Page 357 - Tata_Chemicals_yearly-reports-2021-22

Form ISR – 1

(SEBI circular No. SEBI/HO/MIRSD/MIRSD_RTAMB/P/CIR/2021/655 dated November 03,2021)
REQUEST FOR REGISTERING PAN, KYC DETAILS OR CHANGES / UPDATION THEREOF
[For Securities (Shares / Debentures / Bonds, etc.) of listed companies held in physical form]
A. I / We, request you to Register / Change / Update the following (Tick P relevant box) Date : / /2022
PAN Signature Mobile Number
Bank details Registered Address Email address
B. Security and KYC Details [ to be filled in by the First Holder ]
Name of the Issuer Company Folio No(s).
Face value of Securities Number of Securities
Distinctive number of From To
Securities (Optional)
Email Address
Mobile Number
Serial No { } << Kindly write the Serial no as printed in KYC Form
C. I/We are submitting documents as per Table below (Tick P as relevant, refer to the instructions):
Name(s) of the Security holder(s) in Capital as per PAN PAN PAN Linked to
Copies of PAN of all the Holder(s) duly self-attested with date to be enclosed Aadhar -Y/N
with this Form.
Tick any one [P] *
1. Yes / No
2. Yes / No
3. Yes / No
4. Yes / No
Note: * PAN shall be valid only if it is linked to Aadhar by March 31, 2022, or any other date as may be specified by CBDT.
Bank Account Details of First Holder
Name of the Bank & Branch IFSC

Bank A/c No. Tick any one [P]- Acct type Savings Current
NRO NRE Any other [ ]
Note: Original cancelled cheque leaf bearing the name of the first holder is mandatory, failing which first security holder shall submit copy of bank passbook
/ statement attested by the Bank for registering the Bank Account details.
Demat Account Number 16 digit DP/CL [ ]
Also provide Client Master List (CML) of your Demat Account, provided by the Depository Participant.
Authorization: I / We authorise you (RTA) to update the above PAN and KYC details in my / our above 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 and documents
enclosed are true and correct.

First Holder Joint Holder - 1 Joint Holder - 2 Joint Holder - 3
Signature
Name
Address
PIN
Note: If the address mentioned above differs from the address registered with the Company, you are requested to record the new address by submitting
the documents as specified in point (3) overleaf.

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