opp. Clarence Public School, Bangalore -
560078.

DP ID 12081600 Client ID

First Holder Name

Second Holder Name
Third Holder Name

I/We hereby confirm that I/We do not wish to appoint any nominee(s) in my/our trading/demat account and understand the
issues involved in non-appointment of nominee(s) and further are aware that in case of death of all the account holder(s), my/
our legal heirs would need to submit all the requisite documents/information for claiming of assets held in my/our trading/
demat account, which may also include documents issued by Court or other such competent authority, based on the value of
assets held in the trading/demat account.

First/Sole Holder
or Guardian
F17 (in case of Minor) S6 Second Holder T6 Third Holder

Note: You can add a nominee to your account online on console.zerodha.com after the account is opened.

Sign wherever you see

From,

__________________________

__________________________

__________________________

To,
Zerodha Broking Ltd,153/154
4th Cross 4th Phase,
JP Nagar Opp Clarence School,
Bangalore-560078
Subject: Declaration for Confirmation of Signature

Sir/Madam,

This letter is to confirm that all signatures placed on the account opening forms, and all such other
documents towards Zerodha Broking Limited or any of its group entities, are done solely by me with
complete knowledge of all such terms and clauses contained therein.

I/We, the undersigned, would like to request Zerodha Broking Limited or any of its group entities to
accept the signed account opening forms and documents, even in case there may be slight
variations on a few pages/areas of the document.

I/We, the undersigned, further would like to represent and warrant that in case of any
misrepresentation with respect to the signatures placed on the account opening forms or all such
documents towards Zerodha Broking Limited or any of its group entities by me/us, I/We will
indemnify Zerodha Broking Limited and its directors/employees/agents for all such actions.

Yours faithfully,
Signature:

______________________

Name:
_______________________