Form Sh-4 - Securities Transfer Form Page 2

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Transferees’ Particulars
Father’s/ Mother’s / Spouse
Name in full (1)
Address & E-mail id (3)
Name (2)
1. ________________________
1.______________________
_________________________________
2. ________________________
2.______________________
_________________________________
3. ________________________
3.______________________
_________________ Pin code ________
Email id: _________________________
Occupation (4)
Existing Folio No., if any (5)
Signature (6)
1. _______________________
_____________________
1. ______________________________
2. _______________________
2. ______________________________
3. _______________________
3. ______________________________
Folio No. of Transferee
Specimen Signature of Transferee(s)
__________________
1. _________________________
2. _________________________
3. _________________________
____________
STAMPS
Value of Stamp affixed: Rs.
Enclosures:
1.
Certificate of shares or debentures or other securities
2.
If no certificate is issued, Letter of allotment
3.
Copy of PAN Card of all the Transferee(s)(For all listed Cos.)
4.
Others, Specify, ________________________________
For Office Use Only
Checked by _______________________
Signature Tallied by ________________
Entered in the Register of Transfer on
__________ vide Transfer no _________
Approval Date ___________________
Power of attorney / Probate / Death certificate /
Letter of Administration
Registered on _______________ at
No ____________

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