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Dematerialisation Request Form Only For NRI

Dematerialisation Request Form (DRF) For ICICI Bank use only. To be filled in by holder(s): account no. Mobile no.: Email:.

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Md Asif
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288 views

Dematerialisation Request Form Only For NRI

Dematerialisation Request Form (DRF) For ICICI Bank use only. To be filled in by holder(s): account no. Mobile no.: Email:.

Uploaded by

Md Asif
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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REGISTRAR COPY

ICICI Bank Ltd - Demat Services


DP ID C/o. 3i Infotech Limited, Akruti Trade Centre, 3rd Floor
P.10, Road No.7, MIDC Marol, Bhimnagar, Andheri (East)
DRF Mumbai - 400 093, Maharashtra

Dematerialisation Request Form (DRF)

For ICICI Bank use only

DRN Date of receipt: D D M M Y Y Y Y


CPO Sr. No.: . ..............................................

INDOC no. ............................................................. Sequence no. ................................................... Date D D M M Y Y Y Y

To be filled in by holder(s)
I/We hereby request ICICI Bank to dematerialise the enclosed certificates into my/our demat account as per the details given below:

Account no. Mobile no.:


Email: . ........................................................................................................................................................................................................
Account holder name First/Sole holder
Second holder
Third holder
Quantity of securities to be dematerialised (in figures) (in words)
Name of the securities Face value: Rs.
ISIN (To be filled in by DP) IN

Details of securities Type of securities: Equity Others


Folio no. Certificate no. Quantity (in figures) From distinctive no. To distinctive no.

• In case the space is insufficient, please attach an annexure containing the details of the certificate in the same format.
•Submit different DRF for security certificates of the same company having different ISINs. Bonds and Debentures of different series issued by the same company
generally have different ISINs. Verity them from the branch if in doubt.
•Please use separate form for free securities and locked-in securities.
Total no. of certificates surrendered: . .......................................................................................
Please tick if the dematerialisation request is for locked shares. Lock-in release date: D D M M Y Y Y Y
Lock-in reason: . ......................................................................................................................................................................................................................
Declaration: I/We hereby declare that the above-mentioned securities are registered in my/our name. The original certificate(s) is/are hereby surrendered by me/us for
dematerialisation. I/We also hereby declare that the securities submitted by me/us for dematerialisation are free from any lien or charge or encumbrance and
represents the bonafide securities of the company to the best of my/our knowledge and belief.
Holders’ signture(s) (If the signature registered with the Company/Registrar is different from the specimen signature given to the DP please affix
both signatures on the DRF)
Name Signature
First/Sole holder
Second holder
Third holder

For ICICI Bank use only


Participant Authorisation
Received the above mentioned securities for dematerialisation. The application form has been verified with the certificates surrendered for
dematerialisation and certify that the application form is in accordance with the delails mentioned in the enclosed certificates. It is also certified
that the holders hold beneficiary accounts with us in the same name.
Fowarded by
Name of the DP official:. .........................................................................................................................................................................................................

SIGNATURE PARTICIPANT’S STAMP & DATE


" "
Acknowledgement (To be filled in by holder(s))
ICICI Bank Ltd – Demat Services DP ID DRF
C/o. 3i Infotech Limited
Akruti Trade Centre, 3rd Floor, P.10, Road No.7, MIDC Marol
Bhimnagar, Andheri (East), Mumbai – 400 093, Maharashtra
We hereby acknowledge the receipt of . ............................................. certificate(s) for ................................. Equity/Others (Specify) ............................
of . ...................................................... surrendered for dematerialisation by ........................................having Client ID ...................................................

AUTHORISED SIGNATORYFOR ICICI BANK LTD


SUBJECT TO VERIFICATION

Date D D M M Y Y Y Y

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