CDSL Sr. No.
‘BANK OF BARODA
B ezrng nx nrc orcas
BARODA SUN TOWER, GROUND FLOOR, BKC, MUMBAI-400054,
Account Form
Application No. L
ease fil al the details in Block Letters in Engh
DP ID 1[3]0]1]8{|7]0]0 | Cient1>
. I/We request you to make the folowing ations / modifications / deletions to my/our account n your records.
Details to be changed ‘Addition Modification Existing Details New Details
(Please specify: Change of | /Deletion (Please specify)
address; Bank details;
‘Telephone No. etc.) |
PI. attach Proof
> Change of
Address
> Telephone
/Mobile Number
> Bank Details and
‘account number
> Others
(please specify) |
“Aiach an Areva (with Signature) the space above is found wsuficent. ~
] First/Sole Holder ‘Second Holder ‘Third Holder ]
. Name
Signature
Branch verfication/certificate: -
1) Verified 80s) Signature (s) For Bank of Baroda
2) Verified proof submitted for A/c modification
3) Recovered A/c modification charges, where applicable,
(Branch) Participant Seal ‘Authorized Signatory
Date:
_ (Please Tear Here)
‘Acknowledgement
Received Account Details Adltion / Modification / Deletions request as per details given below
‘pplication No. Date
. DP ID 1|3|0/1/8/7|0\0 nt ID
Tiame/s Of the Account Holder/s
For Bank of Baroda
(Branch) Participant Seal Authorized Signatory