Request for Transmission of Securities by Nominee or Legal Heir (For Transmission of securities on death of the Sole holder)

To:

The Listed Issuer/RTA,

(Address)

Annexure C - ISR 5

______________________________________ (Name of the Listed Issuer/RTA)

Name of the

Claimant(s)

Mr./Ms.

Name of the Guardian

in case the claimant is a minor→ Date of Birth of the minor*

Mr./Ms.________________________________________________________________________

Relationship with Minor:

Father

Mother

Court Appointed Guardian*

[Multiple PAN may be entered] PAN (Claimant(s)/Guardian): | | | | |

| | |

| || KYC

Acknowledgment attached

KYC form attached

Tax Status: Resident Individual

Resident Minor (through Guardian)

NRI

PIO

Others

(please specify)

*Please attach relevant proof

I/We, the claimant(s) named hereinabove, hereby inform you about the demise of the below mentioned Securities Holder(s) and request you to transmit the securities held by the deceased holder(s) in my/our favour in my/our capacity as -

Nominee

Legal Heir Successor to the Estate of the deceased

Administrator of

the Estate of the deceased

Name of the deceased holder(s)

Date of

demise**

1)

DD / MM / YYYY

2)

DD / MM / YYYY

3)

DD / MM / YYYY

**Please attach certified copy of Death Certificate.

Securities(s) & Folio(s) in respect of which Transmission of securities is being requested

No. of

%

of

Name of the Company

Folio No.

Securities

Claim@

1)

2)

3)

4)

@As per Nomination OR as per the Will/Probate/Succession Certificate/Letter of Administration/ Legal Heirship Certificate (or its equivalent certificate)/ Court Decree, if applicable.

Contact details of the Claimant (s) [Provision for multiple entries may be made]

Mobile No.+91| | | | | | | | | |Tel. No. STD -

Page 1 of 3

Email Address

Address (Please note that address will be updated as per address on KYC form / KYC Registration Agency records)

Address Line 1

Address Line 2

City:

State

PIN | | | | | |

Bank Account Details of the Claimant

Bank Name

Account No.

|11-digit IFSC |

|

| | | | | |

| | |

A/c. Type (✓)

SB Current NRO NRE FCNR

| 9-digit MICR No.| |

|

| | | | | |

Name of bank branch

City

PIN | | | | | |

Please attach &tick✓ Cancelled cheque with claimant's name printed OR Claimant's Bank Statement/Passbook (duly attested by the Bank Manager)

I also request you to pay the UNCLAIMED amounts, if any, in respect of the deceased securities holder(s) by direct credit to the bank account mentioned above.

Additional KYC information (Please tick✓whichever is applicable)

Occupation

Private Sector Service

Public Sector Service Government Service

Business

Professional

Agriculturist

Retired Home Maker

Student Forex Dealer

Others_________________________________ (Please specify)

The Claimant is a Politically Exposed Person Related to a Politically Exposed Person Neither (Not applicable)

Gross Annual Income (₹) Below 1 Lac

1-5 Lacs 5-10 Lacs 10-25 Lacs 25

Lacs-1crore >1 crore

FATCA and CRS information

Country of Birth __________________________________Place of Birth _____________

Nationality _____________

Are you a tax resident of any country other than India? Yes No

If Yes, please mention all the countries in which you are resident for tax purposes and the associated Taxpayer Identification Number and its identification type in the column below

Country

Tax-Payer Identification Number

Identification Type

Page 2 of 3

Nomination@ (Please✓one of the options below)

I/We DO NOT wish to make a nomination. (Please tick ✓ if you do not wish to nominate anyone)

I/We wish to make a nomination and hereby nominate the person/s more particularly described in the attachedNomination Form to receive the securities held in my/our folio in the event of my / our death.

@ Guardian of a minor is not allowed to make a nomination on behalf of the minor

Declaration and Signature of the Claimant(s)

I/We have attached herewith all the relevant / required documents as indicated in the attached Ready Reckoner as per Annexure A.

I/We confirm that the information provided above is true and correct to the best of my knowledge and belief.

I/Weundertaketokeep

________________________________________________________ (Name of the

Company) / its RTA informed about any changes/modification to the above information in future and also undertake to provide any other additional information as may be required by the RTAs.

I/Weherebyauthorize

________________________________________________________ (Name of the

Company) and its RTA to provide/ share any of the information provided by me/us including my holdings in the (Name of the Company) to any governmental or statutory or judicial authorities/agencies as required by law without any obligation of informing me/us of the same.

Place___________________________

Date

Signature of Claimant(S)

Documents Attached

  • Copy of Death Certificate of the deceased holder
  • Copy of Birth Certificate (in case the Claimant is a minor)
  • Copy of PAN Card of Claimant / Guardian
  • KYC Acknowledgment OR
  • KYC form of Claimant

Cancelled cheque with claimant's name printed OR

Claimant's Bank

Statement/Passbook

Nomination Form duly completed

  • Annexure D - Individual Affidavits given EACH Legal Heir
  • Original security certificate(s)
  • Annexure E - Bond of Indemnity furnished by Legal Heirs
  • Annexure F - NOC from other Legal Heirs

*Note: For transmission service requests, Form ISR-4 as per SEBI circular SEBI/HO/MIRSD/MIRSD_RTAMB/P/CIR/2022/8 dated January 25, 2022 will not be required.

Page 3 of 3

Attachments

  • Original Link
  • Original Document
  • Permalink

Disclaimer

Radico Khaitan Limited published this content on 12 May 2023 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 12 May 2023 06:12:09 UTC.