ZEBU SHARE AND WEALTH MANAGEMENTS PRIVATE LIMITED DP ID :12080400

CIN : U67120TZ2013PTC019704
DEMATERIALISATION REQUEST FORM
P S K Booshnam Mahal, No 127, First Floor, 100 Feet Bypass Road, Velachery, Chennai-600042
044-48557991 www.zebuetrade.com assist@zebuetrade.com
Please fill all the details in BLOCK LETTERS in English (Fill up a separate DRF for free securities and Locked-in-Securities)
DRF NO. Client ID 1 2 0 8 0 4 0 0
(To be filled up by the Depository Participant) DRN
Date D D M M Y Y Y Y (To be filled up by the Depository Participant)
I/We request you to dematerialise the enclosed certificates / certificates as registered in my / our account

Details of Securities Free Securities Locked-in-Securities

Name of the Company

ISIN
Equity Debentures Bonds
Type of Securities
Units Others(Specify)

No. of Certificates

Face Value of Securities

Quantity to be ( in figures )
Dematerialised ( in words )

Folio No.
From
Certificate Nos.
To
From
Distinctive Nos.
To
Quantity

* if the space above is found to be insufficient, an Annexure containing the certificate details in the same
format may be attached.

In case of Locked - In Securities fill up a separate DRF for Locked - In Securities having different release dates

Lock in Reason

Lock in Release Date

The original certificates / original option letter / documents are hereby surrendered by me / us dematerialisation and the same are free
any lien or change or encumbrance and represent the bonafide securities of the Issuer Company of the best of my / our knowledge
and belief.

First / Sole Holder Second Sole Holder Third Sole Holder

Name

Signature with DP

Signature with RTA

Participant Authorisation (From DP to RTA)

( For Office Use Only )

We have received the above mentioned securitied bearing above ISIN for dematerialisation.
The application form is verified with certificates / original option letter / Documents surrendered for dematerialisation and we certify
that the application form is in a accordance with the details mentioned in the enclosed certificates/documents. It is also certified that
the holder (s) of securities have a beneficiary account with us in the same name(s) and order of name(s).

Name of the Executive Authorised Signatory & Seal