(To be submitted in Duplicate)
To,
Client Name ____________________________________________________ Contact No. ____________________________________________________ Submission Date: D D M M Y Y Y Y
SBICAP Securities Ltd.
2nd Floor Mafatlal Chamber, N. M. Joshi Marg, Lower Parel (East), Mumbai 400 005.
Dear Sir/Madam, Please make necessary changes / add in my / our client account as per details given below. (Please tick appropriate option to make necessary changes) CHANGE TO BE EFFECTED IN: Trading Code.: Name of 1st Holder Name of 2nd Holder Name of 3rd Holder Trading Account Depository Account BO ID: ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Trading + Depository Account
Re: Income Declaration Form
DETAILS OF FIRST / SOLE HOLDER
Occupation Source of Income Service Housewife Professional Business Retired Others (Specify) _________________________ Student
(for student / housewife / Retired / other)
Financial Status
Income Range per Annum
Up to Rs.1 Lac Rs.10 Lac to Rs.25 Lac
Rs.1 Lac to Rs.5 Lac
Rs.5 Lac to Rs.10 Lac
Rs.25 Lac to Above (Specify) _______________________
DETAILS OF SECOND HOLDER
Occupation Source of Income
(for student / housewife / Retired / other)
Service Housewife
Professional Business Retired Others (Specify) _________________________
Student
Financial Status
Income Range per Annum
Up to Rs.1 Lac Rs.10 Lac to Rs.25 Lac
Rs.1 Lac to Rs.5 Lac
Rs.5 Lac to Rs.10 Lac
Rs.25 Lac to Above (Specify) _______________________
DETAILS OF THIRD HOLDER
Occupation Source of Income Service Housewife
(for student / housewife / Retired / other)
Professional
Business
Retired
Student
Others (Specify) _________________________
Financial Status
Income Range per Annum
Up to Rs.1 Lac Rs.10 Lac to Rs.25 Lac
Rs.1 Lac to Rs.5 Lac Rs.5 Lac to Rs.10 Lac Rs.25 Lac to Above (Specify) _______________________
I/We hereby confirm that the details furnished above are true and correct to the best of my/our knowledge and belief. In case of any changes I/We undertake to intimate you immediately in writing. I/We further confirm that I/ we shall provide such necessary information at all times as may be required by SBICAP Securities Limited to furnish to any regulatory authority and I/We shall extend full co-operation in this regard.
Yours faithfully, First / Sole Holder Signature Name Place:
D:\M urli\Income Declaration Form.p65
Second Holder
Third Holder