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    Dematerialization Request Form

    Uploaded by

    Veer More Official

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Dematerialization Request Form

    Uploaded by

    Veer More Official
    10 views1 page

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    10 views1 page

    Dematerialization Request Form

    Uploaded by

    Veer More Official

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 1

    Dematirialization request form has to be filled in triplicate

    One copy for Beneficial Owner | One copy for DP | One copy for Issuer/RTA

    Documents Required: Physical Share Certificate and Self-attested ID proof

    GROWW INVEST TECH PRIVATE LIMITED


    Corporate office: No 11, 80 feet Road, ST Bed, Koramangala 4th Block, Bangalore – 560034
    SEBI Registration Number: IN-DP-417-2019 | CDSL DP:12088700
    DEMATERIALISATION REQUEST FORM (CDSL)
    Please fill all the details in Block Letters in English (FILL UP ISIN WISE. SEPARATE DRF FOR FREE SECURITIES AND LOCKED-IN SECURITIES)

    Account No. 1 2 0 8 8 7 0 0

    Date DRN (to be filled by DP) Application Slip/Ref. No. /DRF No.
    D D M M Y Y Y Y
    I/We request you to dematerialise the enclosed certificates registered in my/our name into my / our demat account.
    Details of Securities Free Securities Locked-in-Securities
    Name of the Company
    ISIN I N

    Type of Security Equity Debentures Bonds Units Other (Specify)

    Folio No. Certificate No. Distinctive No. Quantity


    From To From To

    Total

    Number of Certificates (In words) Face Value of Securities Rs.


    Quantity to be (In Figures)
    Dematerialised
    (In words)
    (If the space above is found to be insufficient, an annexure containing the certificate details duly signed in the same format may be attached.)
    In case of Locked-in Securities fill up a separate DRF for Locked - in Securities having different release dates.
    Lock-in Reason
    Lock-in Release Date
    The Original Certificates / documents are hereby surrendered by me / us for dematerialisation and the same are free from any lien or charge or encumbrance
    and represent the bona fide securities of the Issuer Company to the best of my / our knowledge and belief.
    Names

    Signature with DP

    Signature with RTA/Issuer/Co.

    First / Sole Holder Second Holder Third Holder

    Participant Authorisation (From DP to RTA)


    We have received the above mentioned securities bearing ISIN No. for Dematerialisation. The application form is verified with the
    Certificates / Documents surrendered for dematerialisation and we certify that the application form is in accordance with the details mentioned in the enclosed
    certificates / documents. It is also certified that the Holder(s) of securities have a beneficiary account with us in the name (s) and order of name(s).

    Signature verified
    Name & Signature of Authorized DP Official
    Acknowledgement (DP TO BO) DP ID No.: 12088700 DP SEBI Reg. No: IN-DP-417-2019
    GROWW INVEST TECH PRIVATE LIMITED
    Corporate office: No 11, 80 feet Road, ST Bed, Koramangala 4th Block, Bangalore – 560034
    Application No. CDSL
    We hereby acknowledge the receipt of the following securities for dematerialisation subject to verification:
    Account No. 1 2 0 8 8 7 0 0
    Sole / First Holder Name
    Name of the Company
    Type of the Security Equity Debentures Bonds Units Other Specify)
    ISIN No. of Securities No. of Certificates

    Stamp & Signature

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