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DATE ____ / ____ / 20 ____ AXISDIRECT ACCOUNT NO. : CLIENT NAME: .......................................................................................................................................................................................................................................... To, AXIS
DATE
____
/
____
/ 20 ____
AXISDIRECT ACCOUNT NO. :
CLIENT NAME:
..........................................................................................................................................................................................................................................
To,
AXIS Securities Limited
Unit No. 2, Phoenix Market City, 15, LBS Road, Near Kamani Junction, Kurla (west), Mumbai-400070
Dear Sir,
I/We request you to update the following details in your records for the above mentioned Client code
Address Details
Contact Details
Bank Details
DP Details
Income in Lac __________
ADDRESS MODIFICATION DETAILS
Modification requested in
Permanent or
Correspondence Address
Existing Details
Address
........................................................................................................................................
New Details
.....................................................................................................
.....................................................................................................
.....................................................................................................
City
...............................................................................
Pin
code
...........................................
.....................................................................................................
State
.........................................................................................................................................
.....................................................................................................
Document:
Passport
Driving License
Voter Id
Bank Passbook
Ration Card
Telephone Bill
Electricity Bill
Rent Agreement
CONTACT DETAILS
Existing Details
Tel. No
....................................................................................................................................
New Details
....................................................................................................
Mobile No
..........................................................................
Pin
code
............................................
...................................................................................................
Email ID
....................................................................................................
ADDITIONAL/ MODIFICATION OF BANK DETAILS
Existing Details
A/C No
.....................................................................................................................................
New Details
...................................................................................................
A/C Type
..................................................................................................
Bank Name
..................................................................................................
Branch
............................................................................
Pin
code
..........................................
...................................................................................................
MICR
...................................................................................................
IFSC Code (RTGS / NEFT) :
....................................................................................................
..................................................................................................
Branch Code :
...........................................................................................................................
...................................................................................................
ADDITIONAL/ MODIFICATION OF DP DETAILS
Existing Details
First Holder
..............................................................................................................................
New Details
...................................................................................................
Second Holder
....................................................................................................
Third Holder
..............................................................................................................................
...................................................................................................
DP ID
............................................................................
Pin
code
.....................................
....................................................................................................
Client ID
..............................................................................................................................
....................................................................................................
Document:
Copy of Holding statement
Client Master.& Duly executed Power of Attorney for Demat account
I/We hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I/We undertake to inform you of any changes therein immediately in writing.
Note: Addition or Change in Demat /SB account will be charged at Rs 100 + applicable service tax per request.
Place
DATE
/
/ 20 ____
Signature (Client)

Copies of the documents may be obtained after due verification and certification by the client with the originals thereof

SEBI Reg. No.- NSE-INB/INF/INE 231481632, BSE- INB 011481638,MCX SX-INB/INF/INE 261481635, ARN No. 64610, CDSL-IN-DP-CDSL-693-2013. Main/Dealing off.- Unit No. 2, Phoenix Market City, 15, LBS Road, Near Kamani Junction, Kurla (west), Mumbai-400070, Tel No. – 18001030808/022-61480808, Reg. off. address-Axis House, 8th Floor, Wadia International centre, Pandurang Budhkar Marg, Worli, Mumbai-400 025.