Annexure-14

New Smart Card Request / Attach Additional Account Form

(For Smart Card Users – Corporates / Clearing Members)

To Date:

DP Name : ____________

DP Id : ____________

We have subscribed to SPEED-e service and intend to do the following:

Tick 4 any one or both of the following:

o Option I : New smart card required

o Option II : Attach new accounts to existing smart card

The details are given below:

  1. Organisation Name : _____________________________________

    2.  

  2. Mailing Address (of Authorised Signatory) : Name _______________________________

: Designation ___________________________

: Address ______________________________

: _____________________________________ : _____________________________________

: City _____________ PIN ________________

: Tel No. _______________________________

: Fax No. ______________________________

: Email ________________________________

Option I : New smart card required

Existing Smart Card Details

Certificate Serial No. : ____________________

Smart Card Serial No. : ____________________

User Id (any one) : ____________________

Corresponding Client Id : ____________________

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

Option II : Attach new accounts using existing smart card

Existing Smart Card Details

Certificate Serial No. : ____________________

User Id (any one) : ____________________

Corresponding Client Id : ____________________
 

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

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. Strike off whichever is not applicable.

______________________________________________________________________________________

Acknowledgment

Date : _____________

Received an application for subscribing to SPEED-e from _________________________ (sole/first holder name) having Client Id _________ .

 

(DP’s Stamp & Signature)