Spaisa Capital Limited Su Infotech Park, 15 Floor, Plot NoB-23, Road No 16V, MIDC, Thane Industrial Area, Wagle Estate, ‘Thane, Maharashtra 400 604. Tel + 91 89766 89766: E-mail supportaSpaisacom DSL DP ID: 12082500 eign tat ACCOUNT CLOSURE REQUEST FORM ay Closure initiated by 0 80 0 DP G CDsL {Tobe filed y the 30 fn case of 8O-ntate closure) Pleas fl al he deals» BLOCK LETTERS in Falsh ‘CLOSURE FOR © Only Trading Ale C Only Demat Ale © Both (Pease Tick) whichever ap Application No SEGMENT 0 Cash & F&O C Currency (Pease Tice (v) whichever is applicable) # LOGIN ID (For Trading A/C) Date # CDSL BO ID: 12082500 - (For Demat A/C) | We the Sole Holder Joint Holders Guardian (in case of Mi thisapplication, Thedetails of my/our accountare given below. ACCOUNT HOLDER'S DETAILS: Clearing Member request you to close my/ our account with you fram thedateof Name of the Fist / Sole Holder Name of the Second Holder Name of the Third Holder [Address for Correspondence Gay State PIN DETAILS OF REMAINING SECURITY BALANCES IN THE ACCOUNT (IF ANY) Reasons for Closing the Account| Balance remaining inthe account (i any) to be 1 Partly rematerialised and parly transferred LH Remateralsed 1 tens DPD. Ghent 1D Balance present ina/e for (To be filled by DP, applicable] Ear - marked 1 pledged C1 Pending for Dematerialisation L] Frozen L] Pending for Rematerialisation L] Lock-in DECLARATION: In case of Account Closure due to SHIFTING OF ACCOUNT: (We declare and confirm that all the transactions in my/ our demat account are true) authentic. First/ Sole Holder ‘Second Holder Third Holder red to anal er account (Number given T Not applicable Name SIGNATURE INSTRUCTIONS TO ACCOUNT HOLDER(S): > Suomita duly filed RRF ifthe balances aretoberemateialized > Submita duly-tiled Delvery Instruction Sip [IS] (off market instruction slip) thebalancesareto be transferred ta another isnotapplicable in tnecaseo# “SHIFTING OF ACCOUNT, TRANSFER CUM CLOSURE > Accountsopenedin thenameofProprietoship/Partnership/ HUF/Corporats/Tusts stampot therespectveentityhastobeaffxed along withthesignature > all thenecessary details along with thesignature should be led in with Black o ue ink ony. I the farmisilled& signedw th other inkor pene, the samewiliberejected > Incase of TRANSFER CUM CLOSURE, reason fo closing theaccount should be "SHIFTING OF ACCOUNT > Incase of TRANSFER CUM CLOSURE atest Client Master Report (DPM generated) duly stamped &signed by oficial ofthenew DP isrequired. + HDPorCDStinitatesaccountclosure, Signatures) of account holders) not required unt. This equitemen *Client's contactnumber + For DP use only + Closure Instruction ID Closure Release Di Maker Sign Checker Sign Spaisa Capital Limited Application No, bat Weherebyacnowledgethereclotoftheyournstruction for Cong the following Account subject to veto: ‘PID: €DS-72002500 ‘Cer reer Tame oftheSecona older Name ofthe ald Reson for Close Depository Participant Seal and Signature