APPLICATION FOR OPENING OF

A DEPOSITORY ACCOUNT
(For Individuals Only)

Date : D D MM Y Y Y Y Employee ID Code: BDE Code: CLIENT ID :

(To be filled by Participant)

Branch :____________________ Sol ID : Scheme Code : DP ID : I N 3 0 0 4 8 4

A) TYPE OF ACCOUNT* :
I/We request you to open a depository account in my/our name/s as per the following details: (Please fill all the details in CAPITAL LETTERS only)
Resident Ordinary Resident HUF Margin Promoter HUF-Promoter Others#____________
NRI-Non-
NRI-Non- NRI-Repatriable-
NRI NRI-Repatriable DR Repatriable- Others#____________
Repatriable Promoter
Promoter
Foreign Foreign Foreign National-
DR (#Please specify) Others#____________
National National Promoter

B) PERSONAL DETAILS : (Name as mentioned on PAN Card)

Sole/First Holder Name* :

(Mr. /Ms. )

Second Holder Name :

(Mr. /Ms. )

Third Holder Name :

(Mr. /Ms. )

C) NAME OF FATHER/HUSBAND :

Sole/First Holder (Mr.) :

Second Holder (Mr.) :

Third Holder (Mr.) :

D) FIRST HOLDER’S ADDRESS DETAILS :

Address for Communication/Corporate Benefits (Default option is Local Address) Local/Permanent Address Correspondence Address/Foreign Address
Local/Permanent
Address*

City ST Pin Code :

Correspondence
Address

City ST Pin Code :

Date of Birth D D MM Y Y Y Y
E) SECOND HOLDER’S ADDRESS DETAILS :
Same as Local/Permanent Address of First Holder Same as Correspondence Address of First Holder
If different
Pin Code : Date of Birth : D D M M Y Y Y Y
F) THIRD HOLDER’S ADDRESS DETAILS :
Same as Local/Permanent Address of First Holder Same as Correspondence Address of First Holder
If different
Pin Code : Date of Birth : D D M M Y Y Y Y
G) COMMUNICATION DETAILS :
First Holder Second Holder Third Holder
<<DPRTL-FEB-2010 Ver 2.05>>

Telephone Number
Fax Number
Mobile Number
SMS Facility* Yes No Yes No Yes No
E-mail ID
Occupation
* In case SMS alert is not indicated, it will be treated as ’’Yes”.
All fields marked in * are mandatory
Please ensure that all mandatory fields have been filled correctly else the form is liable to be rejected.
Axis Bank Ltd., Solaris ’C’ Building, 9th Floor, Opp. L & T Gate No. 6, Saki Vihar Road, Powai, Mumbai - 400072. E-mail: dp.operations@axisbank.com

1
 H) GUARDIAN DETAILS : (In case the Sole Holder is a minor)
Name of Guardian :
(Mr./Ms.)

Relationship (if any) Date of Birth : D D M M Y Y Y Y

(of minor)
Address Same as Local/Permanent Address of First Holder Same as Correspondence Address of First Holder
If Different

City Pin Code :

I) IN CASE OF NRIs : (Foreign Address)*

Same as Local/Permanent Address of First Holder Same as Correspondence Address of First Holder
If Different

City Pin Code :

RBI Reference No. RBI Approval Date D D M M Y Y Y Y

J) BANK DETAILS* : (for dividend Purpose only)

Bank Account Type Bank Account No.
SB CA CC

Bank Name
Branch Address
(Mandatory)
Pin Code :

9-digit Code Number of the Bank and branch appearing on the MICR cheque issued by the Bank

K) FINANCIAL DETAILS* :
P. A. N. IT Circle/Ward/District No.
Sole/First Holder
Second Holder
Third Holder
Guardian
(In case of Minor)
ADDITIONAL FINANCIAL DETAILS * :
Financial Status (Annual Income) Nature of Business
Rs. <5 Lac Rs. 5-10 Lac Rs. 10-15 Lac Rs. >15 Lac
First Holder

Second Holder

Third Holder

L) STANDING INSTRUCTIONS :

I/We authorise you to receive credits automatically into my/our account Yes No
(if not indicated, Standing Instruction will be treated as “Yes”)
Account to be operated through Power of Attorney (PoA) Yes No

Date of Power of Attorney (PoA) D D M M Y Y Y Y

2
M) PHOTOGRAPHS* :

DECLARATION :
Sole/First Holder The rules and regulations of the Depository and Depository Participants pertaining to an account which are in force
Please Paste recent now have been read by me/us and I/we have understood the same and I/we agree to abide by and to be bound
(not more than six months old) by the rules as are in force from time to time for such accounts. I/We also declare that the particulars given by me/us
colour passport size
photograph here.
are true to the best of my/our knowledge as on the date of making such application. I/We further agree that any
Please do not use Pins, false/ misleading information given by me/us or suppression of any material fact will render my/our account liable
Staples or Tape. for termination and further action. I/We request you to issue booklet of Delivery instructions/Inter Depository Delivery
Please Sign across Photograph Instructions to me/us.

Second Holder / Guardian NAME (S) OF HOLDER (S)* SIGNATURE (S)*

Please Paste recent
(not more than six months old) Sole/First Holder
First Holder
colour passport size (Mr./Ms.)
photograph here.
Please do not use Pins, Axis Bank Cust. ID
Staples or Tape.
Please Sign across Photograph Second Holder
Second Holder
(Mr./Ms.)
Axis Bank Cust. ID
Third Holder
Please Paste recent
Third Holder
(not more than six months old) Third Holder
colour passport size (Mr./Ms.)
photograph here. Axis Bank Cust. ID
Please do not use Pins,
Staples or Tape. Guardian Guardian
Please Sign across Photograph
(in case of Minor) (in case of Minor)
(Mr./Ms.)
Instruction for branch : Applicant’s Photograph is required to be verified by branch official under his/her signature & Branch Seal

N) DETAILS OF IN-PERSON VERIFICATION* : (For Branch use only)

Date : D D M M Y Y Y Y Place
CONFIRMATION : I have personally verified each of applicant’s identity and address. Applicant/s has/have affixed the above signature/s in my presence.
Name of the Officer : Employee No.:
Sign. of Employee & Branch Stamp :

O) STANDING INSTRUCTION FOR DEBITING CHARGES :

Operative Bank A/c. No. :

Dear Sir,
I/We hereby authorise you to Debit my/our operative Bank A/c with Axis Bank _____________________ Branch for all the charges relating to my/our
demat account. Please treat this authorisation as irrevocable till further instruction from my/our side is received in writing and duly acknowledged by you

Thanking You,
Signature of Operative Bank A/c.
1st Holder 2nd Holder 3rd Holder

(For Central Office use only) Name on PAN Card verified with IT department website
Name of the Officer : Employee No.: Sign. & Bank Stamp :

A/c. Verified By : Name of DP Official :

3
 NOMINATION
Annexure JA I/We wish to make a nomination and do hereby nominate the following person in whom all rights and / or amount payable in respect of
securities held in the Depository by me/us in the said beneficiary owner account shall vest in the event of my / our death.

I/We do not wish to make a nomination.

Name of the Nominee
(Mr. / Ms.)

Relationship with Address of the Same as Local/Permanent Same as Correspondence

the Applicant (if any) Nominee Address of First Holder Address of First Holder
If Different
Pin Code :

Date of Birth
(in case of minor) D D M M Y Y Y Y Signature of
Nominee/Guardian
Name of the Guardian
(Mr./Ms.)
(in case Nominee
is a minor)
Address of the Same as Local/Permanent Same as Correspondence
Guardian : address of First Holder address of First Holder

If Different

Pin Code :

Signature of two Witneses Name 1. 2.

Address 1. 2.

Recent
Recent
(not more than
(not more than
six months old)
six months old)
colour photograph of
colour photograph of
Guardian
Nominee
(In case Nominee is Minor) Witness 1 Witness 2
Signature of Nominee Signature Signature
Signature of Guardian
across Photograph
across Photograph with date with date

Signature of Sole / First Holder Signature of Second Holder Signature of Third Holder

FEMA DECLARATION [In case of NRI(s) / Foreign National(s)]

I/We hereby confirm that I am a /we are non-resident Indian/s / foreign national/s individual/s. I/We also confirm that – I/we have complied with FEMA
(erstwhile FERA) regulations and I / we would continue to comply with FEMA (FERA) regulations.

Signature of Sole / First Holder Signature of Second Holder* Signature of Third Holder*

Place:
Date:

(* To be signed only if second and/or third holder/s is/are NRI/s or FN/s. Not to be signed if second and/or third holder/s is/are resident Indian/s)

4
AGREEMENT BETWEEN THE DEPOSITORY PARTICIPANT AND THE PERSON SEEKING TO OPEN AN ACCOUNT WITH THE
DEPOSITORY PARTICIPANT
This agreement made and entered into this day of
between
situated at

(hereinafter called “the Client”) and AXIS BANK LTD. situated at Solaris ‘C’ Building, 9th Floor, Opp. L & T Gate No. 6, Saki Vihar Road, Powai, Mumbai –
400072 (hereinafter called “the Depository Participant”).

Witnesseth
WHEREAS the Client has furnished to the Depository Participant the duly filled in application form requesting therein to open an account with the Depository
Participant.
NOW THEREFORE in consideration of the Depository Participant having agreed to open an account for the Client, both the parties to the agreement hereby
covenant and agree as follows:
1. The Client shall pay such charges to the Depository Participant for the purpose of opening and maintaining his account, for carrying out the instructions
of the Client and for rendering such other services as may be agreed to from time to time between the Depository Participant and the Client as set out in
Schedule A. The Depository Participant shall reserve the right to revise the charges by giving not less than thirty days notice in writing to the Client.
2. The Client shall have the right to get the securities which have been admitted on the Depository dematerialised in the form and manner laid down under
the Bye–Laws and Business Rules. The Depository Participant further undertakes that it shall not create or permit to subsist any mortgage, charge or other
encumbrances over all or any of such securities submitted for dematerialisation except on the instructions of the Client.
3. The Depository Participant hereby undertakes that it shall maintain a separate account of its own securities held in dematerialised form with the Depository
and shall not commingle the same with the securities held in dematerialised form on behalf of the Client.
4. The Depository Participant undertakes that a transfer to and from the accounts of the Client shall be made only on the basis of an order, instruction,
direction or mandate duly authorised by the Client and that the Depository Participant shall maintain adequate audit trial of such authorisation.
5. The Depository Participant agrees that the Client may give standing instructions with regard to the crediting of securities in his account and the Depository
Participant shall act according to such instructions.
6. The Depository Participant undertakes to provide a transaction statement including statement of accounts, if any, to the Client at monthly intervals unless
the Depository Participant and the Client have agreed to the provision of such statements at shorter intervals. However, if there is no transaction in the
account, then the Depository Participant shall provide such statement to the Client at least once a quarter.
7. The Depository Participant shall have the right to terminate this agreement, for any reasons whatsoever, provided the Depository Participant has given a
notice in writing of not less than thirty days to the Client as well as to the Depository. Similarly, the Client shall have the right to terminate this agreement
and close his account held with the Depository Participant provided no charges are payable by him to the Depository Participant. In such an event, the
Client shall specify whether the balances in its account should be transferred to another account of the Client held with another Depository Participant or
to rematerialise the security balances held. Based on the instructions of the Client, the Depository Participant shall initiate the procedure for transferring
such security balances or rematerialise such security balances within a period of thirty days, as per the the procedure laid down in the Bye–Laws and
Business Rules. Provided further, termination of this agreement shall not affect the right, liabilities and obligations of either party and shall continue to
bind the parties to their satisfactory completion.
8. On the failure of the Client to pay the charges as laid out in Clause (1) of this agreement within a period of thirty days from the date of demand,
Depository Participant shall terminate this agreement and close the account of the Client by requiring it to specify whether the balances in its account be
transferred to the account of the Client held with another Participant or be rematerialised in the manner specified in the Bye Laws and Business Rules.
9. The Client further agrees that in the event of the Client committing a default in the payment of any of the amounts provided in Clause (1) within a period
of thirty days from the date of demand, without prejudice to the right of the Depository Participant to close the account of the Client, the Depository
Participant may charge interest @ not more than 24% p.a. or such other rate as may be specified by the Executive Committee from time to time for the
period of such default. In case the Client has failed to make the payment of any of the amounts as provided in Clause (1) of this agreement, the Depository
Participant shall have the right to discontinue the Depository services till such time he makes the payment along with interest, if any, after giving two days
notice to the Client.
10. The Depository Participant shall have a right to provide such information related to the Client’s account as may be requested by the National Securities
Depository Limited from time to time.
11. The Client shall have the right to create a pledge of the securities held in the dematerialised form with the Depository Participant only in accordance with
the procedure and subject to the restrictions laid down under the Bye–Laws and Business Rules.
12. The Depository shall not be liable to the Client in any manner towards losses, liabilities and expenses arising from the claims of third parties and from
taxes, and other governmental charges in respect of securities credited to the Client’s account.
13. The client may exercise the right to freeze his account maintained with the Depository Participant so as to lock the securities held with the Depository
Participant in accordance with the procedures prescribed in the Bye–Laws and Business Rules.
14. The Client may exercise the right to defreeze his account maintained with the Depository Participant in accordance with the procedure and subject to the
restrictions laid down under the Bye Laws and Business Rules.
15. The Client shall notify the Depository Participant, within seven days, of any change in the details set out in the application form submitted to the Depository
Participant at the time of opening the account or furnished to the Depository Participant from time to time.
16. The Depository Participant undertakes to resolve all legitimate grievances of the Client against the Depository Participant within a period of thirty days.
17. The Depository Participant and the Client shall abide by the arbitration and conciliation procedure prescribed under the Bye–Laws of the National
Securities Depository Limited and that such procedure shall be applicable to any disputes between the Depository Participant and the Client.
18. The Depository Participant and the Client further agree that all claims, differences and disputes, arising out of or in relation to dealings on the Depository
including any transactions made subject to the Bye–Laws or Business Rules of the Depository or with reference to anything incidental thereto or in
pursuance thereof or relating to their validity, construction, interpretation, fulfilment or the rights, obligations and liabilities of the parties thereto and
including any question of whether such dealings, transactions have been entered into or not, shall be subject to the exclusive jurisdiction of the courts at
Mumbai only.
IN WITNESS WHEREOF the Client and the Depository Participant has caused these presents to be executed as of the days and year first above written.
Signed and delivered by

1) Signature of Witness

2) Name of Witness:

3) Address of Witness:

(For and on behalf of the Client )

Signed and delivered by

(For and on behalf of AXIS BANK LTD.) Witness :

5
 APPLICATION FOR AVAILING e-DEPOSITORY SERVICES AND TERMS & CONDITIONS FOR PROVIDING TRANSACTION AND
HOLDING STATEMENTS BY E-MAIL AND / OR ON WEBSITE
Axis Bank Ltd., Solaris ‘C’ Building, 9th Floor, Opp. L & T Gate No. 6, Saki Vihar Road, Powai, Mumbai – 400072.
DP ID-IN300484
To Date : DD MM Y Y Y Y
The Branch Head,
Axis Bank Limited, Branch

Dear Sir,
I/We hold a NSDL DEMAT account with your branch. The details of my/our relationship are as under:

NSDL DP ID & Client ID: (8 digits) ** I N 3 0 0 4 8 4 -

I/We would like to subscribe for the following service(s) as per the terms and conditions appended below. (Please tick () whichever is
required)
iConnect Depository Service:
I/We require access to DEMAT account through internet banking service/website. The existing iConnect User-ID is

Tele Depository Service: ‘Dial-your-DEMAT’

I/We require to access the above DEMAT account through telephone and request you to issue me/us a PIN.
Auto E-Mailer Service:
I/We would like to have the statement of transaction and holding e-mailed to me/us at the following e-mail id:
E-mail ID (write clearly): @ .
Please mail me/us the same at the following frequency (please tick () whichever is required)
On Monthly basis On Weekly basis On a Daily basis
I/We the under mentioned Beneficial Holders hereby agree, undertake and declare that , the aforementioned services are provided by
Axis Bank Limited subject to the Terms and Conditions mentioned herein and as amended from time to time.

TERMS & CONDITIONS FOR PROVIDING TRANSACTION AND HOLDING STATEMENTS BY E-MAIL AND / OR ON WEBSITE
1. I/We am/are aware that I/we will not receive the transaction statements in paper form.
2. I/We will take all the necessary steps to ensure confidentiality and secrecy of the login name and password of the Internet / e-mail
account.
3. I/We am/are aware that the transaction statement may be accessed by other entities in case the confidentiality / secrecy of the login
name and password is compromised. I/We take the entire responsibility of the same.
4. I/We agree that the transaction statements are sent by e-mail, I/we shall immediately inform the DP about change in e-mail address,
if any.
5. I/We agree and aware that DP shall have the right to terminate such service provided a written notice is given at least 10 days in
advance and vice versa.
6. I/We agree that the above terms and conditions are in addition to and not in contravention of the terms and conditions forming a part
of the “AGREEMENT BETWEEN THE PARTICIPANT AND THE PERSON SEEKING TO OPEN AN ACCOUNT WITH THE PARTICIPANT”
signed by me/us at the time of opening the Demat account with the Bank.
Please do the needful at the earliest at my/our sole responsibility and activate the services as mentioned above for my/our DEMAT
Account.

  
Signature of Sole / First holder*** Second holder*** Third holder***

BankCust. ID [9 Digit] **

** Compulsory fields to be provided. *** All DEMAT Account Holders must sign the form

(FOR BRANCH USE ONLY)

Account holder/s signature/s verified by :

  
Name of the Officer Employee No. Signature of Employee & Branch Stamp

For Use at Central Office – Depository Services only:

Processing Unit Processing Stage Emp. No. Signature Seal / Remarks
Central Unit Account Activation iConnect DP
Tele DP Service
Auto E-mailer service
Central Unit PIN Printing
PIN Status: Sent / Rejected / PIN Dispatch Date: / /20

6
NOTES :
1. All communications shall be sent at the address of the Sole / First holder only.
2. Thumb impressions and signatures other than English or Hindi or any of the other language not contained in the 8th Schedule of the
Constitution of India must be attested by a Magistrate or a Notary Public or a Special Executive Magistrate.
3. As per NSDL Circular No. NSDL/PI/2004/1622 dated September 7, 2004 pursuant to SEBI Circular No. MRD/DoP/Dep/Cir-29/2004
dated August 24, 2004 a copy of any one of the following documents may be accepted as proof of identity / proof of address (local/
correspondence/foreign address as the case may be):
Proof of Identity : Passport, Voter ID Card, Driving license, PAN card with photograph (mandatory), Identity card/document with
applicant’s Photo, issued by a) Central / State Government and its Departments, b) Statutory/Regulatory Authorities, c) Public Sector
Undertakings, d) Scheduled Commercial Banks, e) Public Financial Institutions, f) Professional Bodies such as ICAI, ICWAI, ICSI, Bar
Council etc., to their Members; and g) Photo Credit cards/Debit cards issued by Axis Bank only.
Proof of Address : Ration card, Passport, Voter ID Card, Driving license, Bank passbook, verified copies of Electricity bills (not more
than two months old) / Residence Telephone bills (not more than two months old) / Leave and License agreement / Agreement for sale,
Self-declaration by High Court & Supreme Court Judges, giving the new address in respect of their own accounts, Identity card / docu-
ment with address, issued by a) Central / State Government and its Departments, b) Statutory / Regulatory Authorities, c) Public Sector
Undertakings, d) Scheduled Commercial Banks, e) Public Financial Institutions, f) Professional Bodies such as ICAI, ICWAI, Bar Council
etc., to their Members.
Participants must verify the copy of the document with the original.
4. Instructions related to nomination, are as below:
I. The nomination can be made only by individuals holding beneficiary owner accounts on their own behalf singly or jointly. Non–
individuals including society, trust, body corporate, partnership firm, Karta of Hindu Undivided Family, holder of Power of Attorney
cannot nominate. If the account is held jointly all joint holders will sign the nomination form.
II. A minor can be nominated. In that event, the name and address of the Guardian of the minor nominee shall be provided by the
beneficial owner.
III. The Nominee shall not be a trust, society, body corporate, partnership firm, Karta of Hindu Undivided Family or a Power of
Attorney holder. A non-resident Indian can be a Nominee, subject to exchange controls in force from time to time.
IV. Nomination in respect of the beneficiary owner account stands rescinded upon closure of the beneficiary owner account. Similarly,
the nomination in respect of the securities shall stand terminated upon transfer of the securities.
V. Transfer of securities in favour of a Nominee shall be valid discharge by the depository against the legal heir.
VI. The cancellation of nomination can be made by individuals only holding beneficiary owner accounts on their own behalf singly or
jointly by the same person who made the original nomination. Non-individuals including society, trust, body corporate, partnership
firm, Karta of Hindu Undivided Family, holder of Power of Attorney cannot cancel the nomination. If the beneficiary owner account
is held jointly, all joint holders will sign the cancellation form.
VII. On cancellation of the nomination, the nomination shall stand rescinded and the depository shall not be under any obligation to
transfer the securities in favour of the Nominee.
5. Strike off whichever is not applicable.

7
 CHECK LIST FOR CLIENT ACCOUNTS (For Bank Use Only)
Common Mandatory Requirements
I. Application Form Duly filled & Signed
II. Agreement duly stamped & witnessed
III. Scheduled of charges - Acceptance by client
IV. PAN Card with Photograph
V. Nomination Form / Declaration for Not Availing Nomination (Part of AOF)
VI. Certification regarding AML (refer circular ref. no. SSD/DS/8/2009-10 dated October 03, 2009)

Individuals - (Ordinary Residents)

(A) Proof of Identity (All Joint Holders) - Duly verified by Branch Official (refer master circular ref. no. SSD/DS/3/2009-10 dated June 09, 2009)
1) Passport which is valid
2) Voter ID Card
3) Driving License which is valid
4) PAN Card with Identifiable Photograph
5) Identity Card / documents with applicant’s photo issued by :
a) Central / State Governments and its Departments b) Statutory / Regulatory Authorities
c) Public Sector Undertakings d) Scheduled Commercial Banks
e) Public Financial Institutions f) Professional Bodies such as ICAI, ICWAI, ICSI, Bar Counsil etc.,
to their Members
g) Photo Credit Cards / Debits Cards issued by Axis Bank only.

(B) Proof of Address (All Joint Holders) - Duly verified by Branch official (refer master circular ref. no. SSD/DS/3/2009-10 dated June 09, 2009)
1) Ration Card
2) Passport which is valid
3) Voter ID Card
4) Driving License which is valid
5) Bank Passbook
6) Bank Statement of Account (refer circular no. SSD/DS/5/2009-10 dated September 4, 2009)
7) Verified copies of
a) Electricity Bills (not more than two months old) b) Residence Telephone Bills (not more than two months old)

c) Leave and License Agreement / Agreement for sale.

8) Self Declaration by High Court & Supreme Court Judges, giving the new address in respect of their own accounts.
9) Identity card / documents with address, issued by
a) Central / State Government and its Departments b) Statutory / Regulatory Authorities

c) Public Sector Undertakings d) Scheduled Commercial Banks

e) Public Financial Institutions f) Professional Bodies such as ICAI, ICWAI, ICSI, Bar Counsil etc.,
to their Members
(C) NRI /Foreign National
1) FEMA Declaration

ACKNOWLEDGEMENT
Axis Bank Ltd., Solaris ‘C’ Building, 9th Floor, Opp. L & T Gate No. 6, Saki Vihar Road, Powai, Mumbai – 400072.
E-mail: dp.operations@axisbank.com
DP ID-IN300484

Received the application from Mr./Ms.

as the sole / First Holder alongwith
and
as the Second and Third Holders respectively for opening of a depository account. Your Client ID will be intimated to you shortly on
acceptance. Please quote the DP ID & Client ID allotted to you in all your future correspondence.

Date : Participant Stamp & Signature