ContactDetails:

PRECHECK
Following precheck to be done before sending the requests for modification in
contact details (Trading and DP accounts) to enable us to process the requests
expeditiouslyandtoavoidpossiblerejections.

1. Correspondenceaddressshouldbeinthenameofclientonly,ifitsinthename
of Spouse, relationship proof is must (for e.g. Passport, Marriage Certificate)
whichshouldcontainthenameofyourspouse.

2. IftheaddressproofprovidedcontainsshortaddressoroldLandMarkwhichdoes
not exist anymore, you can always mention famous Land Mark nearby (for e.g.
above, next to, opposite to, behind etc) it will help us to deliver the
correspondencetoyouontime.

3. PermanentaddressshouldnotbeginwithC/o,Hostel,Shop;Office&Itshouldbe
inthenameoftheClientonly.

4. Supporting documents should be self attested (whether provided in original or

photocopy)

5. Validityofsupportingdocuments.Fore.g.billshouldnotbemorethan3months
old(Frombillingdate),&Documentshavingvaliditydateshouldnotbewithin6
monthsoftheexpiryDate.

6. Allholdersarerequiredtosignthemodificationrequestform.

7. SignaturesofalltheholdersshouldmatchwithSSLrecords.

8. Mobilenoshouldbein10digits,MentionSTDorISDcode(Whicheverapplicable)
whilementioningthecontactno.

9. MobileNoprovidedshouldnotberegisteredinDONOTCALLList

(To be submitted in Duplicate)

To,

SBICAP Securities Ltd.

Client Name ____________________________________________________

A Wing, 2nd Floor Mafatlal Chamber,

N. M. Joshi Marg, Lower Parel (East),
Mumbai 400 013.

Contact No. ____________________________________________________

Submission Date: D

D M M Y

Re: Change in Address and Contact Details

Dear Sir/Madam,
Please make necessary change/s / addition in my / our account/s as per details given below. (Please tick appropriate option to make necessary changes)
CHANGE TO BE EFFECTED IN:

Trading Account

Trading Code:

Depository Account

Trading + Depository Account

BO ID:

Name of 1st Holder

____________________________________________________________________________________________________

Name of 2nd Holder

____________________________________________________________________________________________________

Name of 3rd Holder

____________________________________________________________________________________________________

CORRESPONDENCE ADDRESS OF HOLDER

Existing Details

New Details

Building / Tower / Apartment / Palace / Chamber / Mansion

Building / Tower / Apartment / Palace / Chamber / Mansion

Street / Road / Marg / Lane / Avenue / Rasta

Street / Road / Marg / Lane / Avenue / Rasta

City / District

City / District

State

State

/ Country

Pincode (Mandatory)

/ Country

Pincode (Mandatory)

PERMANENT ADDRESS OF HOLDER

Existing Details

New Details

Building / Tower / Apartment / Palace / Chamber / Mansion

Building / Tower / Apartment / Palace / Chamber / Mansion

Street / Road / Marg / Lane / Avenue / Rasta

Street / Road / Marg / Lane / Avenue / Rasta

City / District

City / District

State

State

/ Country

Pincode (Mandatory)

/ Country

Pincode (Mandatory)

CONTACT DETAILS OF HOLDER

Existing Details

New Details

Telephone :

Telephone :

Mobile

Mobile

Email Id :

Email Id :

Note: 1. Please furnish proper proofs for change in master. 2. If changes are to be done in DP - then all holder as per DP A/c must sign the documents.

I/We hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I/we undertake to inform you
of any changes therein immediately in writing.

Holder
Signature

SB ICAP Se cu ritie s Lt d. SB ICAP Se cu ritie s

Securities Ltd. SBICAP Securities Ltd. SBICAP
SB ICAP Se cu ritie s Lt d. SB ICAP Se cu ritie s
Securities Ltd. SBICAP Securities Ltd. SBICAP
SB ICAP Se cu ritie s Lt d. SB ICAP Se cu ritie s
Securities Ltd. SBICAP Securities Ltd. SBICAP

Lt d. SB ICAP
Securities Ltd.
Lt d. SB ICAP
Securities Ltd.
Lt d. SB ICAP
Securities Ltd.

FH

SB ICAP Securities Ltd. SBI CAP Secu rit ie s

Securities Ltd. SBICAP Securities Ltd. SBICAP
SB ICAP Securities Ltd. SBI CAP Secu rit ie s
Securities Ltd. SBICAP Securities Ltd. SBICAP
SB ICAP Securities Ltd. SBI CAP Secu rit ie s
Securities Ltd. SBICAP Securities Ltd. SBICAP

Ltd. SBICAP SB ICAP Securities Ltd. SBI CAP Secu rit ie s

Securities Ltd. Securities Ltd. SBICAP Securities Ltd. SBICAP
Ltd. SBICAP SB ICAP Securities Ltd. SBI CAP Secu rit ie s
Securities Ltd. Securities Ltd. SBICAP Securities Ltd. SBICAP
Ltd. SBICAP SB ICAP Securities Ltd. SBI CAP Secu rit ie s
Securities Ltd. Securities Ltd. SBICAP Securities Ltd. SBICAP

SH

Ltd. SBICAP
Securities Ltd.
Ltd. SBICAP
Securities Ltd.
Ltd. SBICAP
Securities Ltd.

TH

Holders Name
For Office Use Only

Demat

Trading

Scrutiny By Name EMP Code

Data Entered By

BRANCH STAMP

HO STAMP

Verified By
Reference No.
Contact us: Toll Free: MTNL/BSNL Users: 1800-22-3345 / Private Telecom Users: 1800-209-9345 Or E-mail: helpdesk@sbicapsec.com
SEBI Regn. No: BSE CM: INB 011053031 I NSE CM: INB 231052938 & F&O: INF231052938 I DP SEBI Reg No: IN-DP-CDSL-370-2006
D:\M urli\Address & Contact details Change Form.p 65