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Date

To,
ZERODHA SECURITIES PRIVATE LIMITED
NO. 153/154, GROUND FLOOR,
4TH CROSS, J P NAGAR, 4TH PHASE,
BANGALORE-560078
KARNATAKA

Dear Sir / Madam,

Re : Application No. _______________

Sub : Declaration towards address provided in the account opening form


{NRI / FN}

This has reference to my / our application for opening of a demat account with you

In this connection, please find below our residential address:

______________________________________

______________________________________

______________________________________

______________________________________

Further, I/ we confirm that in case of any change in our above residential address, the same will
be brought to your notice

Thanking you,

Yours truly,

___________________ ___________________ _______________


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

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