To, Date: ________________
Sharex Dynamic (India) Pvt. Ltd.
1, Luthra Ind. Premises
Andheri Kurla Road, Safed Pool,
Andheri (E), Mumbai 400 072.
APPLICATION FORM FOR CHANGE IN SIGNATURE(S)
[Duly Completed Form to be submitted in original with three photo copies]
Unit : ___________________ Folio __________________
One form to be filled per folio and specimen signatures of all shares/debentures/bonds holders are
required, Multiple folios will be accepted only if the same names appear in all the folios. The
specimen sign forms are liable to be rejected if the names do not confirm with the folios mentioned.
Sr. Full Name of all share/debenture/bond Father’s/Husband’s Name Present Age
No holders mentioned in folio below
Full Address of First Holder
Reason for change in Signature
Specimen Signature(s) of all Holders
Attestation by a Bank Manager only
Signature and Stamp :
S/B A/c. No. : 3. _____________________________
Name & Address of Bank
Change in Specimen Sign
IMP á Supporting documentary evidence to be submitted Regn. No.: __________ Date:__________
(Read Instructions carefully)
INSTRUCTION FOR DOCUMENTARY EVIDENCE TO BE SUBMITTED
Two of the documents specified below should be submitted along with this Application Form:
(First item compulsory and photocopy of any one from serial No. ‘2’ to ‘6’ )
(1) Covering letter on the Bank’s letter head from the Bank
Manager who has attested this application form for change
in signature, STATING THE S.B. A/C DETAILS INCLUDING COMPULSORY
FULL NAME, ADDRESS, STATUS OF A/C. AND THE
DATE ON WHICH THE A/C. WAS OPENED.
(2) Ration card
(4) Election Voter identify Card
(5) Driving License
NOTE: Sharex Dynamic (India) Pvt. Ltd. reserves the right to reject any application for change in signature
in case we are not satisfied with the supporting documentary evidence
Once registered, a registration number will be furnished to the account holder(s). In future, Please
ensure that this registration number is quoted against every signature, especially those made on
transfer deeds at the time of sale of securities, requests for change of address, requests for interest /
dividend warrants, Etc.