Reliance Securities Limited, 11th floor, R-Tech I T Park, Western Express Highway, Goregoan (E), Mumbai - 400 063,

Maharashtra, Tel.: 022-33201212

Requisition form for Addition/Deletion/Modification of Account Details
(TO BE FILLED IN CAPITAL BLOCK LETTERS IN BLACK/BLUE INK ONLY)
Name of First Holder
Trading Client ID Date of Birth
First Name Middle Name Last Name
I/We request you to make the following Addition/Deletion/Modification to my/our account in your records. Account details are as under:
ADDRESS & CONTACT DETAILS
Category New Details
oCorrespondence
oPermanent
oSignature
New Mobile No. New Email ID
Line 1
City
State Pincode Country
I/We wish to update the above changes in KRA/ Demat / Trading account.
BANK DETAILS
Addition
o
oModification
oDeletion
New Details Existing Details
Bank Name
Account Number
Bank Name
Account Number
IFSC
MICR
Bank details: o o o
bank authorities not older than two months with cancelled cheque
Copy of cheque with name printed, Copy of bank passbook with cancel cheque, Copy of bank statement of accounts duly attested by
NSE FO BSE FO NSE Currency
o

oo
OTHER MODIFICATION: Running Account Authorisation - Settlement Preference (Tick any one)

o
Once in a calendar Quarter


o
Once in a calendar Month
I/We hereby confirm and consent to retain an amount of upto Rs. 10,000/-
(net amount across segment and across stock exchanges), as per Exchanges circular.
This authorisation shall remain valid until it is revoked by me/us
Income Declaration
Declaration : 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 information is found to be false or
untrue or misleading or misrepresenting, I am/we are aware theat I/we may be held liable for it. Documents pertaining to Rights & Obligations were made available to me/us.
I/we hereby authorize and request Reliance Securities to provide the above details to Reliance Commodities, for updating the same in my Commodity trading account with them.
First/Sole Holder
Name
Second Holder Third Holder
Signature
OFFICE USE ONLY (FOR IN PERSON VERIFICATION)

o
(Originals Verified) Self Certified Document copies received
Employee Name___________________________________
SAP ID: ______________ Designation: _______________ Signature

o
(Attested) True copies of documents received
ACKNOWLEDGMENT RECEIPT FOR CUSTOMER
Date:
QRC No: Name of client
Trading Client ID:
Type of Request
Branch Name Signature & Seal
0 - 1 Lac 1 Lac - 5 Lacs 5 Lacs - 10 Lacs
ooo
10 Lacs - 25 Lacs 25 Lacs and above
oo
DP ID
Pan No. D D M M Y Y Y Y
IFSC
MICR

o
Activation Deactivation
o
EXCHANGE SEGMENT
Date D D M M Y Y Y Y
Address Proofs: Passport, Voter ID card, Driving license, Bank passbook/statement with cancel cheque, Electricity bill (not more than
two months), Telephone bill - Land line (not more than two months) Identity Proof: Pan Card, Passport, Voter ID card, Driving license, UID Card
ooooo o
o ooooo
UID Card,
Line 2
Line 3
1 3 0 4 1 4 0 0
BO ID:
Old Signature New Signature
Ver 3.2 / June 2014 Reliance Securities Limited
BO ID
Primary
o
Secondary
o
Contact Details
QRC No: Branch Code:
NSE SLBS
o