Request Form for Freezing/Defreezing of SPEED-e service

Annexure-10

Freezing / Reactivation of SPEED-e Facility Form

(For Smart Card Users-Individuals)

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

Sole/First Holder Name : ____________________________________

Second Holder Name : ____________________________________

Third Holder Name : ____________________________________

Client Id : ____________________________________

User Id : ____________________________________

Reason : ____________________________________

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

frozen/reactivated)

Name of smart card user : ____________________

Certificate Serial No. : ____________________

Smart Card Serial No. : ____________________

User Id (any one) : ____________________

Corresponding Client Id : ____________________

Reason : ______________________________________________

(Authorised Signatory)

(to be signed by smart card user/account holder).

(Note : If the account holder has frozen the SPEED-e facility, the smart card user cannot reactivate the SPEED-e facility)

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/ReActivating SPEED-e service from __________________________ having Client Id _____________.

(DP’s Stamp & Signature)