Form ISR – 1
(see SEBI Circular No. SEBI/HO/MIRSD/MIRSD-PoD-1/P/CIR/2023/37 dated March 16, 2023 on Common and Simplified Norms for processing investor’s service request by RTAs and norms for furnishing PAN, KYC details and Nomination)
REQUEST FOR REGISTERING PAN, KYC DETAILS OR CHANGES / UPDATION THEREOF
[For Securities (Shares / Debentures / Bonds, etc.) of listed companies held in physical form]
Date: 29-03-2024  
A.  I / We request you to Register / Change / Update the following (Tick ✔ relevant box)


B.  Security Details:

Name of the Issuer Company Folio No.:
No folio details. Click on Add Folio
Name(s) of the Security holder(s)
as per the Certificate(s)
1
2
3
Number & Face value of securities
No. of Securities
Rs.
Distinctive number of securities (Optional)
No distinctive numbers. Click on Add

C.  I / We are submitting documents as per Table below (tick ✔ as relevant, refer to the instructions):

  Document / Information / Details Instruction / Remark
1 PAN of (all) the (joint) holder(s)
     PAN

Whether it is Valid (linked to Aadhaar):
1
2
3


PAN shall be valid only if it is linked to Aadhaar by March 31, 2023*
For Exemptions / Clarifications on PAN, please refer to Objection Memo in Page 6 & 7
2   Demat Account Number
(Optional)
Also provide Client Master List (CML) of your Demat Account, provided by the Depository Participant.
3   Proof of Address of the first holder Any one of the documents, only if there is change in the address;








4   Bank details
IFSC Code
Account Number
Bank Name
Branch Name

Provide the following:
5   E-mail
address #

6   Mobile #
* or any date as may be specified by the CBDT (DP: Depository Participant)
# In case it is not provided, the details available in the CML will be updated in the folio
Authorization:I/ We authorise you (RTA) to update the above PAN and KYC details in following additional folio(s) held in my / our name (use Separate Annexure if extra space is required):
S.No Nameof the Issuer Company Folio No. Quantity of securities Face value of securities Distinctive number of securities (Optional)
1
2
3
4
5
 

in which I / We are the holder(s) (strike off what is not applicable).


Declaration: All the above facts stated are true and correct.


  Holder 1 Holder 2 Holder 3
Signature


Name
Full Address





PIN Code
 Copy from 1st holder  Copy from 1st holder