Investor forms

Form ISR-5.

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

How this form works.

Complete the fields below. The wording is the same as the printed form.
Select Print or save as PDF at the end of the form.
Sign by hand where the printout asks for a signature, and attach any documents the form lists.
Send it to us as you would the printed form.

Nothing you enter leaves your browser. RCMC does not receive or store it until you send us the signed copy.

Need help completing this form? Call Investor Services on +91 11 35020465, email investor.services@rcmcdelhi.com, or ask for digital accessibility assistance.

Download Form ISR-5 as a PDF Alternate format — the printed form, to fill in by hand. PDF

(For Transmission of securities on death of the Sole holder)

To:

The Listed Issuer/RTA,

(Address)

(Name of the Listed Issuer/RTA)

Name of the Claimant(s)Mr./Ms.

Name of the GuardianMr./Ms.

in case the claimant is a minor →

Date of Birth of the minor*

Relationship with Minor:

FatherMotherCourt Appointed Guardian*

PAN (Claimant(s)/Guardian):[Multiple PAN may be entered]

KYC Acknowledgment attached

KYC form attached

(please specify)

*Please attach relevant proof

I/We, the claimant(s) named hereinabove, hereby inform you about the demise of the below mentioned Securities Holder(s) and request you to transmit the securities held by the deceased holder(s) in my/our favour in my/our capacity as –

NomineeLegal HeirSuccessor to the Estate of the deceasedAdministrator of the Estate of the deceased

Name of the deceased holder(s)	Date of demise**
1)	Date of demise**
2)	Date of demise**
3)	Date of demise**

**Please attach certified copy of Death Certificate.

Securities(s) & Folio(s) in respect of which Transmission of securities is being requested
Name of the Company	Folio No.	No. of Securities	% of Claim@
1)	Folio No.	No. of Securities	% of Claim@
2)	Folio No.	No. of Securities	% of Claim@
3)	Folio No.	No. of Securities	% of Claim@
4)	Folio No.	No. of Securities	% of Claim@

@As per Nomination OR as per the Will/Probate/Succession Certificate/Letter of Administration/ Legal Heirship Certificate (or its equivalent certificate)/ Court Decree, if applicable.

Contact details of the Claimant (s) [Provision for multiple entries may be made]

Mobile No.+91

Tel. No.STD -

Email Address

Address

(Please note that address will be updated as per address on KYC form / KYC Registration Agency records)

Address Line 1

Address Line 2

City:

State

Bank Account Details of the Claimant

Bank Name

Account No.

11-digit IFSC

9-digit MICR No.

Name of bank branch

City

Please attach & tick✓

Cancelled cheque with claimant’s name printed ORClaimant’s Bank Statement/Passbook (duly attested by the Bank Manager)

I also request you to pay the UNCLAIMED amounts, if any, in respect of the deceased securities holder(s) by direct credit to the bank account mentioned above.

FATCA and CRS information

Country of Birth

Place of Birth

Nationality

Are you a tax resident of any country other than India?

YesNo

If Yes, please mention all the countries in which you are resident for tax purposes and the associated Taxpayer Identification Number and its identification type in the column below

Country	Tax-Payer Identification Number	Identification Type
Country	Tax-Payer Identification Number	Identification Type
Country	Tax-Payer Identification Number	Identification Type
Country	Tax-Payer Identification Number	Identification Type

Nomination@ (Please ✓ one of the options below)

I/We DO NOT wish to make a nomination. (Please tick ✓ if you do not wish to nominate anyone)I/We wish to make a nomination and hereby nominate the person/s more particularly described in the attached Nomination Form to receive the securities held in my/our folio in the event of my / our death.

@ Guardian of a minor is not allowed to make a nomination on behalf of the minor

Declaration and Signature of the Claimant(s)

I/We have attached herewith all the relevant / required documents as indicated in the attached Ready Reckoner as per Annexure A.

I/We confirm that the information provided above is true and correct to the best of my knowledge and belief.

I/We undertake to keep

(Name of the Company)

/ its RTA informed about any changes/modification to the above information in future and also undertake to provide any other additional information as may be required by the RTAs.

I/We hereby authorize

(Name of the Company)

and its RTA to provide/ share any of the information provided by me/us including my holdings in the (Name of the Company) to any governmental or statutory or judicial authorities/agencies as required by law without any obligation of informing me/us of the same.

Place

Date

Signature of Claimant(S)Sign here by hand after printing.

*Note: For transmission service requests, Form ISR-4 as per SEBI circular SEBI/HO/MIRSD/MIRSD_RTAMB/P/CIR/2022/8 dated January 25, 2022 will not be required.