Request for Transmission of Securities by Nominee or Legal Heir (For Transmission of securities on death of the Sole holder)
To:
The Listed Issuer/RTA,
(Address)
Annexure C - ISR 5
______________________________________ (Name of the Listed Issuer/RTA)
Name of the
Claimant(s)
Mr./Ms.
Name of the Guardian | in case the claimant is a minor→ Date of Birth of the minor* | |||||
Mr./Ms.________________________________________________________________________ | ||||||
Relationship with Minor: | Father | Mother | Court Appointed Guardian* | |||
[Multiple PAN may be entered] PAN (Claimant(s)/Guardian): | | | | | | | | | | | || KYC | ||||
Acknowledgment attached | KYC form attached | |||||
Tax Status: Resident Individual | Resident Minor (through Guardian) | NRI | PIO | Others | ||
(please specify) |
*Please attach relevant proof
I/We, the claimant(s) named hereinabove, hereby inform you about the demise of the below mentioned Securities Holder(s) and request you to transmit the securities held by the deceased holder(s) in my/our favour in my/our capacity as -
Nominee | Legal Heir Successor to the Estate of the deceased | Administrator of |
the Estate of the deceased | ||
Name of the deceased holder(s) | Date of | |
demise** | ||
1) | DD / MM / YYYY | |
2) | DD / MM / YYYY | |
3) | DD / MM / YYYY | |
**Please attach certified copy of Death Certificate.
Securities(s) & Folio(s) in respect of which Transmission of securities is being requested
No. of | % | of | ||
Name of the Company | Folio No. | Securities | Claim@ | |
1) | ||||
2) | ||||
3) | ||||
4) | ||||
@As per Nomination OR as per the Will/Probate/Succession Certificate/Letter of Administration/ Legal Heirship Certificate (or its equivalent certificate)/ Court Decree, if applicable.
Contact details of the Claimant (s) [Provision for multiple entries may be made]
Mobile No.+91| | | | | | | | | |Tel. No. STD -
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Email Address
Address (Please note that address will be updated as per address on KYC form / KYC Registration Agency records)
Address Line 1
Address Line 2
City: | State | ||||
PIN | | | | | | | |||||
Bank Account Details of the Claimant | |||||
Bank Name | |||||
Account No. | |11-digit IFSC | | ||||
| | | | | | | | | | | | | |||
A/c. Type (✓) | SB Current NRO NRE FCNR | | 9-digit MICR No.| | | |||
| | | | | | | | |
Name of bank branch
City
PIN | | | | | |
Please attach &tick✓ Cancelled cheque with claimant's name printed OR Claimant's Bank Statement/Passbook (duly attested by the Bank Manager)
I also request you to pay the UNCLAIMED amounts, if any, in respect of the deceased securities holder(s) by direct credit to the bank account mentioned above.
Additional KYC information (Please tick✓whichever is applicable)
Occupation | Private Sector Service | Public Sector Service Government Service |
Business | Professional | |
Agriculturist | Retired Home Maker | Student Forex Dealer |
Others_________________________________ (Please specify)
The Claimant is a Politically Exposed Person Related to a Politically Exposed Person Neither (Not applicable)
Gross Annual Income (₹) Below 1 Lac | 1-5 Lacs 5-10 Lacs 10-25 Lacs 25 |
Lacs-1crore >1 crore | |
FATCA and CRS information |
Country of Birth __________________________________Place of Birth _____________
Nationality _____________
Are you a tax resident of any country other than India? Yes No
If Yes, please mention all the countries in which you are resident for tax purposes and the associated Taxpayer Identification Number and its identification type in the column below
Country
Tax-Payer Identification Number
Identification Type
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Nomination@ (Please✓one of the options below)
I/We DO NOT wish to make a nomination. (Please tick ✓ if you do not wish to nominate anyone)
I/We wish to make a nomination and hereby nominate the person/s more particularly described in the attachedNomination Form to receive the securities held in my/our folio in the event of my / our death.
@ Guardian of a minor is not allowed to make a nomination on behalf of the minor
Declaration and Signature of the Claimant(s)
I/We have attached herewith all the relevant / required documents as indicated in the attached Ready Reckoner as per Annexure A.
I/We confirm that the information provided above is true and correct to the best of my knowledge and belief.
I/Weundertaketokeep
________________________________________________________ (Name of the
Company) / its RTA informed about any changes/modification to the above information in future and also undertake to provide any other additional information as may be required by the RTAs.
I/Weherebyauthorize
________________________________________________________ (Name of the
Company) and its RTA to provide/ share any of the information provided by me/us including my holdings in the (Name of the Company) to any governmental or statutory or judicial authorities/agencies as required by law without any obligation of informing me/us of the same.
Place___________________________
Date
Signature of Claimant(S)
Documents Attached
- Copy of Death Certificate of the deceased holder
- Copy of Birth Certificate (in case the Claimant is a minor)
- Copy of PAN Card of Claimant / Guardian
- KYC Acknowledgment OR
- KYC form of Claimant
Cancelled cheque with claimant's name printed OR | Claimant's Bank |
Statement/Passbook | |
Nomination Form duly completed |
- Annexure D - Individual Affidavits given EACH Legal Heir
- Original security certificate(s)
- Annexure E - Bond of Indemnity furnished by Legal Heirs
- Annexure F - NOC from other Legal Heirs
*Note: For transmission service requests, Form ISR-4 as per SEBI circular SEBI/HO/MIRSD/MIRSD_RTAMB/P/CIR/2022/8 dated January 25, 2022 will not be required.
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Radico Khaitan Limited published this content on 12 May 2023 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 12 May 2023 06:12:09 UTC.