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Isr 5

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20 views3 pages

Isr 5

Uploaded by

pb2797502
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Request for Transmission of Securities by Nominee or Legal Heir Annexure C –

(For Transmission of securities on death of the Sole holder) ISR 5

To:
(Name Of The Company),
(Address)

Name of the Claimant(s) – 1.


2.
3.
Name of the Guardian in case the claimant is a minor→ Date of Birth of the minor*
(*Please attach relevant proof)
Mr./Ms.________________________________________________________________________
Relationship with Minor: Father Mother Court Appointed Guardian* (*Please attach
relevant proof)
PAN (Claimant(s)/Guardian): 1. | | | | | | | | | | |
2. | | | | | | | | | | |
3. | | | | | | | | | | |

KYC Acknowledgment attached KYC form attached


Tax Status: Resident Individual Resident Minor (through Guardian) NRI PIO Others (please
specify)

I/We, the claimant(s) named hereinabove, hereby inform you about the demise of the below mentioned
Securities Holder(s) and request you to transmit the securities held by the deceased holder(s) in my/our
favour in my/our capacity as –
Nominee Legal Heir Successor to the Estate of the deceased Administrator of the Estate of the
deceased
Name of the deceased holder(s) Date of demise**
1) DD / MM / YYYY
2) DD / MM / YYYY
3) DD / MM / YYYY
**Please attach certified copy of Death Certificate.
Securities(s) & Folio(s) in respect of which Transmission of securities is being requested
No. of % of
Name of the Company Folio No. Securities Claim@
1)
2)
3)
4)
@As per Nomination OR as per the Will/Probate/Succession Certificate/Letter of Administration/ Legal
Heirship Certificate (or its equivalent certificate)/ Court Decree, if applicable.

Page 1 of 3
Contact details of the Claimant (s) :
Mobile No.‐ Claimant 1. +91| | | | | | | | | | Tel. No. STD –
Claimant 2. +91| | | | | | | | | | Tel. No. STD –
Claimant 3. +91| | | | | | | | | | Tel. No. STD ‐
Email Address: Claimant 1‐
Claimant 2‐
Claimant 3‐
Address of Claimant 1:

Address Line 1
Address Line 2
City: State PIN | | | | | |

(Please note that address will be updated as per address on KYC form / KYC Registration Agency records)

Bank Account Details of the Claimant 1:


Bank Name
Account No. |11‐digit IFSC | | | | | | | | | | |
A/c. Type (✓) SB Current NRO NRE FCNR | 9‐digit MICR No.| | | | | | | | |
Name of bank branch
City PIN | | | | | |
Please attach & tick ✓ Cancelled cheque with claimant’s name printed OR Claimant’s Bank Statement/Passbook
(duly attested by the Bank Manager)

I also request you to pay the UNCLAIMED amounts, if any, in respect of the deceased securities holder(s) by
direct credit to the bank account mentioned above.

Additional KYC information (Please tick ✓ whichever is applicable)


Occupation Private Sector Service Public Sector Service Government Service Business
Professional Agriculturist Retired Home Maker Student Forex Dealer Others
_________________________________ (Please specify)
The Claimant is a Politically Exposed Person Related to a Politically Exposed Person Neither (Not
applicable)
Gross Annual Income ( ) Below 1 Lac 1‐5 Lacs 5‐10 Lacs 10‐25 Lacs 25 Lacs‐1 crore > 1 crore
FATCA and CRS information
Country of Birth __________________________________Place of Birth _____________
Nationality _____________
Are you a tax resident of any country other than India? Yes No
If Yes, please mention all the countries in which you are resident for tax purposes and the associated
Taxpayer Identification Number and its identification type in the column below
Country Tax‐Payer Identification Number Identification Type

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Nomination@ (Please ✓ one of the options below)
I/We DO NOT wish to make a nomination. (Please tick ✓ if you do not wish to nominate anyone and
enclose Form ISR 3)

I/We wish to make a nomination and hereby nominate the person/s more particularly described in the
attached Nomination Form to receive the securities held in my/our folio in the event of my / our
death.
Note: Guardian of a minor is not allowed to make a nomination on behalf of the minor
Declaration and Signature of the Claimant(s):
I/We have attached herewith all the relevant / required documents as indicated in the attached Ready
Reckoner as per Annexure A.
I/We confirm that the information provided above is true and correct to the best of my knowledge and
belief.
I/We undertake to keep ________________________________________________________ (Name
of the Company) / its RTA informed about any changes/modification to the above information in future
and also undertake to provide any other additional information as may be required by the RTAs.
I/We hereby authorize ________________________________________________________ (Name
of the Company) and its RTA to provide/ share any of the information provided by me/us including my
holdings in the (Name of the Company) to any governmental or statutory or judicial authorities /
agencies as required by law without any obligation of informing me/us of the same.

Place___________________________ Signature of Claimant 1:


Signature of Claimant 2:
Date ___________________________
Signature of Claimant 3:

Documents Attached
† Copy of Death Certificate of the deceased holder
† Copy of Birth Certificate (in case the Claimant is a minor)
† Copy of PAN Card of Claimant / Guardian
† KYC Acknowledgment OR
† KYC form of Claimant
† Cancelled cheque with claimant’s name printed OR Claimant’s Bank Statement/Passbook
Nomination Form duly completed
† Annexure D ‐ Individual Affidavits given EACH Legal Heir
† Original security certificate(s)
† Annexure E ‐ Bond of Indemnity furnished by Legal Heirs
† Annexure F ‐ NOC from other Legal Heirs

*Note: For transmission service requests, Form ISR‐4 as per SEBI circular
SEBI/HO/MIRSD/MIRSD_RTAMB/P/CIR/2022/8 dated January 25, 2022 will not be
required.

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