Asit C. Mehta INVESTMENT INTERRMEDIATES LTD. Sth Floor, Nucleus House, Opp. L & T Gate No. 7, Saki Vihar Road, Andheri (E), Mumbai - 400 072 Tal: (91-22) 2858 3833 + Fax: (91-22) 2857 76747 + Emall: dp.cdsi@acm.co.in Liu} INVESTMENT ACCOUN’ OSURE REQUEST FORM Dear Sir / Madam, | /We the Sole Holder / Joint Holders / Guardian (in case of Minor) / Clearing Member request you to close my / our account with you ‘rom the date of this application. The details of my/our account are given below: (To be filled by the BO. Please fil all the details in Block Letters in English) Account Holder's Details po ]1]2 [oy 3] 2] 0 | 0 | Cienti Name of the First / Sole Holder Name of the Second Holder Name of the Third Holder We hereby confirm that (Select any one of the below): )[] We do not have any holding in our account, ) [] The balance stock in our account should be transferred to our DP A/C No. Off Market DIS attached for transfer and Client Master Copy of other DP Account attached herewith. ¢)[_] Please sale the balance shares from my account and send the proceed to my registered bank account with you. @) (J Please remateriaize our shares and send them to us (Remat request enclosed herewith). Declaration : In case of Account Closure due to Shifting of Account: 1/ We declare and confirm that all the transactions in my/our demat account are true / authentic. Reasons for Closing Account: We hereby request you to close our following Investment Accounts with you a) Equity code no. b) Derivative code no. ) Commodity code no. ) Mutual Fund code no. We hereby understand that our account closure request will not be processed under the following circumstances: a) There is an unpaid amount in the Financial Ledger. b) We have given a Demat Request which is not processed by registrar ie. Stocks are not crecited to my/our account. ©) There is Stock Balance in my/our Account and We have not given instructions for transferring the same First / Sole Holder ‘Second Holder Third Holder Name Signature Office Use Maker: Closed Date: /__/20__ Checker: Place Depository Participant Seal and Signature ‘Acknowledgement Slip Date: We hereby acknowledge receipt of your instruction for closing the following account subject to veritication 8010 ACMILL Client Code Name of the First Holder For Asit C. Mehta Investment Interrmediates Ltd, Signature of Official