TSR DARASHAW LIMITED

6-10 Haji Moosa Patrawala Industrial Estate, 20 Dr. E. Moses Road,

Near Famous Studio, Mahalaxmi, Mumbai – 400011
Tel 91 22 66568484 Fax 91 22 66568494 (Business Hours: Monday to Friday 10.00 a.m. to 3.30 p.m.)

APPLICATION FORM FOR CHANGE IN SIGNATURE(S)

[Duly completed form to be submitted in original]

One Form is to be completed per folio and the specimen signatures of all the shareholders in the folio are required
on this form. Multiple folios will be accepted only if the folios are registered in the same names and
in the same order. The application form is liable to be rejected if the names do not confirm with the folios
mentioned. Only forms issued by TSR Darashaw Ltd will be accepted for registration.
Date of Application : / /20
Sr. Full names of all the shareholders as registered Present
No. in the folio(s) detailed below Father's / Husband's name age
1

Sr. Co.
Name of the Company(s) Alpha Folio No(s).
No. Series
1

FULL ADDRESS OF THE FIRST HOLDER

PINCODE

Tel. No.: (with STD code) Email:

NOTE: IN CASE THE ADDRESS HAS CHANGED FROM WHAT IS RECORDED WITH THE COMPANY, PLEASE
SEE POINT- (1)c. ON THE REVERSE

SPECIMEN SIGNATURES OF ALL THE

ATTESTATION BY BANK MANAGER ONLY
HOLDERS (COMPULSORY)

Name : 1.

Signature :
2.
Designation :

S/B A/c. No. : 3.

Name and Address of the Bank :

4.
FOR OFFICE USE ONLY:
S/S Regn. No. :

Date :

Initial of Employee :

IMP Supporting documentary evidence to be submitted

(Refer instructions on the reverse of this form)