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❑❑❑❑❑ ❑❑❑❑❑ ❑❑❑❑❑ ❑❑❑❑❑

(To be filled by persons seeking to open a depository account who have given Power of Attorney to operate the depository account toa stock broker/Participant/Portfolio Manager and do not intend to open a Basic Service Demat Account)

Name(s) of Account Holder(s)

Sole/First Holder

Second Holder

Third Holder

�O�p�t�i�o�n� �f�o�r� �I�s�s�u�e� �o�f� �D�I�S� �B�o�o�k�l�e�t�

Option 1

I / We wish to receive the Delivery Instruction Slip (DIS) booklet with account opening.

Option 2

I/We do not wish to receive the DIS booklet with account opening, the DIS booklet should be issued to me/us immediately on my/ourrequest at any later date.

Sole/First Holder

Second Holder

Third Holder

Beneficial Owner Name Signature with Date

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