Form No. 04 - Application for Funds for Services/Programmes - Investor Education and Protection Fund (Awareness and Protection of Investors) Rules, 2001

Form No. 04 (See Rule 14) Application for Funds for Services/Programmes 1. Name of Applicant: 2. Address: Registered Office: Corporate Office Address: 3. Constitution: (Whether Association/Chamber of Commerce/ Institute/Individual) 4. Date of Incorporation/registration 5. Details (Number/Date) of recognition granted by Committee under rule 14 Existing activities: (i) Management: Board of Directors: (ii) Details relating to proposed seminar/programme/activity Date when to be conducted: Venue: Brief Literature on subject matter: 6. Amount required for the proposed seminar/programme/activity and full Justification for the same including following detail: (i) The Nature of Activity; (ii) List of proposed Guests/VIPs who would chair the dais; (iii) Description of expenses proposed to be incurred for the activity; (iv) Venue expenses; (v) Travelling, Boarding and Lodging expenses of Guests for the activity; (vi) Other expenses; (vii) Expected number of people who would attend the activity; (viii) Any other information for the justification of the amount. Signature (with name) President: Vice President Secretary Treasurer