Investor forms

Form ISR-4.

Issue of Duplicate Securities — accessible edition. Complete it here, print it or save it as a PDF, then sign it and send it to us.

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Download Form ISR-4 as a PDF Alternate format — the printed form, to fill in by hand. PDF

(for Securities - Shares / Debentures / Bonds, etc., held in physical form)

Date:

A. Mandatory Documents / details required for processing all service request:

I / We are submitting the following documents / details and undertake to request the Depository Participant to dematerialize my / our securities within 120 days from the date of issuance of Letter of Confirmation, received from the RTA/Issuer Company (tick ✓as relevant, refer to the instructions):

Demat Account No. (If available):

Provide Client Master List (CML) of your Demat Account from the Depository Participant*

Provide the following details, if they are not already available with the RTA (see SEBI circular dated November 03, 2021 in this regard)

PANSpecimen SignatureNomination / Declaration to Opt-out

* (Your address, e-mail address, mobile number and bank details shall be updated in your folio from the information available in your CML). You can authorize the RTA to update the above details for all your folios. In this regard, please refer to and use Form ISR-1 in SEBI circular dated November 03, 2021.

B. I / We request you for the following (tick ✓ relevant box)

Issue of Duplicate certificate

Claim from Unclaimed Suspense Account

Replacement / Renewal / Exchange of securities certificate

Endorsement

Sub-division / Splitting of securities certificate

Consolidation of Folios

Consolidation of Securities certificate

Transmission

Transposition

(Mention the new order of holders here)

C. I / We are enclosing certificate(s) as detailed below**:

Name of the Issuer Company

Folio Number

Name(s) of the security holder(s) as per the certificate(s)

Certificate numbers

Distinctive numbers

Number & Face value of securities

** Wherever applicable / whichever details are available

D. Document / details required for specific service request:

I. Duplicate securities certificate

II. Claim from Unclaimed Suspense Account

Securities claimed

(in numbers)

(in words)

III. Replacement / Renewal / Exchange of securities certificate(that is defaced, mutilated, torn, decrepit, worn out or where the page on the reverse is fully utilized)

IV. Endorsement

V. Sub-division / Splitting of securities certificate

VI. Consolidation of securities certificate/Folios

VII. Transmission

VIII. Transposition

Provide / attach original securities certificate(s) for request for item numbers III to VIII above.

Declaration: All the above facts stated are true and correct to best of my / our knowledge and belief.

	Security Holder 1 / Claimant	Security Holder 2	Security Holder 3
Signature	SignatureSign here by hand after printing.	SignatureSign here by hand after printing.	SignatureSign here by hand after printing.
Name	Name	Name	Name
Full address	Full address	Full address	Full address
PIN	PIN	PIN	PIN

After processing the service request, the RTA shall issue a ‘Letter of Confirmation’ to the securities holder/claimant, which is valid only for 120 days. Using this ‘Letter of Confirmation’, the securities holder/claimant shall request the DP to dematerialize the securities, failing which the securities shall be credited to the Suspense Escrow Demat Account of the Company.