BANK OF BARODA
DPID - 13018700
CENTRAL BACK OFFICE DP OPERATIONS
BARODA SUN TOWER, GROUND FLOOR, BKC, MUMBAI-400051

(TRANSMISSION-CUM-DEMATERIALIZATION REQUEST FORM)
Dear Sir / Madam, Date: ______________
I / We, the surviving joint holder(s) request you to dematerialize the enclosed securities
in our account as per details given below. The securities were held by me/us jointly with
Mr./Mrs./Ms. _______________________________________________who has expired.
The original Death Certificate / a copy of the death certificate, duly notarized or attested
under seal by a Gazetted Officer (strike out what is not applicable), is attached herewith,
along with duly-filled and singed DRF and physical share certificates listed below.
I / We, request you to advise the Issuer /RTA to process the demat request and credit the
securities to the demat account mentioned below:
DP
ID
1 3 0 1 8 7 0 0 Client
ID
Name of the Security / Company :
Type of Security: Equity / Others (Please specify) : -
Quantity (in words & figures) : -
Sr,No. Name of the Survivor(s) Signature(s)
1.
2.
3.
(to be filled in by the DP)
ISIN :
DRN
Instructions:
1. The survivor(s) should fill up separate forms for each ISIN.
2. A copy of the death certificate duly notarized should accompany each form.