ETI-1827223

EQUITY TRADING AND DEMAT ACCOUNT FORM

SAMCO SECURITIES LIMITED

A-302, 3rd Floor, Naman Midtown-A Wing, Senapati Bapat Marg, Prabhadevi, Mumbai-400 013
Tel:022-22227777,Fax:022-24391810,Website:www.samco.in
SET OF ACCOUNT OPENING DOCUMENT
INDEX OF THE DOCUMENTS
S. No. Name of the Document Brief Significance of the Document Page No

MANDATORY DOCUMENTS AS PRESCRIBED BY SEBI & EXCHANGES

1 Account Opening Form A. KYC form - Document captures the basic information about the constituent 3
and an instruction/check list.
B. Document captures the additional information about the Constituent 4–5
relevant to trading account and an instruction /check list.
2 Tariff sheet Document detailing the rate/amount of brokerage and other charges levied 6
on the client for trading on the stock exchange(s).
3 Demat Account Opening Form KYC Form for Demat Account Opening 8
4 A. Nomination Form Nomination form details 10-11
B. Rights and Obligations Document stating the Rights & Obligations of stock broker /trading member Annexure A2
and client for trading on exchanges (including additional rights & obligations
in case of internet/wireless technology based trading).
5 Risk Disclosure Document Document detailing risks associated with dealing in the securities market. Annexure B
(RDD)
6 Guidance note Document detailing dos and don’ts for trading on exchange, for the education Annexure C
of the investors.
7 Policies and Procedures Document describing significant policies and procedures of Stock Broker. Annexure D

VOLUNTARY AND OPTIONAL DOCUMENTS AS PROVIDED BY THE STOCK BROKER

8 Voluntary Authorization Letter Client consent letter for receiving the contract notes statement of account and 7
(Trading) other documents by Email. Letter of Authorization for maintaining a Running
Account with SAMCO. Non Settlement Consent Letter.
9 Voluntary Authorization Letter Voluntary Authorization Letter. Authorisation of debit trading account for the 9
(Demat) demat account charges.Option form for issue of DIS Booklet (Voluntary).
Request for bill/transaction/holding statement through email.
10 DDPI Demat Debit and Pledge Instruction’ (DDPI) for transfer of securities towards 12
deliveries / settlement obligations and pledging / re-pledging of securities.

Checklist while submitting the Trading Application Form

1 Passport Size Photograph – On Page 3. Signature has to be affixed across the Photograph
PAN Card - Self Attested Photocopy
Permanent Address Proof : Aadhar card - Self Attested Photocopy
Bank Proof - Self Attested Cancelled Cheque with your name printed OR Bank Statement stating IFSC & MICR
Income Proof - Self Attested Photocopy of 6 months Bank Statement or Income Tax Return or Salary Slip or Any other
Income Proof
Signatures on 10 areas on the application form
Signatures on Trading Preference Segments Selected on Page 4 of the Form
Demat Proof - Self Attested Photocopy of Client Master Copy or DP Statement or Welcome Letter or Transaction cum
Holding Statement of your DP

1
 Name of the Trading Member: SAMCO SECURITIES LIMITED
Exchange SEBI REGISTRATION NO.& DATE Trading Member ID
Cash F&O CDS
NSE INZ000002535 INZ000002535 INZ000002535 12135
9 AUG 2012 9 AUG 2012 9 AUG 2012
BSE INZ000002535 INZ000002535 25 NOV 2013 935
15 OCT 2004 30 AUG 2007
BSE Star MF ARN120121
MSEI INZ000002535 INZ000002535 INZ000002535 31600
3 JAN 2013 3 JAN 2013 6 OCT 2008
DP-CDSL IN-DP-CDSL-443-2008 17 DEC 2012 CDSL DP ID:54200
Clearing Member Details:
In Cash- BSE, NSE, MSEI: SAMCO SECURITIES LIMITED
In F&O- BSE, NSE, MSEI & In CDS- BSE, NSE, MSEI: IL&FS SECURITIES SERVICES LIMITED
Compliance Officer Details CEO Details
Name Narayan Thanvi Mahesh P Morbia
Tel No. 022-22227777 022-22227777
Email Id [email protected] [email protected]
REGISTERED & CORRESPONDENCE OFFICE:
A-1004, 10th Floor, Naman Midtown-A Wing, Senapati Bapat Marg, Prabhadevi, Mumbai-400 013
For any grievance/dispute please contact to the above address or
Email at [email protected] and Tel:022-22227777
In case not satisfied with the response, please contact the concerned exchange(s) at:
Exchange BSE NSE MSEI
Address Regional Office –West Investor Grievance Cell/Arbitration Vibgyor Towers,5th floor, Plot No C 62,
Dept. of Investor Services Exchange Plaza,5th Floor, Plot No.C/1, G - Block, Opp. Trident Hotel, Bandra
P.J.Towers,1st Floor,Dalal Street, G Block, Bandra Kurla Complex, Kurla Complex, Bandra (E) Mumbai –
Fort,Mumbai-400001 Bandra(E), Mumbai-400051 400098
IG Email Id [email protected] [email protected] [email protected]
Tel No. 022-22728097 022-26598190(IGC) 022-61129028
022-26598192(Arbitration)

To,
SAMCO SECURITIES LIMITED
A-1004, 10th Floor, Naman Midtown-A Wing, Senapati Bapat Marg, Prabhadevi, Mumbai-400 013
Sub: Acknowledgement
I state confirm and declare that I have received the below documents in Electronic / Physical Mode and have read, understood,
acknowledged and agreed to the contents of all the clauses of the below mentioned documents.
I also confirm that I have received the relevant clarifications, if any, wherever required from the officials of SAMCO.
Sl. Brief significance of the Document
No
1. Duly Executed Copy of KYC
2. Rights and Obligations
3. Risk Disclosure document (RDD) for Capital, Derivatives, and Currencies Segments
4. Guidance Note - Do's and Dont's for trading on the Exchange(s) for investors
5. SAMCO Tariff Sheet
6. Policies and Procedures Document pursuant to the SEBI circular dated December 03, 2009
7. General Terms & Conditions governing securities trading and broking services of SAMCO
8. Demat Account opening form (if any)
9. Authorisation of documents for DDPI, Running Account Authorisation and electronic receipt of statements and documents
10. Read SAMCO RMS Policy, Privacy Policy, Legal terms of use and Dislaimer on samco.in/policies
Yours faithfully,

1.
Client Signature
Date: 19/04/2023 YOUSUFRASHID MUHAMMEDRAFIQ MULLA MULLA
Name of the Applicant

2
Know Your Client (KYC) Application Form – For Individuals
KYC Mode: Online KYC Normal EKYC OTP Offline E-kyc
New Change Request (Please fill this form in ENGLISH and in BLOCK LETTERS)
(Please tick the box on left margin of appropriate row where the CHANGE/CORRECTION is required and provide the details in the
corresponding row)
A. IDENTITY DETAILS
1. Name of the Applicant: YOUSUFRASHID MUHAMMEDRAFIQ MULLA
MULLA
2. Father’s/Spouse’s Name: MUHAMMAD RAFIQ MULLA
3. Mother’s Name: FATIMA MULLA
4. Maiden Name:
5. A. Gender: Male Female Transgender B. Marital Status : Single Married
C. Date of Birth : 29 / 12 / 1992
6. Nationality Indian Other (Please Specify)
Status Resident Individual Non Resident
Foreign National (Passport Copy Mandatory) Location : 12.9634, 77.5855

7. A. PAN : BNNPM0120L B. (UID)/Aadhaar, if any: Timestamp: 2023-04-04 12:16:36

8. Proof of Identity Submitted PAN Card

B. ADDRESS DETAILS
1.Correspondence Address :
Address Line 1 : HOUSE NO- 446/1, FATEH MAND
Address Line 2 : BUILDING AAMINA SCHOOL
Address Line 3 : BUILDING , MUSLIM GALLI , ANGOL BELGAUM
City/Town/Village: BELGAUM PIN Code: 590006
State: KARNATAKA Country: INDIA
2. Specify Proof of Address submitted for Residence/Correspondence Address : AADHAR CARD Other ______________.
Validity/Expiry date of proof of address submitted __/__/____.
3. Permanent Address if different from above or overseas address, (mandatory for Non-Resident Applicant)
Address Line 1 : HOUSE NO- 446/1, FATEH MAND
Address Line 2 : BUILDING AAMINA SCHOOL
Address Line 3 : BUILDING , MUSLIM GALLI , ANGOL BELGAUM
City/Town/Village: BELGAUM PIN Code: 590006
State: KARNATAKA Country: INDIA
4. Specify Proof of Address submitted for Permanent Address : AADHAR CARD Other ______________.
Validity/Expiry date of proof of address submitted __/__/____.

5. Contact Details
a. Mobile Number 9916797334 b. EMAIL ID: [email protected]
c. Tel. (Office): d. Tel. (Residence):
6. Any other Information : ____________________
7. Are you a Tax Resident of any country other than India? Yes No
(if yes , please indicate all countries in which you are resident for tax purposes and the associated Tax ID Numbers below)
Country Tax Identification Number % Identification Type(TIN or Other , Please specify)

C. DECLARATION
I hereby declare that the details furnished above are true and SIGNATURE AS PRESENT IN SAMCO SECURITIES RECORDS
correct to the best of my knowledge and belief and I undertake to
inform you of any changes therein, immediately. I am also
authorizing to affix my signature on the application form and 4.
supporting documents. In case any of the above information is
found to be false or untrue or misleading or misrepresenting, I am Signature of Applicant
aware that I may be held liable for it.
Date : 19/04/2023 Place BELGAUM
FOR OFFICE USE ONLY
In Person Verification (IPV) Details:
Name of the person who has done the IPV: FARHAN NAIK
Designation: SENIOR EXECUTIVE
Employee ID: E0118
Name of the Organization : SAMCO SECURITIES LIMITED
Date of IPV : 04/04/2023
Originals Verified and Self Attested Document Copies Received:
Attested True copies of documents received
Main Intermediary:
POS Code:1200000935 Seal & Signature of Authorized Signatory
3
 TRADING ACCOUNT & DEMAT ACCOUNT (if any) RELATED DETAILS
A. BANK ACCOUNT DETAILS: [for Trading & Dividend Bank Details]
Priamry Bank Details
(i) Bank Name: FINCARE SMALL FINANCE (ii) Branch Name: RTGS-HO
BANK LTD
(iii) Bank Account No. 23100000760286 (iv) IFSC Code: FSFB0000001
(v) Account Type: Savings Current (vi) In case of NRI Account: NRE NRO
Others
(vii) Bank Branch Address: , RTGS-HO

Secondary Bank Details

(i) Bank Name: (ii) Branch Name:
(iii) Bank Account No. (iv) IFSC Code:
(v) Account Type: Savings Current (vi) In case of NRI Account: NRE NRO
Others ()
(vii) Bank Branch Address:
B. DEPOSITORY ACCOUNT DETAILS:
(i) Depository (i) Depository SAMCO SECURITIES LTD.
Participant Name: Participant Name:
(ii) Depository Name: NSDL CDSL (ii) Depository Name: CDSL
(iii) Beneficiary (iii) Beneficiary _________________
Name: Name:
(iv) DP ID: (iv) DP ID: 12054200
BO ID: BO ID: As per client master attached
C. PAST ACTIONS:
Details of any action/proceedings initiated/pending/taken by SEBI/Stock Exchange/any other authority against the applicant/constituent or its
partners/promoters/whole time directors/authorized persons in charge of dealing in securities during the last 3 years.
D. TRADING EXPERIENCE:
No Prior Experience Years in Equities:
Years in Derivatives: Years in Other Investment
related Field:
E. DEALING THROUGH SUB-BROKERS/A.P AND OTHER STOCK BROKERS:
If client is dealing through the sub-broker, provide the following details:
Broker/Sub-Broker Name: __________________________ SEBI Registration Number: __________________________
Registered Office Address: _______________________________________________________________________________________
Phone No. __________________________ Website: _________________________________
Whether dealing with any other stock broker/sub broker(in case dealing with multiple stock brokers/sub brokers, provide detail of all)
Name of Stock Broker: __________________________ Name of Sub Broker: __________________________
Client Code: __________________________ Exchange: __________________________
Details of disputes/dues ending from/to such __________________________
stock broker/Sub Broker:
F. ADDITIONAL DETAILS:
(i)Whether you wish to receive (a) Physical contract note (b) Electronic Contract Note (ECN)
If ECN Specify your Email ID: [email protected]
(ii)Whether you wish to avail of the facility of internet trading/wireless technology/mobile trading: Yes No
G. INTRODUCER DETAILS:
Name of Introducer:
Address: ____________________________________________________ Phone No:
Status of the Introducer: Sub-broker/Remiser/Authorised Person/Existing Client: Client ID : sam_38619/others (please specify)
H. TRADING PREFERENCES:
Please sign in the relevant boxes where you wish to trade.The segment not chosen should be struck off by the client.If,in future the client wants
to trade on new segment/new exchange, segment addition mail from client's registered mail ID will suffice.
4. Please sign in all highlighted boxes as selected by you.
Exchange Segment Cash F&O Currency Derivatives
NSE

BSE

BSE Star MF (Mutual Funds)

5.

4
I. OTHER DETAILS (for Trading & Demat (if any))
1. Gross Annual Income range(In Lakh Rs.): Below 1 1-5 5-10 10-25 Above 25 AND/OR
Net-Worth in RS. _____________ (Net Worth should not be older than 1 year) as on ___/___/_____
2. Occupation: AGRICULTURIST
Name of the Employer/Establishment: Nature of Business:
Address: Mobile No.:
Designation: Phone No.
3. Qualification Details
4. Please tick, if applicable Politicaly Exposed Person(PEP) Related to a Politicaly Exposed Person
DECLARATION for details provided above :
I / We have received and read the Rights and Obligations document and terms & conditions and agree to abide by and be bound by the
same and by the Bye Laws as are in force from time to time. I / We declare that the particulars given by me/us above are true and to the
best of my/our knowledge as on the date of making this application. I/We agree and undertake to intimate the DP and Stock Broker 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.

Client Signature: 6.
Place: BELGAUM Date: 19/04/2023
FOR OFFICE USE ONLY
UCC Code allotted to the client:____________
Documents Verified with originals Client Interviewed by In-Person Verification done by
Name of the Employee FARHAN NAIK
Employee Code E0118
Designation of the SENIOR EXECUTIVE
employee
Date 19/04/2023
Seal & Signature of Authorized
Signature
Signatory
I/We undertake that we have made the client aware of :Policy & Procedures”, tariff sheet and all the non-mandatory documents.I/We
have also made the client aware of “Right and Obligations” document(s),RDD and Guidance note. I/We have given /sent him a copy of all
the KYC documents would be duly intimated to the clients. I/we also undertake that any change in the “Rights and Obligations” and
RDD would be made available on my/our website, if any, for the information to the clients.
Signature of the Authorised Signatory:___________________
Date:___________ Place : ___________ Seal/Stamp of the Stock Broker

5
 SAMCO TARIFF SHEET
To,
SAMCO SECURITIES LIMITED
A-1004, 10th Floor, Naman Midtown-A Wing,
Senapati Bapat Marg, Prabhadevi, Mumbai-400 013

Charges for SAMCO Trading Services

I/ We agree to pay the charges as per following charges structure for our Trading account with SAMCO effective ________________
Client Name YOUSUFRASHID MUHAMMEDRAFIQ MULLA MULLA Client PAN BNNPM0120L

Equity Intraday Futures Options* Currency Futures Currency Options*

Rs 20 per executed order or 0.05% of Turnover whichever is lower

Charge Head Brokerage / Charges

Equity Delivery Rs 20 per executed order or 0.5% of Turnover whichever is lower
*Turnover for Options is calculated as (Strike + Premium) *Lot Size
In addition to the brokerage charge the following charges will also be levied
Schedule of Charges:
No Schedule of charges
1 Exchange turnover charges (These are charges are paid to the exchanges like NSE, BSE, MCX)
2 Securities transaction tax (Government tax for transacting in Securities Market)
3 GST (Government tax charged on Brokerage and Exchange Turnover Charge)
4 Stamp Duty:State wise stamp duty as applicable will be levied (State Government tax)
5 Clearing Member charges (These charges are paid to the clearing members for Clearing the trades)
6 SEBI turnover fees (These charges are paid to SEBI)
7 Call N Trade charges (For broker assisted trades, including RMS Square off)
8 Demat Charges (As per Schedule Below)
9 Payment Gateway Charges will be applicable at actual cost (Payable to affiliated Payment Gateway)
Detailed explanation of the Schedule of Charges is available online at https://www.samco.in/charge-list-equities-and-equity-derivatives
DEMAT CHARGES
Sr Services Individual
No.
1 Annual Account Maintenance Charges - AMC Rs.400/- plus GST
2 Deliveries/Debit (Market & Off Market)
1. Within SAMCO DP Rs.15/- plus GST per transaction
2. Outside SAMCO DP 0.02% on transaction value subject to min. Rs.25/- per transaction plus
(Charges are inclusive of CDSL tariff) GST
3 Pledge (Creation/Closure/Invocation) Rs.30/- per ISIN plus GST (Instant Rs.60/-)
4 Dematerialisation Rs.10/- per certification plus Rs.50/- per request towards postal charges
(Coversion of physical certificate to Demat) plus GST
5 Rematerialization Actual CDSL charges plus Rs.50/- per request towards postal charges
(Conversion of demat shares to physical certificate) plus GST
• All charges mentioned above are inclusive of CDSL Charges.
• Any service, which is not mentioned above, will be charged separately as per the rates applicable from time to time.
• SAMCO reserves the right to revise the tariff structure from time to time with a notice of 30 days.
• Billing will be made on monthly basis.
• In addition to the above, all other statutory / regulatory levies such as GST etc. are recovered at the applicable rates from time to
time.
• All instruction for transfer must be received at the DP at least 3.30 p.m. for the same day execution date & 5.00 p.m. for next day
execution date on the pay in date accepted only at client’s risk.
• Operation instruction for the joint account must be signed by all the holders.
• AMC for the first year is absolutely free, However from the second financial year onwards AMC will be auto debited up-
frontly into clients ledger account, subject to credit balance available in ledger, which is Rs.400 plus GST.

7.
Client Signature
YOUSUFRASHID MUHAMMEDRAFIQ MULLA MULLA
Date: 19/04/2023
Name of the Applicant

6
 VOLUNTARY AUTHORIZATION LETTER
To,
SAMCO SECURITIES LIMITED
A-1004, 10th Floor, Naman Midtown-A Wing,
Senapati Bapat Marg, Prabhadevi, Mumbai-400 013

Dear Sir,
Sub: Voluntary Authorization Letter
1) Authorization for Electronic Contract Notes (ECN)
I/We have been/shall be dealing through you as may/our broker on the Capital Market and/or Futures & Options and/or Currency
Derivatives and or Interest Rate Futures Segments. As my/our broker i.e. agent I/We direct and authorize you to carry out
trading/dealings on my/our behalf as per instructions given below.
I/We understand that, I/We have the option to receive the contract notes in physical form or electronic form. In pursuance of the same,
I/We hereby opt to receive contract notes in electronic form. I/We understand that for the above purpose, you are required to take from
the client “an appropriate email account” for you to send the electronic contract notes. Accordingly, please take the following email
account /email id on your record for sending the contract notes to me/us: Email: [email protected]
I/We also agree that non-receipt of bounced mail notification by you shall amount to delivery at my/our email account / email id.
I/We agree not to hold you responsible for late/non-receipt of contract notes sent in electronic form and any other communication for
any reason including but not limited to failure of email services, loss of connectivity, email in transit etc.
I/We agree that the log reports of your dispatching software shall be a conclusive proof of dispatch of contract notes to me/us and such
dispatch shall be deemed to mean receipt by me/us and shall not be disputed by me/us on account of any non-receipt/delayed receipt for
any reason whatsoever.
I/We understand that I am required to intimate any change in the email id/email account mentioned herein above needs to be
communicated by me through a physical letter to you, provided however that if I/We am/are an internet client then in that event the
request for change in email id/email account can be made by me/us through a secured access using client specific user id and password.
Please treat this authorization as written ratification of my/our verbal directions/authorizations given and carried out by you earlier.
I/We shall be liable for all losses, damages and actions which may arise as a consequence of your adhering to and carrying out my/our
directions given above.
2) Authorization for Non settlement of Accounts for the Quarters
I / we am / are doing continuous trading and delivery based business in securities with you. I / We am / are aware that Settlement of
Accounts is mandatory. However, as per Exchange circulars no NSE/INSP/24849 dated October 29, 2013 and BSE circular no
20131029-15 dated October 29, 2013.
I we give my / our consent for not to settle my / our account if the balance is less than 10,000/-.
This undertaking will be valid in all quarter when my/our balance is less than Rs.10000/- till my/our revocation in writing .
3) Running Account Authorization
I/We are dealing through you as a client in Capital Market and/or Future & Option segment and/or Currency segment and/or Interest
Rate future Segment & in order to facilitate ease of operations and upfront requirement of margin for trade. I/We authorize you as
under:
1. I/We request you to maintain running balance in my account & retain the credit balance in any of my/our account and to use the
unused funds towards my/our margin/pay-in/other future obligation(s) at any segment(s) of any or all the Exchange(s)/Clearing
corporation unless I/We instruct you otherwise.
2. I/We request you to retain securities with you for my/our margin/pay-in/other future obligation(s) at any segment(s) of any or all the
Exchange(s)/Clearing Corporation, unless I/We instruct you to transfer the same to my/our account.
3. I/We request you to settle my funds and securities as per Circulars issued by SEBI/Exchanges from time to time.
• Once in a calendar Month
• Once in every calendar Quarter except the funds given towards collaterals / margin in form of Bank Guarantee and /or Fixed Deposit
Receipt
4. In case I/We have an outstanding obligation on the settlement date, you may retain the towards such obligations and may also retain
the funds expected to be required to meet margin obligation for next 5 trading days, calculated in the manner specified by the
exchanges.
5. I/We confirm you that I will bring to your notice any dispute arising from the statement of account or settlement so made in writing
within 7 working days from the date of receipt of funds/securities or statement of account or statement related to it, as the case may be
at your registered office.
6. I/We confirm you that I can revoke the above mentioned authority at any time.
4) Authorization for Account Modification
If I/we were to add/modify/remove any of my detail including brokerage plans and segments addition with SAMCO Securities Ltd, I/we
authorize you to carry it out based on my request sent through an email to [email protected] from my registered email address or
intimation through an interface provided by you, whereto I have been allowed secured access.
If you feel the need to do so, then at your own discretion, you may put in place appropriate mechanism to confirm the request before or
after its execution by way of a call from a recorded line, or otherwise, personal meeting, SMS or other such other mode as you may
deem fit.
5) Subscription for Margin Against Shares / Margin Trading Facility
I/We undertake that we have read all the terms and conditions available on the Samco Website (www.samco.in) of Margin Against
Shares (Stock Plus) and agree & give my consent to subscribe for the said product.

8.
Client Signature
Name of the Applicant
YOUSUFRASHID MUHAMMEDRAFIQ MULLA MULLA
Date: 19/04/2023
7
 Additional KYC Form for Opening a Demat Account
For Individuals
SAMCO SECURITIES LIMITED
DEPOSITORY PARTICIPANT – CENTRAL DEPOSITORY SERVICES LTD
DP ID: 12054200 SEBI REGN NO. IN-DP-CDSL-443-2008
A-1004, 10th Floor, Naman Midtown-A Wing, Senapati Bapat Marg, Prabhadevi, Mumbai-400 013,
Email: [email protected]
(To be filled by the Depository Participant)
DP ID 1 2 0 5 4 2 0 0 Client ID As per client master attached

(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:-
Holders Details
Sole / First YUSUF RASHID PAN B N N P M 0 1 2 0 L
Holder’s Name MOHAMMADRAFIQ MULLA
UID 0
UCC
Exchange Name & ID
Name * ______________________________________________
*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 : _____________________________________ PAN : _____________________________________
Relationship with the applicant : _____________________________________
Standing Instructions
I / We instruct the DP to receive each and every credit in my / our account [Automatic Credit]
(If not marked, the default option would be ‘Yes’) Yes No
I / We would like to instruct the DP to accept all the pledge instructions in my /our account without any other further Yes No
instruction from my/our end
(If not marked, the default option would be ‘No’)
Account Statement Requirement As per SEBI Regulation Daily Weekly Fortnightly Monthly
I / We request you to send Electronic Transaction-cum-Holding Statement at the email ID Yes No
[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)
I / We wish to receive dividend / interest directly in to my bank account as given below through ECS. (If not marked, the Yes No
default option would be ‘Yes’) [ECS is mandatory for locations notified by SEBI from time to time ]

9.
Client Signature
YOUSUFRASHID MUHAMMEDRAFIQ MULLA MULLA
Name of the Applicant
Date: 19/04/2023

8
 Voluntary Authorization Letter
To,
SAMCO SECURITIES LIMITED
A-1004, 10th Floor, Naman Midtown-A Wing, Senapati Bapat Marg, Prabhadevi, Mumbai-400 013

Dear Sir,
Sub: Voluntary Authorization Letter
BO ID: 12054200 Client code :
SMS Alert Facility MOBILE NO. +91 9916797334
Refer to Terms & Conditions given as [(Mandatory , if you are giving Power of Attorney / Demat Debit and Pledge Instruction
Annexure - 2.4 ( POA / DDPI)]
(if DDPI is not granted & you do not wish to avail of this facility, cancel this option).
Transactions Using Secured Texting Facility I wish to avail the TRUST facility using the Mobile number registered for SMS Alert
(TRUST). Facility. I have read and understood the Terms and Conditions prescribed by CDSL for
Refer to Terms and Conditions the same.
Annexure – 2.6 Yes No
I/We wish to register the following clearing member IDs under my/our below
mentioned BO ID registered for TRUST
Stock Exchange Name/ID Clearing Member Name Clearing Member Id (Optional)

Easi 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.

2) Authorisation to debit trading account for the demat account charges

I/We have opened/have a beneficiary account with your CDSL depository along with a trading account for investment and trading
purpose. It would be difficult for me/us to keep issuing separate cheques against your depository bills. I/We therefore authorise you to
debit the charges payable towards operations of the above account. I/We are aware of the charges for operating the said account. Any
such sum debited to my trading account shall be binding on me/us.

3) Option form for issue of DIS Booklet (Voluntary)

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 Demat Debit and Pledge Instruction (DDPI) in favour of SAMCO Securities Limited for executing delivery
instructions for settling stock exchange trades [Settlement related transactions] effected through such Clearing Member. OR
OPTION 2: I / We do not require the delivery Instruction Slip(DIS)for the time being, Since samco provides an OTP based online
instruction service & we will issue a DDPI in favour of SAMCO Securities Limited for executing the delivery instructions for settling
stock exchange trades [settlement related transaction]effected through such Clearing Member. However, the Delivery Instruction Slip
(DIS)booklet should be issued to me / us immediately on my / our request at any later date.
I We here by select OPTION 1 OPTION 2

4) Request 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 at following email address:
[email protected]
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 SAMCO SECURITIES
LIMITED. about change in email address, if any.
In case, the SAMCO Securities Limited is not able to provide bill/transaction statement to its Clients by email or on website due to any
reason (including bounced emails), SAMCO Securities Limited 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 sent the statements: daily fortnightly weekly monthly
5) I am aware of the Basic Services Demat Account and I would still like to go for normal Demat account Yes No
I do not wish to nominate, incase I wish to nominate, I would submit the nomination form received by me separately.

10.
Sole Holder or Guardian (in case of minor)
Date: 19/04/2023

9
 Nomination Form
[Annexure A to SEBI circular No. SEBI/HO/MIRSD/RTAMB/CIR/P/2021/601dated July 23, 2021on Mandatory Nomination for Eligible Trading and Demat Accounts]

TM / DP FORM FOR NOMINATION

Name and Address (To be filled in by individual applying singly or jointly)

Date 1 9 0 4 2 0 2 3 UCC/ DP ID: 1 2 0 5 4 2 0 0 Client ID : As per client master attached

I/We wish to make a nomination. [As per details given below]

Nomination Details

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.

Nomination can be made upto three Details of 1st Nominee Details of 2nd Nominee Details of 3rd Nominee1
nominees in the account.

1 Name of the nominee(s) (Mr./Ms.

2 Share of each Equally 100% % %

Nominee [If not equally,
please specify
percentage]

3 Relationship With the Applicant (

If Any)

4 Address of Nominee(s)

City / Place:
State & Country:

PINCODE SAME AS APPLICANT

5 Mobile/Telephone No. of
nominee(s)

6 Email ID of nominee(s)

7 Nominee Identification details

–[Please tick any one of following and
provide details of same]
Photograph & Signature
PAN Aadhaar
Saving Bank account no.
Proof of Identity
Demat Account ID

Sr. Nos. 8-14 should be filled only if nominee(s) is a minor

8 Date of Birth {in case of minor

nominee(s)}

9 Name of Guardian (Mr./Ms.) {in

case of minor nominee(s)}

10 Address of Guardian(s)

City / Place:
State & Country:

PINCODE

11 Mobile/Telephone no. of
Guardian

12 Email ID of Guardian

13 Relationship of Guardian with

nominee

14 Guardian Identification details

–[Please tick any one of following and
provide details of same]
Photograph & Signature
PAN Aadhaar
Saving Bank account no.
Proof of Identity
Demat Account ID

Name(s) of holder(s) Signature(s) of holder*

Sole / First Holder (Mr./Ms.) YOUSUFRASHID MUHAMMEDRAFIQ

MULLA MULLA

Second Holder (Mr./Ms.)

Third Holder (Mr./Ms.)

* Signature of witness, along with name and address are required, if the account We Accept
holder affixes thumb impression, instead of signature
For SAMCO SECURITIES LTD
Note:
This nomination shall supersede any prior nomination made by the account holder(s),
if any.The Trading Member / Depository Participant shall provide acknowledgement Authorized Signatories
of the nomination form to the account holder(s) REGD. OFFICE: A-1004, 10th Floor, Naman Midtown-A Wing,
Senapati Bapat Marg, Prabhadevi, Mumbai-400 013

10
 Declaration Form for opting out of nomination
[Annexure B to SEBI circular No. SEBI/HO/MIRSD/RTAMB/CIR/P/2021/601 dated July 23, 2021 on Mandatory Nomination for Eligible Trading and Demat Accounts]

To
Date 1 9 0 4 2 0 2 3

Trading Member/Participant’s Name

Trading Member/Participant’s Address

UCC/DP ID

Client ID (only for Demat account)

Sole/First Holder Name YOUSUFRASHID MUHAMMEDRAFIQ MULLA MULLA

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.

Name and Signature of Holder(s)*

1.YOUSUFRASHID MUHAMMEDRAFIQ MULLA 2.___________________________________ 3.___________________________________

MULLA

* Signature of witness, along with name and address are required, if the account holder affixes thumb impression, instead of signature

11
 Demat Debit and Pledge Instruction

S.No. Purpose Signature of Client*

1. Transfer of securities held in the beneficial owner accounts of the client towards Stock
Exchange related deliveries / settlement obligations arising out of trades executed by clients on
the Stock Exchange through the same stock broker

2. Pledging / re-pledging of securities in favour of trading member (TM) / clearing member (CM)
for the purpose of meeting margin requirements of the clients in connection with the trades
executed by the clients on the Stock Exchange.

3. Mutual Fund transactions being executed on Stock Exchange order entry platforms.

4. Tendering shares in open offers through Stock Exchange platforms.

Demat Account Details-Samco Securities Limited

EXCHANGE & SEGMENTS TYPE OF A/C NSDL CDSL

BSE CASH PRINCIPLE A/C IN609351 1205420000001278

BSE CASH EARLY PAYIN A/C 1100001000018570

NSE CASH EARLY PAYIN A/C 1100001100018602

NSE CASH POOL A/C IN560708 1205420000002691

NSE CASH TM/CM CMPA A/C 1205420001505078

NSE CASH SLB POOL A/C 1205420001834205

12