Application Form Application No :

KYC form for opening a Demat account (For Individuals)

Aditya Birla Money Limited

Trading ID : 788903
Demat A/c No :

Application Type : New Modified Photograph

KYC Mode : Normal EKYC OTP EKYC Biometric

Online KYC Offline KYC Digilocker

Identity Details
Name of the Applicant VENUGOPAL PANNALA
Maiden Name

Father’s / Spouse Name SURYABHAGAVANULU PANNALA

Date of Birth 22 / 06 / 1971

Nationality Indian Residential Status Resident Individual
Gender Male Female Transgender
Marital Status Single Married Others
Pan Number AIKPP5296R
Proof of Identity (PoI) Aadhar Passport Driving Licence Voter ID
Proof of Identity No 0783 Proof of Identity Exipry Date

Address Details

Permanent Address C-204 INDIS ONECITY,NEAR MALAYSIAN TOWNSHIP,KPHB PHASE-IV,KUKATPALLY,KPHB COLONY,MEDCHAL-

MALKAJGIRI

City malkajgiri District malkajgiri State Telangana Pincode 500072

Country India Mobile No 9052000742
Tel (Res) Tel (Off.) Email pv_gopal@yahoo.com
Specify the proof of address Telephone Bill Electricity Bill Passport DL Bank statment
submitted for Residence /
Correspondence Aadhar Voter ID Ration Lease Agreement

Others

Correspondence Address C-204 INDIS ONECITY,NEAR MALAYSIAN TOWNSHIP,KPHB PHASE-IV,KUKATPALLY,KPHB COLONY,MEDCHAL-

MALKAJGIRI

City malkajgiri District malkajgiri State Telangana Pincode 500072

Country India

Address Type Residential/ Residential Business Registered Unspecified

Business Office
Declaration
I/We hereby declare that the KYC details furnished by me are true and correct to the best of my/our knowledge and belief and I/we under-take to inform you of any changes therein, immediately. In case any of the
above information 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.

I/We hereby consent to receiving information from Central KYC Registry/CVL KRA/NDML KRA/DOTEX KRA/CAMS KRA/KARVY KRA/BSE KRA through SMS/Email on the above registered number/Email address.

I am/We are also aware that for Aadhaar OVD based KYC, my KYC request shall be validated against Aadhaar details. I/We hereby consent to sharing my/our masked Aadhaar card with readable QR code or my
Aadhaar XML/Digilocker XML file, along with passcode and as applicable, with KRA and other Intermediaries with whom I have a business relationship for KYC purposes only.

Date 25/02/2024 Place malkajgiri Signature of Applicant

For Office use Only

KYC Verification Document Verification with IPV Signed by: VENUGOPAL PANNALA
Reason: Account Update with Aditya Birla Money Ltd by Aditya
Birla Money
eSigned using Aadhaar (digio.in)
Name & E Code Aadhaar OVD or exempted Date: 2024-02-25 18:22:10 IST

Designation

Date / /

Signature
Bank Details (Through which transactions would be routed. Details &1 proof of bank account(s) is required)

Account Type Savings Current Others (Please specify

Bank Account No. 03171140013851

PIS A/C No ( In case of NRI)

MICR Number 5 0 0 2 4 0 0 0 9 H D F C 0 0 0 0 3 1 7
Bank Name HDFC BANK LTD
Bank Address PLOT NO 1355 A,ROAD NO 1 & 45,JUBILEE HILLSHYDERABADANDHRA PRADESH500033

HYDERABAD
City Pincode
State
ANDHRA PRADESH Country INDIA
Please provide additional bank account details (if any) as annexures with proofs.

C. TRADING PREFERENCES
Please sign in the relevant boxes where you wish to trade. Please strike off the segment not chosen by you.

Exchanges NSE & BSE MCX,NCOEX

Cash/
All Segments F&O Currency Commodity Derivatives
Mutual Fund

I do not wish to enable Exchange

# If, in future, the client wants to trade on any new segment/new exchange, separate authorization/letter should be taken from the
client by the stock broker.

1. Gross Annual Income Details (Please Specify) Income range per annum: D Below t 1 Lac D t 1-5 Lac D t 5-10 Lac D t 10-25 Lac D More than t 25 Lacs
OR
Net-worth (Net worth should not be older than 1 year) Amount t as on (date) Dj D
25 / M M
02 / Y lY
2024 Y YJ

2. SMS Alert 0 Yes 0 No

DECLARATION

■ I would like to reactivate my account and hereby acknowledge/confirm that all the transactions in my trading acount were effected
by me and am in receipt of quarterly statement of accounts, trade confirmations through SMS, contract note etc, on all the trade
dates from the date of account opening till date.

■ I hereby further confirm that I have no claim or disputes pertaining to till date and as such declare that i will not make any claim with
reference to the transactions that have been carried out in the aforementioned trading account at any furure date.
■ I hereby consent to receiving information from Central KYC Registry/ KRA/Exchanges /Depositories (as per Annexure - 2.4 Terms
And Conditions-cum-Registration / Modification Form for receiving SMS Alerts from CDSL Definitions) through SMS/Email on the
above registered number/email address
■ Kindly consider my DP holding statement as Income Proof.

Signed by: VENUGOPAL PANNALA

Reason: Account Update with Aditya Birla Money Ltd by Aditya
Birla Money
eSigned using Aadhaar (digio.in)
Date: 2024-02-25 18:22:10 IST
 DigiLocker verified e-Aadhaar
This document is generated from verified Aadhaar XML obtained from DigiLocker with due user consent and authentication

Document type e-Aadhaar generated from DigiLocker verified Aadhaar XML

XML verified

Generation date 2024-02-25T18:05:58.338+05:30 Download date 2024-02-25T18:05:58.338+05:30

Masked Aadhaar number

xxxxxxxx0783
Name Pannala Venugopal

Date of Birth 22-06-1971

Gender Male

c/o , s/o C/O: Suryabhagavanulu

Address C/O: Suryabhagavanulu,C-204 Indis

Onecity,Near Malaysian Township,KPHB
Phase-IV,Kukatpally,Kukatpally,KPHB
Colony,Medchal-malkajgiri,Telangana,500072

Landmark KPHB Phase-IV Locality

City / District Medchal-malkajgiri Kukatpally

Pin Code 500072 State Telangana

Signed by: VENUGOPAL PANNALA

Reason: Account Update with Aditya Birla Money Ltd by Aditya
Birla Money
eSigned using Aadhaar (digio.in)
Date: 2024-02-25 18:22:10 IST

www.digio.in | For Limited Circulation | CONFIDENTIAL

Signed by: VENUGOPAL PANNALA
Reason: Account Update with Aditya Birla Money Ltd by Aditya
Birla Money
eSigned using Aadhaar (digio.in)
Date: 2024-02-25 18:22:10 IST
Signed by: VENUGOPAL PANNALA
Reason: Account Update with Aditya Birla Money Ltd by Aditya
Birla Money
eSigned using Aadhaar (digio.in)
Date: 2024-02-25 18:22:10 IST
Stocks and Securities
Aditya Birla Money Limited
(A subsidiary of Aditya Birla Capital Ltd.)

12. Nomination Option

To,
Aditya Birla Money Limited
Sai Sagar, Plot No: M7
2nd and 3rd Floor, Thiru-Vi-Ka Industrial Estate
Guindy, Chennai – 600 032

Date DDMMYYYY
25022024

UCC 788903

DP ID IN301696

CLIENT ID 11817999

I/We wish to make a nomination (As per details given below)

Nomination Details
I/We wish to make a nomination and do hereby nominate the following person(s) who shall receive all
the assets held in my / our account in the event of my / our death.
Nomination can be made up to three nominees Details of 1st Details of 2nd Details of 3rd
in the account. Nominee Nominee Nominee

1 Name of the nominee(s) (Mr./Ms.) PADMAVATHI PANNALA

2 Share of each Nominee (Equally / in %) 100.00

3 Relationship With the Applicant ( If Any) spouse
Address of Nominee(s) C-204 INDIS
City / Place,State ONECITY,NEAR
Country: MALAYSIAN
TOWNSHIP,KPHB
PIN PHASE-IV,
4 KUKATPALLY,
KPHB COLONY,
MEDCHAL-
MALKAJGIRI

5 Mobile / Telephone No. of nominee(s) 9052700074

6 Email ID of nominee(s) padmavathi.
choppakatla@gmail.
com

Nominee Identification details – [Please tick CFRPP3992Q

7 any one of following and provide details of
same]
Signed by: VENUGOPAL PANNALA
Reason: Account Update with Aditya Birla Money Ltd by Aditya
Birla Money
eSigned using Aadhaar (digio.in)
Date: 2024-02-25 18:22:10 IST
 Pan Demat A/c ID PAN

Aadhar Proof of identity

Photograph &
Bank A/c details Signature

8 13061978
Date of Birth {in case of minor nominee(s)}
Name of Guardian (Mr./Ms.) {in
9
case of minor nominee(s) }
Address of Guardian(s)
City / Place,State
Country:
PIN
10

11 Mobile / Telephone No. of Guardian

12 Email ID of Guardian

13 Relationship of Guardian with nominee

Guardian Identification details – [Please
tick any one of following and provide
details of same]

14 Pan Demat A/c ID

Aadhar Proof of identity

Photograph &
Bank A/c details Signature
Name& Signature (S) OF HOLDER(S)
Sole/First Holder Second Holder Third Holder
VENUGOPAL PANNALA

Note:

This nomination shall supersede any prior nomination made by the account holder(s),if any.

Signed by: VENUGOPAL PANNALA

Reason: Account Update with Aditya Birla Money Ltd by Aditya
Birla Money
eSigned using Aadhaar (digio.in)
Date: 2024-02-25 18:22:10 IST