FORM FOR TRANSMISSION ALONGWITH DEMATERIALISATION

Date :
D
D
M
M
Y
Y
Y
Y
I/We, the undersigned, being the joint holders of the following securities along with Mr. / Mrs. / Ms. ____________________________________________________________________ (name of the deceased) wish to have the name of the deceased deleted from the security certificates. A copy of the death certificate, duly notarised and the dematerialisation request form alongwith the physical certificates are enclosed. I/We request you to process the same and advise the Issuer / R & T Agent accordingly. The details are given below:
BO / Client ID
Company Name
Type of Security Equity / Others
(Please specify)
Quantity (in figures)
(in words)
Sr. No.
Name of the survivor(s)
Signature(s)
1
2
3
(To be filled - in by the Participant)
ISIN
I
N
Dematerialisation Request No.
(DRN) of the dematerialisation request
Instructions:
1. Separate forms should be filled up for each ISIN by the survivor(s).
2. Each form should be accompanied by a copy of the death certificate, duly notorised.
Name and Signature of the Branch official
For DPCPC Use
Name and Signature of the Authorised Signatory
State Bank of India
DP Centralised Processing Cell, CMC House, C-18, Bandra-Kurla Complex, Bandra (East), Mumbai 400 051.
• Help Desk: 1800 22 0488 (Toll free for MTNL/BSNL users) / Ph.: 022-26592123 • Fax : 022-26592127 • Email : querydp [at] sbi [dot] co [dot] in
INDOC No.
DP ID No. : 13019300
Sebi Regn. No.: IN-DP-CDSL-80-2000