Application Form for Change in Name on Ration Card

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Application Form for Change in Name on Ration Card Powered By Docstoc
					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
 1
 2
 3
 4

Full Address of First Holder
                                                              Reason for change in Signature




                    PIN CODE

                                                              Specimen Signature(s) of all Holders
       Attestation by a Bank Manager only
Name :
                                                              1. _____________________________
Signature and Stamp :
                                                              2. _____________________________
Designation :

S/B A/c. No. :                                                3. _____________________________

Name & Address of Bank
                                                              4. _____________________________

                                                              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
(3)      Passport
(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.
 Etc.

				
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Description: Application Form for Change in Name on Ration Card document sample