Reliance Securities Limited

11th Floor, R-Tech IT Park, Western Express Highway, Goregaon (East), Mumbai 400063.

Equities - Change Request Form (for Individuals Only)

Please fill details in BLOCK LETTERS in English
Date

Trading Client Code

DP ID: 13041400 BO ID

I/We request you to update the following details in your client master. I/We understand that the change(s) is / are being carried out at my/ our request and will affect in accounts held by me/us with
Reliance Securities Ltd., under the captioned client code / BO ID.

1. Bank Details Addition/Modification for Trading & Demat Account

Add / Modify New Bank Details

Existing Bank Details

Bank Name

Bank Name

Bank Branch

Bank Branch

Bank A/c No

Bank A/c No

A/c Type
MICR Code

Delete Existing Secondary bank details(Please tick, if required)

Primary bank details can never be deleted

IFSC Code (compulsory)

Please tick any one of 'a' or 'b'
a)

b)

Make above new bank details as Primary/Default bank

(This new bank details to be used for Funds Payin, Payout & Dividend credit.
Existing bank details, if any will be marked as Secondary bank account)

Bank details provided in the POA executed by me/us, shall stand modified with the
bank details provided under this request form

Make above new bank details as Secondary bank

(This new bank details to be used for Funds Payin only )

For Change in Bank details: ? Copy of Cheque with name printed, copy of bank passbook, Copy of bank statement of Accounts duly stamped and attested by bank Authorities, Not older than 3 Months.

2. KYC details updation in Trading, Demat account & KRA updation

Change of Address details
(Please fill and sign the attached "KYC details change form" and submit along with this form dully signed)

Change of Contact Details (Email id and Phone number )

Change in Gross Annual Income Details / Occupation detail

3. Running Account Authorisation - Settlement Preference

Once in a calendar Quarter

(Tick any one)

4. Exchange Segment Addition

Once in a calendar month

(Tick any one)

This authorisation shall remain valid until it is revoked by me/us

Deletion

NSE F&O @
______________________________________

_____________________________________
BSE F&O @

_________________________________
MCX-SX F&O @

NSE Currency
@
Derivatives _____________________________________

MCX-SX Currency
@
Derivatives ____________________________________

MCX-SX Cash
@
Segment _____________________________________

For Derivative segment activation (any one required) Copy of ?ITR Acknowledgment ?Annual Accounts ?Form 16 in case of salary income ?Net-worth certificate ?Salary Slip ?Bank Account Statement
for last 6 months reflecting income.

I/ We have read, understood and are agreeable to the changes as filled, signed and attached
First/Sole Holder

Second Holder

Third Holder

Name

Signature

Mandatory to be filled by branch official

RSL accepting branch should affix rubber stamp of Verified with Original & In Person Verification seal on Proofs, pages should be signed by branch official.
Branch Name:_________________________________

Received on

Customer Signature Verified by

Name of Staff
Employee ID:

QRC No. :

(Sign): ________________________

(For CBO use only)

Updated by

Authorized by

Employee ID

Employee name

Important Instructions:- a) Applicant has to bring the original documents for verification of the proofs, and all photo copies should be self attested b) Copy of PAN, dully signed by customer should
be submitted along with CRF for all changes requested.
Tear Off

Acknowledgment Receipt for Customer

Date
Trading Client Code

QRC NO
Name of the First applicant

Type of Requests
Reliance Securities Limited

Page 1 of 3

CRF/Ver 2.7/Feb 2013

Reliance Securities Limited

CRF/Ver 2.7/Feb 2013