C B MANAGEMENT SERVICES (P) LIMITED

P-22, BONDEL ROAD, KOLKATA-700 019

Doc.No.
APPLICATION FORM FOR TRANSMISSION/TRANSPOSITION/CONSOLIDATION OF FOLIOS/ NAME
CORRECTION/ DELETION ETC
(PLEASE READ INSTRUCTIONS ON REVERSE)
UNIT: …………………………………………….

PLEASE FILL UP IN CLEAR BLOCK LETTERS

A) TYPE OF REQUEST (Tick relevant box) (1) TRANSMISSION (2) TRANSMISSION THROUGH NOMINATION

(3) TRANSPOSITION (4) CONSOLIDATION OF FOLIOS (5) CORRECTION/ CHANGE OF NAME //SURNAME

(5) DELETION OF NAME (6) OTHERS, IF ANY

(B) REGISTERED FOLIO NO. (The (The folio is mentioned on the front/reverse of the certificate)

(C) NAME OF THE HOLDER(S) (As endorsed on certificate(s)

(1)
(2)
(3)

(D) PARTICULARS OF SHARE (if space provided is insufficient, then continue reverse)

CERTIFICATE NO. DISTINCTIVE NOS. NO.OF SHARES

(E) TOTAL NO. OF SHARES

(F) TO BE TRANSMITTED/TRANSPOSED IN FAVOUR OF (In case of consolidation, do not fill up this column)
NAME PAN/GIR OCCUPATION F/H NAME
(1) …………………………………………… ……….………………... ………………... …………………………
(2) …………………………………………… ………..……………….. ………………… …………………………
(3) …………………………………………… …….…..……………….. ………………… ………………………….

(G) FULL ADDRESS OF FIRST HOLDER (H) BANK DETAILS

1) Name of Bank: ………………………………………...
…………………………………………………………………. 2) Type of A/c – SB/CA/NRE/NRO
…………………………………………………………………. 3) A/C NO.: ………………………………………………
…………………………………………………………………. 4) IFSC CODE: …………………………………………..
CONTACT NOs.: …………………….. 5) MICR NO: …………………………………………….
Email Id :…………………………. PINCODE
…………………………………………
(I) SPECIMEN SIGNATURE of all
CLAIMANT(s)
J) FOR OFFICE USE ONLY
DOC.Regn. no. Date of Regn. (1) …. ………………………………………………………..
(2) …..………………………………………………………..
NEW FOLIO NO: (3) ……………………………………………………………
(Duly attested by the Bank Manager
PROCESSED BY: confirming the Bank Account & Signatures of A/c Holders)
Name:
Code No:
Bank Branch with address:
Phone No:
E-mail Id:
Bank Seal:

INSTRUCTIONS
(1) IN CASE OF TRANSMISSION

1) In a Joint Account no names can be deleted APART from the name of the deceased nor can any fresh names be added.

2) Request for Transmission CANNOT be put through in case of shares standing in the singly name of the deceased
merely on the basis of death Certificate. Proper legal documents are required to be submitted.

(II) IN CASE OF TRANSPOSITION

1) Request for Transposition of names can be made for full holdings only.

(III) IN CASE OF CONSOLIDATION OF FOLIOS

1) Consolidation of folios can be done only if order of names are identical in both the accounts.
2) Only one form is required to be filled up if more than one folio is to be consolidated.
3) There is no need to fill up column no. F
4) Mention Register Folio No. in which the shares are to be consolidated.

(IV) PARTICULARS OF SHARE CERTIFICATE(S) (continued from front):

CERTIFICATE NO. DISTINCTIVE NOS. NO. OF SHARES

………………………………………………. ………………………………………………. ……………………………………………….

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