KYC - APPLICATION FORM FOR TRADING AND DEMAT A/C

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.