Stock Holding Corporation of India Limited

Registered office : 301, Centre Point, Dr. Babasaheb Ambedkar Road, Parel, Mumbai – 400012 VER 2.1 271211
Visit us at : www.shcilestamp.com

Application Form for Registration as Authorised Collection Center(ACC)

Date D D M M Y Y Y Y

( To be filled in B L O C K L E T T E R S Only)
DETAILS OF ACC
Name of ACC

Registered Office Address

State PIN

Correspondence Address of
Controlling Branch in the State

State PIN

Telephone No. of Controlling Branch C O D E 1st 2nd

Fax No. of Controlling Branch C O D E 1st 2nd

Company Web Address (URL)

PAN Number

Address Registered in PAN site q Registered office q Correspondence office

Name of the Contact Person for

e-Stamping in Controlling Branch

Correspondence Address

State PIN

Direct Number C O D E 1st 2nd

Fax Number C O D E 1st 2nd

Mobile Number 1st 2nd

E-mail Id

BANK DETAILS
Exact beneficiary name as
appearing in Bank Records

Complete Bank Account Number

(without any truncation)

Type of Account Number Whether CBS / RTGS / NEFT compliant q Yes q No

Name of the Bank

Address of the Bank (with PIN)

PIN*

IFSC (in words)

GENERAL INSTRUCTIONS
Please ensure that:

● The form is filled in ENGLISH in BLOCK LETTERS only.

● You have read the ACC AGREEMENT which contains the terms & conditions before filling up this Application Form.

● All fields are mandatory (*Compulsory). Fields not applicable to you should be mentioned as N.A (Not Applicable)

● Each box, wherever provided, should contain only one character each.

● All requisite details and documents have been provided in order to avoid unnecessary delays and / or rejection of your application.

DECLARATION
I/We understand that the Application Form to act as Authorized Collection Center is subject to approval.
I/We have read and agree to be bound by the Terms and Conditions of SHCIL’s ACC Agreement.

Place :

Date :

Authorised Signatory
( In Black Ink Only )

DOCUMENTS TO BE SUBMITTED

Check list:

● Memorandum of Association & Articles of Association / Partnership Deed 

● Copy of the Pan Card (Mandatory) 

● Tax Exemption Certificate (if any) 

● TAN Number 

● Networth Certificate 

● Copy of the Board Resolution 

● Audited Accounts for the last three financial years (if available) 

FOR USE BY CRA- ADMIN ONLY

I verify that the Application Form is in order

ACC Code :

Checked By :

Employee Code :

Signature :

Date :

Remarks :