Pledge Request Form (PRF)

Pledge Request Form (PRF) F/DEM/7.5/12Please fill all the details in Block Letters in EnglishPRF No.DateI/We request you to Pledge the following securities held in my/ our name in our demat accountwith you. I/We have read and understood the Depositories Act, SEBI Regulations, Bye Laws andthe Pledge Agreement in relation to pledge of securities and I/We agree to abide by and bebound by the Act, Regulations, Bye Laws and the Pledge Agreement as are in force from time totime for such pledges.Pledgor’s DetailsDP ID 1 2 0 1 9 8 0 0 Client IDPledgor’sName1.2.3.Pledgee’s DetailsDP IDPledgee’s Name 1.2.3.Details of Securities: ❑ Free SecuritiesClient ID❑ Locked – in SecuritiesDetails of Securities offered for Pledge.Sr.No.ISIN ISIN Name Quantity PSN(SystemGenerated)Attach an annexure duly signed by the account holder(s), if the space above is insufficient.Pledge Expiry DatePledge Value (Rs.)Agreement No.Date of PledgingI / we declare that the particulars given by me/ us above are true to the best of my/ ourknowledge.Signature of the PledgorFirst/ Sole Applicant Second Applicant Third ApplicantI/ we confirm that the details of the Beneficial Owners stated above are true and correct. Alsothe balance of ISIN’s offered for pledge is unencumbered and is a free balance.P.T.O.

Pledge Request Form (PRF) F/DEM/7.5/12Depository Participant Seal and SignatureI/ We agree to accept the above securities for pledge and a pledge be created in my / our favor.This pledge is subject to the Act, Regulation, Bye Laws as are in force from time to time and alsoto the pledge agreement entered into with the pledgor(s) mentioned above.Pledge Sequence Number Accepted RejectedTick whichever is applicable.Signature of Pledgee(s) *First Holder Second Holder Third Holder* If the Pledgee is a bank DP, the signature of the pledgee need not be taken on the Pledgerequest form.