Motilal Oswal Financial Services Limited

DEMATERIALISATION SEBI Regn. No. IN-DP-NSDL-152-2000

2nd Floor, Palm Spring Centre,
REQUEST Malad-Link Road, Malad - (W),
FORM Mumbai – 400 064
(RTA / MOFSL COPY) Tel. : (91-22) 7188 1001 Fax : 2844 9200

Please fill all the details in BLOCK LETTERS in English. (Fill up a separate DRF for Free securities and Locked – in securities).
DP ID I N Client ID

Serial No.
23049 DRN No. Date:

(To be filled up by MOFSL)

I / we request you to dematerialize the enclosed certificates registered in my / our name into my / our account.

Sole/First Holder Name

Second Holder Name
Third Holder Name R
T
Details of Securities: o Free Securities o Locked -in Securities
Name of the Company A
ISIN
Type of Security o Equity o Debentures o Bonds o Units o Others (Specify)
Total Number of Certificates
Quantity to be in figures
Face Value of Securities
C
Dematerialized in words Quantity should match with that in figures O
Folio No.
Certificate From P
Number
Distinctive
To
From
Y
Number To
Quantity

Details of Locked-in Securities:

Lock-in reason
Lock-in release date

(In case the space is found to be insufficient, an annexure containing the certificate details in the same format may be attached.
Please use separate form for free securities and locked-in securities)
Declaration
I/We hereby declare that the above mentioned securities are registered in my/our name. The original certificates are hereby
surrendered by me/us for dematerialization. I/We also hereby declare that the securities surrendered by me/us for dematerialization are
free from any lien or charge or encumbrance and represents the bonafide securities of the companyto the best of my/our knowledge and
belief.
Holder(s) Signature(s)

Sole/First Holder Name

Sign Here
Second Holder Name Sign Here
Third Holder Name Sign Here
Participant Authorization

We have received the abovementioned securities for dematerialization. The application form is verified with the certificates surrendered for
dematerialization and we certify that the application form is in accordance with the details mentioned in the enclosed certificates. It is also certified that
the holders ofthe securities have beneficiaryaccount with us in thesame name(s).

Name of the Executive:

Date:
Participant’s Stamp & Signature
 Motilal Oswal Financial Services Limited

DEMATERIALISATION SEBI Regn. No. IN-DP-NSDL-152-2000

2nd Floor, Palm Spring Centre,
REQUEST Malad-Link Road, Malad - (W),
FORM Mumbai – 400 064
(RTA / MOFSL COPY) Tel. : (91-22) 7188 1001 Fax : 2844 9200

Please fill all the details in BLOCK LETTERS in English. (Fill up a separate DRF for Free securities and Locked – in securities).
DP ID I N Client ID

Serial No.
23049 DRN No.
(To be filled up by MOFSL)
Date:

I / we request you to dematerialize the enclosed certificates registered in my / our name into my / our account.

Sole/First Holder Name M

Second Holder Name O
Third Holder Name
F
Details of Securities: o Free Securities o Locked -in Securities S
Name of the Company
ISIN L
Type of Security o Equity o Debentures o Bonds o Units o Others (Specify)
Total Number of Certificates Face Value of Securities
Quantity to be in figures C
Dematerialized in words Quantity should match with that in figures
Folio No. O
From
Certificate
Number To
P
Distinctive From Y
Number To
Quantity

Details of Locked-in Securities:

Lock-in reason
Lock-in release date

(In case the space is found to be insufficient, an annexure containing the certificate details in the same format may be attached.
Please use separate form for free securities and locked-in securities)
Declaration
I/We hereby declare that the above mentioned securities are registered in my/our name. The original certificates are hereby
surrendered by me/us for dematerialization. I/We also hereby declare that the securities surrendered by me/us for dematerialization are
free from any lien or charge or encumbrance and represents the bonafide securities of the companyto the best of my/our knowledge and
belief.
Holder(s) Signature(s)

Sole/First Holder Name

Sign Here
Second Holder Name Sign Here
Third Holder Name Sign Here
Participant Authorization

We have received the abovementioned securities for dematerialization. The application form is verified with the certificates surrendered for
dematerialization and we certify that the application form is in accordance with the details mentioned in the enclosed certif icates. It is also certified that
the holders ofthe securities have beneficiaryaccount with us in thesame name(s).

Name of the Executive:

Date:
Participant’s Stamp & Signature