Modification

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To, Trading Code:

IIFL Securities Limited


CDSL DP ID-12044700 BO ID
IIFL House, Sun Infotech Park, Road No. 16V,
Plot No. B-23, MIDC, Thane Industrial Area, NSDL DP ID-IN302269 Client ID
Wagle Estate, Thane - 400 604. PAN
Date: D D M M Y Y Y Y
Dear Sir,
Please make necessary change/add in my / our client account as per details given below, (PLEASE TICK APPROPRIATE OPTION TO MAKE NECESSARY CHANGES)
CHANGE TO BE EFFECTED IN : Trading + Depository Account Depository Account Trading Account
Name of 1st Holder Name Middle Name Surname
Name of 2nd Holder
Name of 3rd Holder
CHANGE OF PERMANENT/CORRESPONDENCE ADDRESS AND TELEPHONE NUMBER (Proof Required)
Permanent Address Correspondence Address
Old Address New Address

Landmark Landmark
City PIN* City PIN*
State State
Tel. No. Fax No. Tel. No. Fax No.

1st Holder 2nd Holder 3rd Holder


Mobile + 9 1 Mobile No. + 9 1 Mobile No. + 9 1 Mobile No.
Number I hereby declare that the Mobile No I hereby declare that the Mobile No I hereby declare that the Mobile No
Declaration belongs to belongs to belongs to
Self Spouse My Children Self Spouse My Children Self Spouse My Children
My Parents My Parents My Parents
Email ID Email ID Email ID Email ID
Email I hereby declare that the Email ID I hereby declare that the Email ID I hereby declare that the Email ID
belongs to belongs to belongs to
Declaration Self Spouse My Children Self Spouse My Children Self Spouse My Children
My Parents My Parents My Parents
BANK DETAILS (Proof required) Update the Given Bank A/C as Default / Future Transaction
Bank Name
Bank A/c No. Type of A/c
MICR No. IFSC Code
Branch Address
DP Details (Proof to be submitted for same) Default Option
LINK DP ID DP NAME CLIENT ID
Update PAN / DOB. 1st Holder 2nd Holder 3rd Holder
Declaration: I/We hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief. In case any of
the above mentioned is found to be false or untrue or misleading or misrepresenting, I am/we are aware that I/we may be held liable for it.

Signature 1st Holder 2nd Holder 3rd Holder

NOTE: 1. Please furnish proper supporting proofs for change in client master.
2. Please submit the same in duplicate for acknowledgment.
3. If changes are to be done in DP-then all holder as per DP A/c must sign the documents.
4. *Family to strictly includes spouse, dependent - children and dependent parents only. (Kindly tick relevant option)
For Office Use Only
Data Maker By
Data Checker By
BRANCH STAMP HO STAMP
Reference No.
Official Sign.

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