Annexure 3.1
UCC
Date (dd/mm/yyyy)
DP ID
1 2 0 8 1 8 0 0
Client ID
Name of First / Sole Holder
Name of Second Holder
Name of Third Holder
First / Sole Holder Second Holder Third Holder
Name
Client's Signature
Details
(Please specify change of address,
bank details, mobile*, email*, etc.)
Addition /
Modification / Deletion
(Please Specify)
Existing Details
New Details
Please fill all the details in Block Letters in English
Account Holder’s details
I / We request to carry out the change of address / signature in the demat account
I/We request to carry out the change of address / signature in the KRA and demat account
I / We request you to make the following additions / modifications / deletions to my / our account in your records.
Acknowledgement Receipt
(Please Tear Here)
Received Account Details Addition / Modification / Deletions request as per details given below:
UCC
Date (dd/mm/yyyy)
D
P
I
D
1 2 0 8 1 8 0 0 Client ID
Name of First / Sole Holder
Name of Second Holder
Name of Third Holder
Modification requested for:
Registered Office: 807, New Delhi House, Barakhamba Road, Connaught Place, New Delhi, 110 011
Correspondence Office: RKSV Securities India Private Limited, Salasar Business Park, Off 150 Feet Flyover Road, Bhayander West, Thane, Maharashtra 401101
Telephone: +91-22-6130-9999 | Fax: +91-22-6710-7492 | Email: trading@rksv.net, www.upstox.com
Powered by RKSV Securities India Private LimitedSEBI REG NO.IN-DP-118-2015
ACCOUNT DETAILS ADDITION / MODIFICATION / DELETION REQUEST FORM
CHANGE ACCOUNT DETAILS
Trading CDSL Commodity
PAN Aadhaar No.
Tick either one box or both boxes to specify change
Permanent Address Correspondent Address
Proof of address to be provided by applicant. Please submit ANY ONE of the following valid documents & TICK against the document attached
*Latest Bank A/C Statement/Passbook
Others (Please Specify)
Passport Ration Card Registered Lease/Sale Agreement of Residence Driving Licence
*Latest Telephone Bill (Only landline)
Voter Identity Card
*Latest Electricity Bill
*Not more than 3 months old. Validity/Expiry date of proof of address submitted (dd/mm/yyyy)
Proof of Identity submitted for PAN exempt cases. Please tick.
Aadhaar Card Passport Voter ID Driving Licence Others
* The mobile and email address provided belong to me. (Note on mobile and email declaration.)
Attach an Annexure (with signature(s)) if the space above is found insufficient.
Proof of Bank
Copy of canceled cheque leaf/ Pass book/ Bank Statement (Please ensure the document specifies the name of the constituent, MICR Code and/or IFSC code of the bank.)
*Latest Gas Bill
Aadhaar Card
FOR OFFICE USE ONLY
AMC/Intermediary name OR code
(Originals verified) True copies of documents received
(Attested) True copies of documents received Main Intermediary
Seal/Stamp of the intermediary should contain Staff
Name, Designation, Name of the Organization,
Signature, Date
IPV Done
on (dd/mm/yyyy)
DATE (DD/MM/YYYY)
PLACE:
Declaration
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 case any of the above information is found to be false or untrue or misleading or misrepresenting, I am/We are
aware that I may be held liable for it.
