ANNEXURE JA
FORM FOR NOMINATION / CANCELLATION OF NOMINATION
(To be filled in by individual applying singly or jointly)
I/We and the holders of beneficiary owner account
bearing Client Id No. held with M/s a NSDL
Depository Participant bearing DP Id No; wish to *make a nomination /
cancel the nomination dated and do hereby *nominate / cancel the nomination
made by me/ us on the day of the following person in whom all rights of
transfer and / or amount payable in respect of securities held in the Depository by me/
us in the said beneficiary owner account shall vest in the event of my/our death /* and
consequently all rights and liabilities in respect of beneficiary ownership in the securities held by
me/ us in the said account shall vest in me/us.
(* strike out whichever is not applicable)
Photograph
of the
Nominee
Name and Address of Nominee
Name: ..............................................................................................................
Address: ...........................................................................................................
Date of Birth* : ...............................................................................................
(to be furnished in case the Nominee is a minor)
Signature of the Nominee : .....................................................................
**The Nominee is a minor whose guardian is : ..............................................
Address of the Guardian .................................................................................
.........................................................................................................................
Signature of the guardian: ......................................................................
(in case of guardian his photograph should be affixed) (to be deleted if not applicable)
Beneficial Owner 1) Signature: ...........................................................
Name: ................................................................
Address: .............................................................
Date: ..................................................................
2) Signature: ...........................................................
Name: ................................................................
Address: .............................................................
Date: ..................................................................
Signature of two Witnesses
Name and Address Signature with date
1.
2.
Instructions:
1. The nomination can be made only by individuals holding beneficiary owner accounts
on their own behalf singly or jointly. Non- individuals including society, trust, body
corporate, partnership firm, karta of Hindu Undivided Family, holder of power of
attorney cannot nominate. If the account is held jointly all joint holders will sign the
nomination form.
2. A minor can be nominated. In that event, the name and address of the Guardian of the
minor nominee shall be provided by the beneficial owner.
3. The Nominee shall not be a trust, society, body corporate, partnership firm, karta of
Hindu Undivided Family or a power of Attorney holder. A non-resident Indian can
be a Nominee, subject to the exchange controls in force, from time to time.
4. Nomination in respect of the beneficiary owner account stands rescinded upon closure
of the beneficiary owner account. Similarly, the nomination in respect of the securities
shall stand terminated upon transfer of the securities.
5. Transfer of securities in favour of a Nominee shall be valid discharge by the depository
against the legal heir.
6. The cancellation of nomination can be made by individuals only holding beneficiary
owner accounts on their own behalf singly or jointly by the same persons who made
the original nomination. Non- individuals including society, trust, body corporate,
partnership firm, karta of Hindu Undivided Family, holder of power of attorney cannot
cancel the nomination. If the beneficiary owner account is held jointly, all joint holders
will sign the cancellation form.
7. On cancellation of the nomination, the nomination shall stand rescinded and the
depository shall not be under any obligation to transfer the securities in favour of the
Nominee.