Revocation 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 revoke/SPEED-e facility as per the details given below:
(Tick 4 in the appropriate box below)
o Revoke SPEED-e facility for specific account.
o Revoke 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
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 DP. NOT TO BE FILLED UP BY CLIENT)
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 revocation of SPEED-e facility from _________________ _______________________having Client Id _____________.
(DP’s Stamp & Signature)