c, sbi securities

DEMATERIALISATION
REQUEST FORM RTA COPY

CIN : U65999MH2005PLC155485 I DP Registration No.: IN-DP-314-2017

Corporate Office : Marathan Futurex, Unit No. 1201, B-Wing, 12th Floor, N M Joshi Marg, Mafatlal Mill Compound, Lower Parel East, Mumbai 400013
Tel.: 91-22-42273300 / 01 I Fax: 91-22-4227 3331 I Call us: (022) 6854 5555 I Website: www.sbisecurities.in I Email: helpdesk@sbicapsec.com

Please fill all the details in BLOCK LETTERS in English (Fill up a separate DRF for Free Securities and Locked - in securities).
□ CDSL I □ NSDL DP ID Client ID

Date DRN No. (To be filled up by SSL)

I/We request you to dematerialise the enclosed certificates registered in my/our name into my/our account. DRF No. 1260701
Details of Securities : Free Securities Locked - in Securities
Name of the Company
ISIN I N
Type of Security Equity Debentures Bonds Units Other (Specify)
Number of Certificates Face Value of Securities
Quantity to be in figures
Dematerialised in words
Folio No.
Certificate From
Number To
Distinctive From
Number To
Quantity
( if the space above is found to be insufficient, use Annexure given below)
In case of locked-in Securities fill up separate DRFs for Locked-in Securities having different release dates.
Lock-in Reason
Lock-in Release Date
I/We hereby declared that the above mentioned securities surrendered by me/us for dematerialisation and the same are free from any lien, or charge of
encumbrance and represent the bonafide securities of the issuer Company to the best of my / our knowledge and belief.
First / Sole Holder Second Holder Third Holder
Name

Signature
with
SSL
Signature
with
RTA

First/Sole holder Mobile No.: ____________________ email: ________________________________________________________________________

PARTICIPANT AUTHORISATION (From SSL to RTA to be filled up by SSL)

We hereby acknowledge the receipt of certificates / documents in respect of the following securities for dematerialization. The application form is verified
with the certificates surrendered for dematerialisation and we certify that the application form is in accordance with the details mentioned in the enclosed
certificates. It is also certified that the holders of the securities have beneficiary account with us in the same name(s).
Depository Participant Seal and Signature

Name of the Executive Signature SBICAP Securities Limited

Instructions :
1. In case of transmission cum demat, a notarized copy of death certificate of the deceased holder, copy of the order of the court etc. to be attached with the DRF.
2. In case of the transposition cum demat, a duly executed transposition request form to be attached with DRF.
Annexure
Folio No.
Certificate From
Number To
Distinctive From
Number To
Quantity

( If the Annexure above is insufficient, attach another annexure containing certificate details in same format)
Central Depository Services (India) Limited
 c, sbi securities
DEMATERIALISATION
REQUEST FORM CLIENT COPY

CIN : U65999MH2005PLC155485 I DP Registration No.: IN-DP-314-2017

Corporate Office : Marathan Futurex, Unit No. 1201, B-Wing, 12th Floor, N M Joshi Marg, Mafatlal Mill Compound, Lower Parel East, Mumbai 400013
Tel.: 91-22-42273300 / 01 I Fax: 91-22-4227 3331 I Call us: (022) 6854 5555 I Website: www.sbisecurities.in I Email: helpdesk@sbicapsec.com

Please fill all the details in BLOCK LETTERS in English (Fill up a separate DRF for Free Securities and Locked - in securities).
□ CDSL I □ NSDL DP ID Client ID

Date DRN No. (To be filled up by SSL)

I/We request you to dematerialise the enclosed certificates registered in my/our name into my/our account. DRF No. 1260701
Details of Securities : Free Securities Locked - in Securities
Name of the Company
ISIN I N
Type of Security Equity Debentures Bonds Units Other (Specify)
Number of Certificates Face Value of Securities
Quantity to be in figures
Dematerialised in words
Folio No.
Certificate From
Number To
Distinctive From
Number To
Quantity
( if the space above is found to be insufficient, use Annexure given below)
In case of locked-in Securities fill up separate DRFs for Locked-in Securities having different release dates.
Lock-in Reason
Lock-in Release Date
I/We hereby declared that the above mentioned securities surrendered by me/us for dematerialisation and the same are free from any lien, or charge of
encumbrance and represent the bonafide securities of the issuer Company to the best of my / our knowledge and belief.
First / Sole Holder Second Holder Third Holder
Name

Signature
with
SSL
Signature
with
RTA

First/Sole holder Mobile No.: ____________________ email: ________________________________________________________________________

PARTICIPANT AUTHORISATION (From SSL to RTA to be filled up by SSL)

We hereby acknowledge the receipt of certificates / documents in respect of the following securities for dematerialization. The application form is verified
with the certificates surrendered for dematerialisation and we certify that the application form is in accordance with the details mentioned in the enclosed
certificates. It is also certified that the holders of the securities have beneficiary account with us in the same name(s).
Depository Participant Seal and Signature

Name of the Executive Signature SBICAP Securities Limited

Instructions :
1. In case of transmission cum demat, a notarized copy of death certificate of the deceased holder, copy of the order of the court etc. to be attached with the DRF.
2. In case of the transposition cum demat, a duly executed transposition request form to be attached with DRF.
Annexure
Folio No.
Certificate From
Number To
Distinctive From
Number To
Quantity

( If the Annexure above is insufficient, attach another annexure containing certificate details in same format)
Central Depository Services (India) Limited