TRADING & DEMAT ACCOUNT OPENING FORM - NJ PMS

ADDITIONAL DETAILS FOR OPENING DEMAT ACCOUNTApplication No.GNJ INDIA INVEST PVT. LTD.Registered & Correspondence Office Address : 9th Floor, B Tower, Udhna Udyognagar Sangh CommercialComplex, Central Road No.10, Udhna, Surat - 394 210, Gujarat. Phone: 0261 398 5500 Fax: 0261 398 5880This information is the sole property of the trading member/DP/brokerage house and would not be disclosed to anyoneunless required by law or except with the express permission of Clients(To be filled by DP)DP Internal Reference No.Date:DP ID 1 2 0 6 4 2 0 0 Client ID(To be filled by the applicant in BLOCK LETTERS & with BLACK BALL POINT PEN in English )I/We request you to open a Demat Account in my/our name as per the following details:Type of Entity / Account (Please Tick Whichever is Applicable)StatusSub-StatusPrivate Ltd. Co. Public Ltd. Co. BanksClearing House Mutual Fund CharitiesBody Corporate Govt. Body SocietyNon Govt. Organisation Defense EstablishmentLLPOCBBOIOtherCMFIFIIAOPNGOsTrustTo be filledby the DPSEBI Registration No.(If applicable)RBI Registration No.(If applicable)Nationality: Indian Others (specify)SEBI Registration dateRBI Registration dateHolders DetailsSole / First Holder’s NameSearch NamePANSecond Holder’s NamePANThird Holder’s NamePANName*:*In case of Firms, Association of Persons (AOP), Partnership Firm, Unregistered Trust, etc., although the account is opened in the name of the naturalpersons, the name of the Firm, Association of Persons (AOP), Partnership Firm, Unregistered Trust, etc., should be mentioned above.5