CDSL CLOSURE FORM

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Account Closure Request Form

  A lication No.                                                           Date                                   y                  "(
  Closure Initiated b           D BO        D DP          D CDSL
(To be filled by the BO (in case of BO-initiated closure). Please fill all the details in Block Letters in English)

To,
 KMS STOCK BROKING CO PVT LTD
 297/301, MAY BUILDING, GROUND FLOOR, PRINCESS STREET, MARINE LINES (EAST)
MUMBAI - 400 007
TEL:22071111/22081111


Dear Sir / Madam,

I / We the Sole Holder / Joint Holders / Guardian (in case of Minor) / Clearing Member request you to close my / our
account with you fram th e date af t his aoo Iication. The detaiIs af my,/our account are aiven b elow:
Account Holder's Details
  DP ID            I     I    I   I       I     I     I    I    I      Client ID I      I     I     I   I I I I
  Name of the First / Sole Holder
  Name of the Second Holder
 Name of the Third Holder
 Address for Correspondence




 City                                                     I State    I                        I PIN I       I   I    I       I       I

Details of remaining security balances in the account (if any)
 Reasons for Closing the Account
 Balance remaining in the account (if any) to be :
 D partly rematerialised and partly transferred.                    D Rematerialised
 D Transferred to another account (Number given below)              D Not applicable
 DP ID             I     I     I     I  I    I     I I  I Client ID       I     I    I              I      I    I        I       I
 Balance present in account for                        D Ear - marked                                    D Pledged
 (To be filled by DP, if applicable)                   D Pending for Dematerialisation                   D Frozen
                                                       D Pending for Rematerialisation                   D Lock-in




           DECLARATION: In case of Account Closure due to SHIFTING OF ACCOUNT:
           I/We declare and confirm that all the transactions in my/our demat account are true/ authentic.



                         First / Sole Holder                  Second Holder                             Third Holder
  Name

  Signature*


*If DP or CDSL initiates account closure, Signature(s) of account holder(s) not required.
-------------------------------(�e�e TesHea0------------------------------
                                              Acknowledgement Receipt
Application No.                                                                           Date :-

We hereb)Y ac know IedIae the receipt af the your instruction or C osina th e faIIowina Account sub)ject to verifi1cation: -
DP ID                I    I     I    I     I          I     I   I Client ID         I    I   I    I     I    I      I    I
Name of the First / Sole Holder
Name of the Second Holder
Name of the Third Holder
Reason for Closure

                                                                            Depository Participant Seal and Signature
Instructions to Account Holder(s)
     o   Submit a duly-filled RRF if the balances are to be rematerialized.
     o   Submit a duly-filled Delivery Instruction Slip [DIS] (off market instruction slip) if the balances are to be
         transferred to another Account. This requirement is not applicable in the case of"SHiffiNG OF ACCOUNT".