Please fill this form in ENGLISH and in BLOCK LETTERS. (Use black ink) A. IDENTITY DETAILS 1 Name of the Applicant 2 Name of Father/Spouse Male Single b. Marital Status c. Date of Birth D D M M Y Y Y Y 3 a. Gender Female Married Indian Resident Individual Non Resident b. Status 4 a. Nationality Pls specify (if other) Other Foreign National b. UID/Aadhaar 5 a. PAN, copy attached Id Proof for PAN exempt Cases (DP A/c only) 6 Specify Identity proof submitted B. ADDRESS DETAILS 1 Correspondence Address City/Town/Village State Affix recent passport size Photograph and Sign across it 1 PIN Code Country 2 Specify proof of correspondence address submitted Telephone (office) Fax No. 3 Contact Details Email ID Telephone (Res) Mobile No. Permanent Address (if different from above. Mandatory for Non4 Resident Applicant to specify overseas address) City/Town/Village State 5 Specify the Proof of Permanent address submitted PIN Code Country C. DECLARATION I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware I may be held liable for it and the same will render my account liable for termination and suitable action. 2 Place Signature of 1st / Sole Applicant Documents verified with Originals by Client interviewed by Date D D M M Y Y Y Y In-Person Verification done by Staff Name FOR OFFICE USE ONLY Code & Designation Signature Date D D M M Y Y Y Y D D M M Y Y Y Y D D M M Y Y Y Y I / We undertake that we have made the client aware of ‘Policy and (Original verified) Self Certified Documents copies received Procedures’, tariff sheet and all the non-mandatory documents. I/We have (Self Attested) True copies of documents received also made the client aware of ‘Rights and Obligations’ document (s), RDD and Guidance Note. I/We have given/sent him a copy of all the KYC documents. I/We undertake that any change in the ‘Policy and Procedures’, tariff sheet and all the non-mandatory documents would be duly intimated to the clients. I/We also undertake that any change in the ‘Rights and Obligations’ and RDD would be made available on my/our website, if any, Sign/Seal/Stamp of the intermediary for the information of the clients. (5) AMC / INTERMEDIARY NAME & CODE : Ashika Stock Broking Limited • CVL POS Code : 1100034500 • NDML MI ID : P0340 Form should be filled in English and in Block Letters (Use Black ink only) KYC - APPLICATION FORM FOR TRADING AND DEMAT A/C - INDIVIDUAL KYC - APPLICATION FORM FOR DEMAT A/C - INDIVIDUAL (For Joint A/c) Please fill this form in ENGLISH and in BLOCK LETTERS. (Use black ink) 1 Second Holder's Name 2 Name of Father/Spouse Affix recent passport size Photograph and Sign across it 3 Permanent Address Single Married b. Status Resident Individual D D M M Y Y Y Y Non Resident Foreign National b. UID/Aadhaar 7 a. PAN, copy attached 8 Specify proof of Identity submitted 10 Contact Details c. Date of Birth 9. Specify address proof submitted Telephone (Resi) Telephone (Office) Fax No. Mobile No. E-mail ID 1 Third Holder's Name 2 Name of Father/Spouse Affix recent passport size Photograph and Sign across it 3 Permanent Address Correspondence 4 Address, (if different from above) Male b. Marital Status 5 a. Gender Female Indian Pls specify (if other) 6 a. Nationality Other Married b. Status Resident Individual c. Date of Birth D D M M Y Y Y Y Non Resident Foreign National b. UID/Aadhaar 7 a. PAN, copy attached 8 Specify proof of Identity submitted 10 Contact Details Single 9. Specify address proof submitted Telephone (Resi) Telephone (Office) Fax No. Mobile No. E-mail ID DECLARATION I/We hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I/We undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I/We am/are aware I/We may be held liable for it and the same will render my/our account liable for termination and suitable action. Signature of the 2nd Applicant Signature of the 3rd Applicant Place IPV Done D D M M Y Y Y Y D D M M Y Y Y Y Staff details (Name, code & Designation) (Self Attested) True copies of documents received (Original verified) Self Certified Documents copies received Date on Signature Seal/Stamp of the intermediary (6) Date D D M M Y Y Y Y AMC / INTERMEDIARY NAME & CODE : Ashika Stock Broking Limited • CVL POS Code : 1100034500 • NDML MI ID : P0340 Form should be filled in English and in Block Letters (Use Black ink only) Correspondence 4 Address, (if different from above) Male b. Marital Status 5 a. Gender Female Indian Pls specify (if other) 6 a. Nationality Other ASHIKA STOCK BROKING LIMITED Depository Participant of Central Depository Services (I) Ltd. Corporate Office: 1008, 10th Fl., Raheja Center, 214, Nariman Point, Mumbai ‐ 400021, Ph.: 022‐6611‐1700 , Fax : 022‐6611‐1710 Head Office: TRINITY, 226/1, A.J.C.Bose Road, 7th Fl., Kolkata ‐ 700020, Ph.:033‐2283‐9952, Fax : 033‐2289‐1555 EMAIL : [email protected] DPID : 12034500, SEBI Regn.No. IN‐DP‐CDSL‐250‐2004 ACCOUNT DETAILS ADDITION / MODIFICATION / DELETION REQUEST FORM APPLICATION No. Date D D M M Y Y Y Y Please fill all the details in Block letters in English Applicant's Detail DPID Client ID 1 2 Applicants' Name 3 I/We request to carry out the change of address / signature in the Demat Account I/We request to carry out the change of address / signature in the KRA and Demat Account I / We request to make the following Additions / Modifications / Deletions to my / our Demat Account in your records:‐ Addition / Modification / Deletion Pls. Specify Details (Pls. specify change of Address, Bank details, Contact Numbers etc. Existing Details New Details Attach an Annexure with signature(s) if the space above is found insufficient Name of Sole/1st Holder Name of 2nd Holder Name of 3rd Holder Sign of Sole/1st Holder Sign of 2nd Holder Sign of 3rd Holder ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Acknowledgement Reciept Received Account Details Addition / Modification / Deletions request as per details given above : Applicant's Detail DPID Client ID 1 Applicants' Name 2 3 For, Ashika Stock Broking Limited Seal & Signature Ashika Stock Broking Limited, Depository Particiapnt of NSDL DPID:IN303591 "Trinity", 226/1, AJC Bose Road, 7th Floor, Kolkata - 700020 Modified by Modification Request No. Modification Request form Verified by From, Client ID : 1 0 Date : 0 / / Sole/First Holder Second Holder Third Holder Address: Dear Sir, You are requested to change my **Bank Details / Local Address / Correspondence Address / other details as under. I/We am/are enclosing the required proof for the same, with originals for your verification. Proof of Identity and latest transaction statement is also enclosed as per your requirement . Current Bank Details New Bank Details Bank Name Bank Name Bank A/c No. Bank A/c No. Bank A/c Type Bank A/c Type Bank Address Bank Address Pin Code Pin Code MICR No. MICR No. Current Local/Correspondance Details New Local/Correspondance Details Address Address Pin Phone Pin Phone Email Mobile Email Mobile SMS Alerts (if Mobile No. provided, pl tick) Yes / No SMS Alerts (if Mobile No. provided, pl tick) Yes / No Thanking you, Sincerely yours, Signature of Sole/First Holder Signature of Second Holder All Joint Holders must sign the request form Signature of Third Holder Note : ** Strike out whichever is not applicable In case of Bank Particulars Changes , please provide your Latest Bank Statement/Pass Book and one duly signed Cancelled cheque. In case of Address Change , please provide your ID Proof , Address Proof and latest Transaction Statement sent to you by us. Any Change sought in the respective Demat account is to be supported by proper proof with originals for verification. (Voluntary) From: Name : ____________________________________________ Address: ____________________________________________ ____________________________________________ Date: ____________________ To M/s. Ashika Stock Broking Limited “Trinity” 226/1, A. J. C. Bose Road, 7th Floor, Kolkata – 700020 Dear Sir, Ref : Mandate to issue Contract Notes and Quarterly Statement in Electronic Format I/We hereby agree and consent to accept the Contract Notes for transaction carried on by me/us with you and the quarterly statements of funds and securities (hereinafter referred to as “quarterly statement”), in terms of the agreement entered into between us, in electronic form, Electronic Contract Notes & quarterly statements issued by you as per the terms and conditions specified hereunder shall be binding on me/us. I/We undertake to check the Contract Notes & quarterly statements and bring the discrepancies to your notice within 24 hours and 30 days respectively of such issuance of Contract Notes & quarterly statements. My/our non-verification or not accessing the Contract Notes and quarterly statements on regular basis shall not be a reason for disputing the Contract Notes & quarterly statement at any time. The mandate is subject to terms and conditions mentioned herein below: This instruction to issue digital contract notes & quarterly statements is applicable with immediate effect. Yours faithfully, ___________________________________________ Signature of the Client E-mail Id:______________________________ Client Code___________________________________ Tel. No.___________________________ Mobile. ___________________________ Dear Customer, We thank you very much for opting for our offer to send you the Contract Notes & quarterly statements in the electronic form. Terms and conditions for availing the facility of the electronic Contract Notes & quarterly statements digitally signed are as follows. Please sign it as an acceptance to it. 1. 2. 3. 4. 5. 6. 7. 8. 9. The client will ensure availability of the above mentioned e-mail ID at all times. That the non-receipt of bounced e-mail notification by ASBL once ECNs / Quarterly Statement / Margin Statement are sent to Client’s above mentioned e-mail ID can be safely taken of having been received . The client shall update for any change in e-mail ID through a duly executed physical letter. The Contract Notes, Daily margin statement & Quarterly Statements will be issued in electronic form in compliance with the guidelines issued by SEBI / Exchange from time to time. Electronic Contract Notes, Daily margin statement & Quarterly statements will also be available on URL https:/www.ashikadirect.com Clients can view the electronic Contract Notes, Daily margin statement & Quarterly statements on URL by using the username & password. Electronic contract Notes will be archived at an interval of 15 days. If client intends to view the electronic Contract Notes for a period prior to 15 days, client may request for the same in writing. In case of any failure in system or errors in electronic Contract Notes, daily margin statement and quarterly statements, will be issued in physical form, which shall be binding on the client. Any changes in the terms and conditions shall be intimated from time to time.
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