This affidavit is to be executed on Non-judicial Stamp paper ... - NSDL

<strong>Th<strong>is</strong></strong> <strong>affidavit</strong> <strong>is</strong> <strong>to</strong> <strong>be</strong> <strong>executed</strong> on Non-judicial Stamp paper ofappropriate value.A F F I D A V I T(<strong>to</strong> <strong>be</strong> given by Nominee. In case of Minor Nominee the Guardian shall execute the same)I _____________________________________________________son/daughter/spouse of_____________________________________residing at _______________________________do hereby solemnly affirm on oath and state as under :-1.That Mr./Mrs._________________ the deceased, was holding a Client account no.________with ___________ a Deposi<strong>to</strong>ry Participant having DP Id ____________. The said deceasedwas holding the following securities :ISIN Name of Company No. of securities2. That the deceased made a valid Nomination in favour of :-“3. That the aforesaid nominee Master/Kum.___________________ aged _____years <strong>is</strong> a minorand he/she <strong>is</strong> <strong>be</strong>ing represented by h<strong>is</strong>/her father/mother and natural guardian Mr./Mrs.____________________________________.4. That the nominee / has applied <strong>to</strong> _________________ (DP name) <strong>to</strong> reg<strong>is</strong>ter the aforesaidsecurities in my individual <strong>be</strong>neficial owner account having Client Id. ________________ andDP Id. ________________._____________________DEPONENT

V E R I F I C A T I O N(<strong>to</strong> <strong>be</strong> given by Nominee. In case of Minor Nominee the Guardian shall execute the same)I hereby solemnly affirm and say that what <strong>is</strong> stated herein above are true <strong>to</strong> my knowledge andnothing has <strong>be</strong>en concealed therein and that I am competent <strong>to</strong> contract and entitled <strong>to</strong> rightsand <strong>be</strong>nefits of the above securities.Solemnly affirmed at ________ on the ________ day of _______ of _____.Full Name and : ______________________________Address of ______________________________Mag<strong>is</strong>trate/ ____________________________________________________________Notary ______________________________Signed in the presence of(Signature of Mag<strong>is</strong>trate/Notary)Pin :Regd. No______________________________Use space <strong>be</strong>low <strong>to</strong> affix:No<strong>to</strong>rial/Court Fee StampsOfficial Seal of Mag<strong>is</strong>trate/NotaryNotes: 1. <strong>Th<strong>is</strong></strong> <strong>affidavit</strong> <strong>is</strong> <strong>to</strong> <strong>be</strong> <strong>executed</strong> in the presence of a first class or stipendiaryMag<strong>is</strong>trate/Public notary /Judicial.2. <strong>Th<strong>is</strong></strong> <strong>affidavit</strong> should <strong>be</strong> signed by each deponent separately.