Application Form for change in name on account of Divorce

Company Name(s): 

Dear Sir,
Change in Name
Scheme: _________________________
Pin Code: _____________________
The Manager,
UTI Mutual Fund/SU-UTI,
Application for change in name on account of Divorce
Name: ______________________
Address: ___________________________
Pin Code:
I enclose the court order of the divorce.
Yours faithfully,
Account No. Name & Address of the Witness _________________
Bank & Branch name: __________________________________________
Address: __________________________________________
_____________________ _____________________
(Signature in maiden name) (Signature in maiden name)
Bank Particulars: Signature of Witnesses _________________________
I, Smt. ____________________________________________________________, a holder of units under folio no./Investor
ID._______________________ have legally divorced from Shri _______________________________________________
on ____________________ and will be known in future as Kum
_________________________________________________________________________. My bank particulars have been
given below. I, therefore, request you to make the necessary amendments in your records in his regard.
I declare the above statements as true.