SHAREKHAN LIMITED

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2 D
1 M
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2 Y
2 Y0 Y
2 3Y

FORM FOR NOMINATION / CANCELLATION OF NOMINATION

(To be filled in by individual applying singly or jointly)
Trading Code 1 6 3 3 0 5 3
SHAREKHAN LIMITED
10th Floor, Beta Building, Lodha iThink Techno Campus, Off. JVLR, NSDL IN300513 CLIENT ID 2 1 6 1 7 1 7 5
Opp. Kanjurmarg Station, Kanjurmarg (E), Mumbai - 400 042, Maharashtra.
Tel: 022 - 6115 0000 | Fax: 022 - 6748 1899 | Website: www.sharekhan.com CDSL 12036000 CLIENT ID
I/We wish to cancel the nomination made by me / us earlier and consequently all rights and liabilities in respect of beneficiary ownership in the securities held by me / us in the said account shall vest in me/us. [Strike off the nomination details below]
NOMINATION ( ✔ Depository A/c only ✔ Trading A/c only ✔ MF A/c only ✔ All)
✔
I/We wish to make a nomination and do hereby nominate the person, details of whom are provided on nomination form who is/are entitled to
receive securities / funds/ Mutual fund units balances lying in my/our account, in the event of my/our death.
Nomination can be made upto st
three nominees in the account. Details of 1 Nominee Details of 2nd Nominee Details of 3rd Nominee
SONAM NILESH KHAKHARIA
1 Name of the nominee(s) (Mr./Ms.)
Equally
2 Share of each Nominee [If not equally,
100% %
please specify
% %
percentage] Any odd lot after division shall be transferred to the first nominee mentioned in the form.
3 Relationship With the Applicant ( If Any) SPOUSE
4 Address of Nominee(s) C 404 SHYAM UPAVAN
MAHAJANWADI MIRA GAOTHON
MIRA ROAD EAST
City / Place: THANE
State & Country: MAHARASHTRA INDIA
PIN Code 401107
5 Mobile/Telephone No. of nominee(s) 8655402025
6 Email ID of nominee(s)
7 Nominee Identification details –
[Please tick any one of following and provide PAN CARD
details of same]
Photograph & Signature PAN Aadhaar CLXPK8498N
Saving Bank Account No.
Proof of Identity Demat Account ID
Sr. Nos. 8-14 should be filled only if nominee(s) is a minor:
8 Date of Birth {in case of minor nominees(s)}
9 Name of Guardian (Mr./Ms.) {in case of
minor nominee(s)}
10 Address of Guardian(s)
City / Place:
State & Country:
PIN Code
11 Mobile/Telephone No. of Guardian
12 Email ID of Guardian
13 Relationship of Guardian with nominee
14 Guardian Identification details-
[Please tick any one of following and provide
details of same]
Photograph & Signature PAN Aadhaar
Saving Bank Account No.
Proof of Identity Demat Account ID

Name(s) of holder(s) Signature(s) of holder

NILESH KHAKHARIA

N0205154
Nomination Registration No _________________________ 21 02
D D ______
Date:_____ 2023
M M ________
Y Y Y Y