SyndicateBank, Depository Services
2nd Floor, SyndicateBank Building, 26, Sir P M Road, Fort Mumbai - 400 001
Transmission Request Form
(In case of death of the sole holder)
(Please fill all the details in BLOCK LETTERS in English)

Application No. Date D D M M Y Y Y Y

To,
SyndicateBank, Depository Services
2nd Floor, SyndicateBank Building, 26, Sir P M Road, Fort Mumbai - 400 001
Dear Sir / Madam,
PART – I : (where nomination is recorded)
I, Nominee / Successor/ Guardian of the successor or nominee (in case of Minor) request you to transmit the following securities
due to the death of the sole account holder. Original Death Certificate / copy of Death Certificate (duly notarized / attested under
seal by a Gazetted Officer) is attached herewith.
Name of the deceased BO:
Account Number of the deceased BO:
DP ID 1 3 0 5 0 6 0 0 Client ID
Kindly transmit all securities in the deceased BO’s account mentioned above to the BO account mentioned below.
Successor BO Account Number
DP ID Client ID
Name
Date of Transmission
Sr.
No.
Name of Security ISIN Quantity of securities to be
Transmitted
Attach an annexure duly signed by the Nominee / Successor / Guardian of the successor or nominee (in case of Minor), if the
space above is insufficient.
(Nominees / Successor / Guardian of successor or nominee (in case of Minor))
First / Sole Holder Second Holder Third Holder
Name
Signature
PART – II : (where nomination is not recorded)
No Objection Statement from other heirs/successors who are non-applicants
1. I/We, the undersigned, residing at___________________, am/are legal heir(s) of the said deceased.
2. I/We do not desire to make any claim of title of the said securities and have no objection whatsoever in transmitting the said
securities in the name(s) of Mr. / Mrs. ___________________________ who has/have opened a beneficial owner account(s) under
Client ID ______________ and DP ID _______________.
3. In consideration of registration of the aforesaid securities in the client account of Mr. / Mrs. __________________ under DP ID
__________ Client ID ___________ at my request, I/We hereby renounce all my/our rights existing as well as those that may
accrue to me/us in future in respect of the aforesaid securities.
2
Signed in the presence of
___________________ ______________________
Bank Manager Signature of the legal heir
Full Name and Address of Bank Manager:
Name : _________________________
Address : _________________________
_________________________
Note for all legal heirs/successors who are applicants / non-applicants:
Only one Transmission Request Form is to be submitted by claimants/non-claimants to the DP of the deceased BO for the
transmission of securities wherein the intentions of the legal heirs/successors are collectively stipulated.
Depository Participants Seal & Signature
=====================================(Please Tear Hear)=========================================
Acknowledgement Receipt
Application No. Date :
We hereby acknowledge receipt of the instructions for transmission of securities from the deceased BO’s account to the account of
the Nominee / Successor / Guardian of the successor or nominee (in case of Minor), as per details given on the transmission form.
Account Number of the deceased BO:
DP ID 1 3 0 5 0 6 0 0 Client ID
Successor BO Name(s)
First / Sole Holder Second Holder Third Holder
Documents submitted
Subject to Verification.
Depository Participants Seal & Signature