Date Security’s Information Messrs Securities Depository CenterPlease issue a statement of securities’ account in accordance with the following for the period From To Security’s Information Security’s Information Particular Security All Securities Security Name Security No. Security Type - Choose-StocksBondsRights issueIslamic bonds Member’s Information Member Type Particular Member Broker Custodian All Members Central Registry Member Name Member No Account’s Information Account’s Information Particular Account Maintained by the Member All Accounts Maintained by the Member Account Name Account Type Investor’s Information Name of the Securities’ Owner SDC No Name of Authorized Signatory for Judicial Entities Signature Official Stamp for Judicial Entities Agency Information Agency Type Caretaker Custodian Agent Trustee Receiver Guardian Liquidator أخرى Agent’s Name SDC No. Nationality Signature I, the signatory above, acknowledge that the data and information stated above are correct, accurate and complete and I assume the full responsibility arising therefrom withoutholding the Securities Depository Center responsible for the invalidity, inaccuracy and/or incompleteness of the said data and information. Statement’s Reception Information Name of Statement(s) Receiver Date Signature For Securities Depository Center’s Use For Securities Depository Center’s Use Operation NAme Sgnature Date Entry الاسم التوقيع التاريخ Audit Name Signature Date Approval Name Signature Date Signed Before Name Signature Date Important Notice:- All information and data should be filled accurately and clearly.- In cases where there is an agent, the power of attorney issued by the competent authorities shall be attached, and if it is issued outside the Kingdom, it shall be duly certified.- The following valid identification documents must be attached to this form: - For Natural Persons: - For Jordanians: Passport or Identity Card issued by the Civil Status and Passport Department, provided that it contains the National Number. - For Non-Jordanians: Passport. - For Judicial Entities: - For Jordanians: Registration Certificate at the official competent authorities. - For non-Jordanians: Certificate of registration, duly certified. Required Documents Please attach Required Documents One file only.110 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. CAPTCHA Get new captcha! What code is in the image? Enter the characters shown in the image. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
