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1. NameofTradingMember&DP: MIRAEASSETCAPITALMARKETS(INDIA)PRIVATELIMITED
SEBIRegistrationNoandDate:StockBroker(NSE&BSE):- INZ000163138(22/01/2018), DepositoryParticipant(CDSL):-IN-DP-589-2021(24/05/2021),
Merchant Banker :- MB/INM000012485 (14/03/2018), Research Analyst :- INH000007526 (14/01/2020), Trading and Clearing Member Code: 90144 and
M52040, BSEClearingNo:6681, CDSLDPID:12092900, AMFIRegistered(ARN) MutualFundDistributor:188742
PANNoandGSTRegistrationNo.: AALCM3742Kand27AALCM3742K1Z3
RegisteredOfficeAddress: UnitNo506,5thFloor,WindsorBldg.,Kalina,Off.CSTRoad,Santacruz(East), Mumbai-400098 Tel.:022-62661300
Main / Correspondence Office Adress : Unit No 502, 5th Floor, Leela Business Park, Andheri Kurla Road, Near Airport Road Metro Station, Andheri (East),
Mumbai–400059 Tel: 18002100818 EmailID:help@mstock.com
2
Modication of
1
1. Address Details Existing Details New Details
PLEASE FILL ALL THE DETAILS IN BLOCK LETTERS IN ENGLISH (Please mark (ü) on the appropriate box)
Account Holder’s Details
2. Contact Details Existing Details New Details
PAN:
Correspondence
Permanent
Registered
3
*If Mobile No./Email ID is of 'Other than Self', please provide the following details.
2a. Mobile No.
2b. Email ID
City:
State:
Country: Pin Code:
City:
State:
Country: Pin Code:
Addition
Or
Modication
Spouse Dependent children Dependent parents Authorised Signatory Director Trustee
Spouse Dependent children Dependent parents Authorised Signatory Director Trustee
Tel No.:
Mobile No. of: Self Other than Self*
Mobile No.:
Email ID:
Email ID of: Self Other than Self* Email ID of: Self Other than Self*
Tel No.:
Mobile No. of: Self Other than Self*
Mobile No.:
Email ID:
Name of the person whose mobile number has been provided:
Name of the person whose email id has been provided:
ACCOUNT DETAILS ADDITION/MODIFICATION REQUEST FORM (BROKING/DEMAT ACCOUNT)
Seal and Signature
Acknowledgment Receipt
We hereby acknowledge the receipt of the your instruction for modication of the following Account subject to verication:
Address Details Mobile No./Email ID Declaration Gross Annual Income Details
Modication request for
NOTES: 1. For Address Details update please submit any one of the proofs (Self attested by client and all joint holders): Copy of Passport, Driving License, Proof of possession of Aadhaar number,
Voter's Identity Card issued by Election Commission of India, Job card issued by NREGA duly signed by an ofcer of the State Government, Letter issued by the National Population Register
containing details of name, address, or any other document as notied by the Central Government in consultation with the Regulator. 2. For Individual account use the form to update either
Correspondence or Permanent address. For Non-Individual account use the form to update either Correspondence or Registered address. 3. Other than the persons specied, Mobile
No./Email ID of no other persons can be updated.
Dear Sir/Madam,
CDSL DP ID: 1 2 0 9 2 9 0 0 BO ID: Client Code:
Date: D D M M Y Y Y Y
I/We request you to make the following additions/modications to my/our KRA record/CERSAI record/Broking/Demat account in your records.
CDSL DP ID: 1 2 0 9 2 9 0 0 BO ID: Client Code:
Date: D D M M Y Y Y Y
Contact Details
Second Holder Third Holder
Signature
Client Name
First/Sole Holder/Authorized Signatory
3. Gross Annual Income Details as on the Date of this Declaration: Income Range per annum (Please Specify)
Net worth should not be older than 1 year. In case of Non-Individual, Gross Annual Income Details and Net Worth both are required.
Net worth as on (Date) `
Below `1 Lac 1 - 5 Lacs 5 - 10 10 - 25 more than - `25 Lacs
` ` `
Lacs Lacs
In Person Verication/Original Veried/Signature in My Presence CDSL DP ID:
Branch : Employee Name : Employee Code:
Employee Sign. : Date: Place:
1 2 0 9 2 9 0 0
D D M M Y Y Y Y
I/We hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief. In case any of the above mentioned information is found to be false or
untrue or misleading or misrepresenting, I/we am/are aware that I/we may be held liable for the same. Further, I/we hereby give my/our consent to MACM that in future if they receive my/our
updated annual income details / net-worth details, if any, then they are authorized to update the same in my/our broking and/or demat account with them, in my/our records with the stock
exchanges, depositories and/or any other regulated entities, and/or to any regulatory authorities without seeking any conrmation from me/us in this regard.
MIRAE ASSET CAPITAL MARKETS (INDIA) PRIVATE LIMITED