Nomination Form
[Annexure A to SEBI circular No. SEBI/HO/MIRSD/RTAMB/CIR/P/2021/601 dated July23, 2021
on Mandatory Nomination for Eligible Trading and Demat Accounts]
Request Ref No:
I/We wish to make a nomination and do hereby nominate the following person(s) who shall receive all the assets
held in my / our account in the event of my / our death.
Fields as per SEBI Nomination Form
Details
Date
DP ID
Client ID
First Nominee Details (including minor)
Is 1st Nominee a minor
Date of birth of 1st Nominee (minor)
Name of 1st Nominee (Ms./Master./Mr./Mrs.)
Distribute Equally
Share of 1st Nominee
Relationship With the Applicant (If Any)
Address of 1st Nominee
State and Country
PIN Code
Mobile No. of 1st Nominee
Email ID of the 1st Nominee
1st Nominee Identification Details
First Guardian Details (in case nominee is minor)
Name of the 1st Nominee's Guardian (Mr./Mrs.)
Relationship with 1st Nominee
Address of 1st Guardian
State and Country
PIN Code
Mobile No. of 1st Guardian
Email ID of 1st Guardian
1st Guardian identification details
Second Nominee Details (including minor)
Is 2nd Nominee a minor
Date of birth of 2nd Nominee (minor)
Name of 2nd Nominee (Ms./Master./Mr./Mrs.)
Distribute Equally
Share of 2nd Nominee
Relationship With the Applicant (If Any)
Address of 2nd Nominee
State and Country
PIN Code
Mobile No. of 2nd Nominee
16-03-2023
711346
No
Rajini
Spouse
H no mig 7 New housing board colony Gadwal Jogulamba district
TELANGANA ,INDIA
509125
7989189930
EQRPR6000L
No
59979671
IN301549
Digitally Signed by:
Name:R VAMSHI KRISHNA GOUD
Reason:Nomination Update
Date:Thu Mar 16 12:55:36 IST 2023
