Document No :

Request for new DIS ( as per Revised Format )

Depository Dept,
Geojit BNP Paribas Financial Services Ltd,
34/659-P, Civil Line Road,Padivattom,
Kochi-682 024.
I/We hereby request to issue a new DIS booklet in the below noted accounts as per the details given
below (tick the appropriate option and strike off the other one);
Option -1: Send the booklet directly to my correspondence address given in the
demat account.
Option-2: Send the booklet to your ................................................office. I/We will
arrange to collect it in-person or through an authorised bearer from the same office
whose details are authorised below. (Person collecting new booklet should provide
an identity document).
{Bearer Name:

Client Ids:

Bearer Signature:

1.
2.
3.
Sole or First Holder

Joint Holder-1

Joint Holder-2

Name of a/c
holder/s

Signature of
a/c Holder/s
Place :
Date :
For GBNPP branch use only:
Date :

Employee Name:

Office Seal:

Emp.Code:
Emp.Signature:
Remarks if any:

Geojit BNP Paribas Financial Services Ltd 34/659-P, 1st Floor, Civil Line Road, Padivattom, Kochi - 682024
Send your queries to customercare@geojit.com or call our Customercare at Toll Free Line : 1800 425 5501, 1800 103 5501
(within India) or +91 0484 3911777 (Paid Line) Monday to Friday 8:30 A.M to 5:30 P.M. Saturdays : 10:00 A M to 1:00 P M