Destimoney Securities Pvt. Ltd. : _______________________ Contact No.

Branch Name and Code: 6th Floor, A Wing, Tech Web Centre,, New Link Road,_____________ Date: _____/_____/___________ Oshiwara, Jogeshwari - West Mumbai, Maharashtra 400102
Change of Account Details (Address/Contact Number/Email ID/Bank) Date: / / (Please fill all the details in BLOCK LETTERS in English) Application No. _________________

Client Name : ______________________

Login ID :________________________________ (For Trading A/c) Client ID: 12045500_________________________________(For Demat A/c) Account Holders Details
Name of First/Sole Holder Name of Second /Sole Holder
Name of Third/Sole Holder

I/We request you to make the following changes to my/our account in your records.

Please tick( ) the details to be change:

Change of Address Change of Mobile /Landline no Change of Email Bank Change Change in Mode for Contract Notes

Existing Details Old Address:

New Details New Address:

City : State: Pin Code: Old Email ID: Old Mobile No./Landline No.:

City : State: Pin Code: New Email ID: New Mobile No./Landline No.: Removal Trading A/c

For Change in Bank Details Please tick () the details to be change Addition Trading A/c Change Demat & Trading A/c
Existing Details New Details

Bank Name: Branch Location: Bank Account Number: Account Type: Bank Address: MICR Code Savings B Current B Over Draft B

Bank Name: Branch Location: Bank Account Number: Account Type: Bank Address: Savings B Current B Over Draft B

*9 Digit Code Number of the bank and branch appearing on the Cheque issued by Bank. For availing ECS Facility MICR needs to be provided. CONTRACT NOTE STATUS (ECN will be sent to Email Id as mentioned in the KYC)

Physical Contract Notes Electronic Contract Notes I/We do hereby solemnly declare that the details hereinabove submitted by me/us is/are true to my /our own knowledge.

Attached an Annexure (with signature(s)) if the space above is found insufficient First/ Sole Holder Second Holder
Name Signature

Third Holder

*For DP use only * Rejected Reason: Sign Checked by:________________ Process by:___________________Process date: _____________________ Documents Required
* FOR BANK CHANGE* 1. 2. 3. Cancelled personalized cheque leaf (If cheque is not personalized, then last 6 months bank statement with bank seal is required) Addition & Deletion Applicable only for Trading account . Modification Applicable for both Trading & Demat

(Any of the below documents may be submitted as address proof )

Address Proofs Identity Proofs Ration Card / Valid Passport / Valid Driving License / Landline Tel. Bill / Electricity Bill / Bank Passbook / Bank Statement. Copy of Passport / Voters ID Card / Driving License / PAN card with photograph.

____________________________________________________________________________________________ Application No. ________________ Acknowledgement Receipt Date : / / Received Account Details Addition/Modificaition/Deletions request as per details given below: DP ID: 1204550 Client ID: Name of First/ Sole Holder Name of Second Holder Name of Third Holder Modification requested for: (Specify reason) Depository Participant Seal and Signature