Request Form for Freezing/Defreezing of SPEED-e service

Freezing / Reactivation of SPEED-e Facility Form

(For Smart Card Users – Corporates / Clearing Members)

To, Date: ___________

DP Name : ________________

DP Id : ________________

Dear Sir/Madam,

I/We request you to freeze/reactivate the SPEED-e facility as per the details given below:

(Tick 4 in the appropriate box below)

Only specific Account	Only Smart Card

o Freeze SPEED-e facility for specific account	o Freeze Smart Card

o Reactivate SPEED-e facility for specific account.	o Reactivate Smart Card

Fill up any one or both of the following (as may be applicable)

Only specific account

Account Name : ____________________________________

Client Id : ____________________________________

CM-BP-Id : ____________________________________

(if Clearing Member)

User Id : ____________________________________

Reason : ____________________________________

Smart Card (SPEED-e facility for all accounts using this smart card will be

frozen/reactivated)

Organisation Name : ____________________________________

Certificate Serial No. : ____________________________________

Smart Card Serial No. : ____________________________________

User Id (any one) : ____________________________________

Corresponding Client Id : ____________________________________

Reason : ____________________________________

(Authorised Signatory)

For office use only (to be filled up by the Participant. NOT TO BE FILLED BY CLIENT)

For Account Freezing /ReActivation, effect on SPEED-e
For smart card Freezing /ReActivation, effect on SPEED-e and forward the request to NSDL

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

Name of the Authorised Signatory : __________________________

Signature : __________________________

(DP’s stamp and Date)

For office use (to be filled by NSDL)

Maker : _____________ Sign & Date : __________

Checker : _____________ Sign & Date : __________

Acknowledgment

Date : ______________

Received an application for freezing / Reactivation SPEED-e facility from __________________________ having Client Id _____________.

(DP’s Stamp & Signature)