Documents required for Change of Name

1. Request letter from the holder

2. Marriage Certificate/Govt. gazette or Affidavit of Rs.20/- (Duly attested by Bank Manager
mentioning holder’s SB Account Number
3. Original Share/Debenture Certificates
IMPORTANT : Please Submit separate forms for SHARES and each series of DEBENTURES along with
relative certificates(s) to:

(Registrar & transfer Agent for Company Name.)

1. Registered office :

To
Company Name, Date :________________

Dear Sirs,
RE : ENDORSEMENT OF MY CHANGED NAME

I, the undersigned ________________________________________________ the holder of ____________

Equity Share(s) / Debenture(s) in your Company, hereby inform you that consequent upon _____________
My name stand changed from ______________________________________________________________
To_________________________________________________I request you to give effect to this change in
Hereunder I furnish such other particulars/information as may be required.

FULL NAME Occupation Father’s Husband’s

Name

1.

2.

3.

4.

ADDRESS OF THE 1ST HOLDER Yours faithfully

1.

2.

3.

4.

T O B E F I LLE D I N B Y S H A R E / D E B E N T U R E D E P A R T M E N T

Internal Seller No. of Shares/ Distinctive Number Certificate No. Buyer

Transfer No. Master Folio Debentures From Master Folio
Document Registration Specimen Signature (s):
No._______ Date ____________
1. __________________________
Internal
Transfer No. ________________ 2. __________________________

Date ______________________ 3. __________________________

4. __________________________
This form along with relative Certificate(s) should be forwarded to :KARVY CONSULTANTS LIMITED
(Registrar & transfer Agent for Company Name. Registered office : 46, Avenue 4, Street No. 1,
Banjara Hills, Hyderabad – 500 034.