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FD/BONDS Nomination Details

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FD/BONDS Nomination Details


7.75% Savings (Taxable) Bonds, 2018 (Tenure: 7 Years) Nomination Form
A/c No. : 8501161830
Application No : 7438777
Date : 17/03/2020
To,
RBI Bonds Operations
ICICI Securities Limited
Shree sawan knowledge park,gr. floor
Plot no. D-507 T.T.C. industrial area, MIDC Turbhe
Navi Mumbai 400706.
Dear Sir,
I SIVARAMAKRISHNAN JAYARAMAN, residing at 3 SULABHA BLDG CHEMBUR
PRASHANTI PLOT NO 28/29 CHHEDA NAGAR CHEMBUR MUMBAI MAHARASHTRA
400089the holder of Bond Ledger account no nominate the following person/s
who shall on my death have the right to the bond / recieve payment to whom in the event of the
amount for the time being due on the bond specified below:
Particulars of Nominee
Date of Particulars
Full Name with Expanded
Date of Amount Date of Birth Relationship of
Sr.No. initials and address of
Issue (Rs.) Repayment [dd/mm to Holder Bank
nominee *
/yyyy] * Account
Shiba
Name :
1. 17/03/2020 200000 Sivaramakrishnan 25/05/1969 Spouse
06:13:21 Address
Flat#3, Sulabha
:
Chheda Nagar
Chembur
City : Mumbai
Pin : 400089
(if Nominee is minor then fill the line below)
As the sole nomine above is a minor on this date, I appoint Shri/ Smt. Kum , residing at
___________________
___________________ to receive the amount for the time being due on the above bond in the event
of my death during the minority of the said nominee
_________________________________________ (name of nominee who is a minor). The
nomination is in substitution of the nomination previsously made be me and earlier nomination shall
stand cancelled on registration of this nomination.
Place _________________________ Date _____________________
_________________
Signature/ Thumb impression of the 1st applicant
Witness(es)
Name :__________________ Name :__________________
Signature*** :__________________ Signature*** :__________________
Address :__________________ Address :__________________
__________________ __________________
__________________ __________________
Place :__________________ Place :__________________
Date :__________________ Date :__________________
***Thumb impression to be attested by 2 witnesses
*Indicates mandatory fields
For ICICIdirect office use:

1 of 2 17-03-2020, 06:13 am
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To: 7.75% Savings (Taxable) Bonds, 2018 (Tenure: 7 Years)


Kindly nominate as per the details given above.
Regards,
Authorised Signatory and Seal for ICICI Securities Limited.

2 of 2 17-03-2020, 06:13 am

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