Nomination Form

Annexure A

NOMINATION DETAILS

I/We Wish to make a nomination and do hereby nominate the following person(s) who shall receive all assets held in my/our account in the event of my/our death.

Eureka Stock & Share Broking Services Ltd
1101, Merlin Infinite, DN 51, Sector V, Salt Lake City, Kolkata - 700091

FORM FOR NOMINATION

(To be filled in by individual applying singly or jointly)

Trading Code :

Pan No :

DP Id :

* NSDL:IN302105 | CDSL:12055800

Client Id :

Client Name :

Nomination can be made upto three Nominees in the account

Details of 1st Nominee

Details of 2st Nominee

Details of 3st Nominee

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

Share of each Nominee

Equally
[if not equally please specify percentage]

Any odd lot after division shall be transferred to the first nominee mentioned in the form.

Relationship with the Applicant(if any)

Address of Nominee(s)

City / Place:
State & Country:

Pincode of Nominee(s)

Mobile/Phone No. of Nominee(s)

Email Id of Nominee(s)

Nominee Identification Details : [Please tick any of the following and provide details of same]

PAN Aadhar
Saving Bank Account No
Demat Account ID

Please Provide the Selected Id Number :

SHOULD BE FILLED ONLY IF NOMINEE IS A MINOR

Date of Birth {in case of minor nominee(s)}

Name of Guardian(Mr/Ms) {in case of minor nominee(s)}

Address of Guardian

City / Place:
State & Country:

Pincode of Guardian

Mobile/Telephone no. of Guardian

Email ID of Guardian

Relationship of Guardian with nominee

Guardian Identification Details :
[Please tick any of the following and provide details of same]

PAN Aadhar
Saving Bank Account No
Demat Account ID

Please Provide the Selected Id Number :

Note :

This nomination shall supersede any prior nomination made by the account holder(s), if any.

The Trading Member / Depository Participant shall provide acknowledgement of the nomination form to the account holder(s)

Declaration Form for opting out of nomination

Annexure B

To
Eureka Stock & Share Broking Services Ltd

1101, Merlin Infinite, DN 51, Sector V, Salt Lake City, Kolkata - 700091

Date :

Trading Code :

Pan No :

DP Id :

* NSDL:IN302105 | CDSL:12055800

Client Id :

Client Name :

I / We hereby confirm that I / We do not wish to appoint any nominee(s) in my / our trading / demat account and understand the issues involved in non-appointment of nominee(s) and further are aware that in case of death of all the account holder(s), my / our legal heirs would need to submit all the requisite documents / information for claiming of assets held in my / our trading / demat account, which may also include documents issued by Court or other such competent authority, based on the value of assets held in the trading / demat account.

Nomination Form

I Wish to Nominate

I Do not Wish to Nominate

Nomination Form

Annexure A

NOMINATION DETAILS

FORM FOR NOMINATION

Nomination can be made upto three Nominees in the account

Details of 1st Nominee

Details of 2st Nominee

Details of 3st Nominee

SHOULD BE FILLED ONLY IF NOMINEE IS A MINOR

Declaration Form for opting out of nomination

Annexure B