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India Infoline Ltd., IIFL House, Sun Infotech Park, Road No. 16V, Plot No. B-23, MIDC,
Thane Industrial Area, Wagle Estate, Thane - 400 604 Tel: (91-22) 2580 6650 • Fax: (91-22) 2580 6654
First/Sole Holder
Second Holder
Third Holder
Authorised Signatories
Names Signatures
Note:
1. Please note that incase of accounts opened in the name of Proprietorship/ Partnership/ HUF/ Corporates/ Trusts stamp of the respective entity has to
be affixed along with the signature.
2. All the necessary details along with the signature should be filled in with Black or Blue ink only.If the form is filled & signed with other ink or pencil,
the same will be rejected.