Form ISR – 1
(see SEBI circular No. SEBI/HO/MIRSD/MIRSD_RTAMB/P/CIR/2021/655 dated November 03, 2021 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: 29-06-2022  
  1. I / We request you to Register / Change / Update the following (Tick ✔ relevant box)

  2. 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
  3. 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, 2022*
    For Exemptions / Clarifications on PAN, please refer to Objection Memo in page 4
    2   Demat Account Number 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:
      original cancelled cheque with name of security holder printed on it or Bank Passbook or Bank Statement attested by the Bank #
    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 my / our folio (s) _________, ________,(use Separate Annexure if extra space is required) 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