SyndicateBank, Depository Services
2nd Floor, SyndicateBank Building, 26, Sir P M Road, Fort Mumbai - 400 001
Transmission Request Form
(In case of death of one / more of the joint holders)
(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,
I / We, the joint holder(s) / Successors request you to transmit the securities balance from:
DP ID 1 3 0 5 0 6 0 0 Client ID
To
DP ID Client ID
Due to the death of ---------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------(Name of the deceased account holder(s)).
Original Death Certificate / copy of Death Certificate (duly notarized / attested under seal by a Gazetted Officer) is attached
herewith.
First / Sole Holder Second Holder
Name(s) of the surviving holder(s)
Signature (s) of the surviving holder(s)
Depository Participants Seal & Signature
=====================================(Please Tear Hear)=========================================
Acknowledgement Receipt
Application No. Date :
We hereby acknowledge the receipt of the following instructions for transmission from:
DP ID 1 3 0 5 0 6 0 0 Client ID
To
DP ID Client ID
Surviving Holder(s) Name(s)
First / Sole Holder Second Holder
Documents submitted
Subject to Verification.
Depository Participants Seal & Signature