SPEED-e Application Form

For Smart Card Users – Corporates / Clearing Members)

 

To, Date:

DP Name : _________________________

DP Id : _________________________

We wish to register for SPEED-e service and intend to operate our demat accounts using a smart card as per the details given below:

  1. Organisation Name : _____________________________________
  2. Registration No. : _____________________________________
  3. (allotted by Registrar of Companies

    in case of a company)

  4. Date of incorporation : _____________________________________
  5. Income Tax PAN No. : _____________________________________
  6. Bank Details
  7. Bank Name : _____________________________________

    Branch : _____________________________________

    Account No. : _____________________________________

    Type of Account : _____________________________________

     

  8. Registered Office Address : _____________________________________
  9. : _____________________________________

    : _____________________________________

    : City _____________ PIN ________________

  10. Website address, if any : _____________________________________
  11. Mailing Address (of Authorised Signatory) : Name ________________________________
  12. : Designation ___________________________

    : Address _______________________________

    : _____________________________________ : _____________________________________

    : City _____________ PIN ________________

    : Tel No. _______________________________

    : Fax No. ______________________________

    : Email ________________________________

  13. No. of Directors : ________________________________
  14. (Enclose one sheet as per format for each director)

     

  15. Type of Digital Signature Certificate required _____For NSDL SPEED-e Service__
  16. No. of smart cards required : ___________

Smart Card No. 1

Tick 4 any one of the following:

o Full smart card kit required

o Only smart card required

 

To be filled by Client

To be filled by DP

To be filled by NSDL

Sr. No.

Client Id

CM-BP-Id (if Clearing Member)

User Id

Registration Request No.

Token Id

Smart Card Serial No.

Certificate Serial No.

1

2

3

4

5

Smart Card No. 2

Tick 4 any one of the following:

o Full smart card kit required

o Only smart card required

 

To be filled by Client

To be filled by DP

To be filled by NSDL

Sr. No.

Client Id

CM-BP-Id (if Clearing Member)

User Id

Registration Request No.

Token Id

Smart Card Serial No.

Certificate Serial No.

1

2

3

4

5

 

Smart Card No. 3

Tick 4 any one of the following:

o Full smart card kit required

o Only smart card required

 

 

To be filled by Client

To be filled by DP

To be filled by NSDL

Sr. No.

Client Id

CM-BP-Id (if Clearing Member)

User Id

Registration Request No.

Token Id

Smart Card Serial No.

Certificate Serial No.

1

2

3

4

5

 

Declaration

The rules and regulations pertaining to SPEED-e service which are in force have been read and understood by us and we agree to abide by and to be bound by the same. We declare that the account details given above indeed belong to us.

Sr. No.

Name of Authorised Signatory

Signature

   

 

   

 

 

   

 

 

 

 

For office use (DP) – Not to be filled up by Applicant

The application form is verified with the details of the beneficial owner’s account and certify that the same is in order.

Name of Authorised Signatory : __________________________

Signature : __________________________

(DP’s stamp & Date)

For office use (NSDL)

Maker : ______________ Sign. & Date : _____________

Checker : ______________ Sign. & Date : _____________

Instructions:

  1. In case you need more smart cards or want to attach more accounts to a specific smart card, please fill-up details in a separate sheet and attach to this form.

  2. Enclose the following :

    1. a copy of the Memorandum of Association and Articles of Association.

    2. enclose a board resolution for authorised signatories for SPEED-e facility

    3. the details of directors as per prescribed format

  3. Strike off whichever is not applicable.

______________________________________________________________________________________

Acknowledgment

Date : _____________

Received an application for subscribing to SPEED-e from _________________________ having Client Id _________

\

(DP’s Stamp & Signature)