Schedule I - Application for settlement - Securities and Exchange Board of India (Settlement Proceedings) Regulations, 2018

SCHEDULE-I (See regulation 3) Part-A FORM Application for settlement (To be filed only after conclusion of investigation, inspection, inquiry or audit, as the case may be) _____________________________________________________________________________________ (For Office use only) Date of receipt of the application: Application Registration Number: _____________________________________________________________________________________ ( Instructions : All particulars, including submission regarding details of loss caused to investors, profit made and proposed settlement amount must be filled, else application shall be returned. Put NA only where NOT APPLICABLE.) Before the Securities and Exchange Board of India In the matter of .. 1. Name/Trade name of the applicant/co-applicants: (a) Registration no., if applicable : (b) Date of Registration, if applicable : (c) PAN/DIN/CIN number, as available: (d) Paid-up capital of applicant: 2. If stock broker, name of the stock exchange: 3. If sub-broker/authorised person, name of stock broker with whom affiliated and name of the stock exchange: 4. Name of the segment (Cash/derivative etc.): 5. Form of organization: corporate body/ sole proprietorship / partnership / LLP/ financial institution (if listed co., details of listing): 6. Names of promoters/directors/proprietors/partners: 7. Key management personnel(s): 8. Address/correspondence address, contact no./fax no. and email (any changes in aforesaid details shall be communicated to the Board promptly): 9. Name and contact details (including e-mail) of the contact person (s): 10. Other registration(s) with the Board, if applicable: (a) Trade name : (b) Registration type : (c) Registration no. : 11. Case(s) pending with the Board/SAT/Court (Pl. specify): 12. Case(s) pending under 11B/Adjudication/Enquiry/others (pl. specify): 13. Stage at which pending 3 [ , including details of hearing opportunity given by the Board or AO, if any ] : 14. Interim order(s) in the pending proceedings (gist of the orders passed), if any: 15. Other actions pending with/concluded by the Board, if any (with their details): (a) Against the applicant : (b) Against its associates : (c) Against its key management personnel(s) : (d) Against its other promoters/directors: (e) Other details, if any: 16. Date of show cause notice/summons/communication indicating probable cause of action, if any, against which the settlement is sought (PLEASE ENCLOSE COPIES)*: 17. Full and true disclosure of facts (including the loss caused, profit made, loss avoided, gross fees, brokerage, commissions, etc., in respect of the cause of action, with manner of calculation thereof): [APPLICANT TO TAKE INTO ACCOUNT THE GUIDELINES PROVIDED IN SCHEDULE-II ] 18. Specific charges alleged: 19. Submissions in respect of sub-regulations (2), (3) (4) of Regulation 5 : 20. Terms of settlement proposed by the Applicant:- (a) Monetary terms, with manner of calculation:- (b) Non-monetary terms, including manner of calculation of terms of disgorgement due:- 21. Original documents to be enclosed: (a) Undertakings and waivers (as per Format specified in Part C). (b) Authority letter/Board resolution. 22. List of other enclosures: (a) A copy of the notice to show cause/summons/communication/other notices indicating the probable cause of action, if any, against which the settlement is sought; (b) Complete Annual Reports / other relevant financial details for the last three financial years and the quarterly audited financial results of the current year; (c) A statement showing net worth of the applicant (only for those applicants who are required to comply with the networth requirements as specified by the Board or by the stock exchanges), gross annual income before tax, the amount of gross profit made/loss avoided, including the gross brokerage, fees, management/performance/transaction fee, carried interest, compensation, etc., in respect of the said default; (d) Copy of PAN card/ DIN/CIN details; (e) Complete Income-tax Returns of the applicant for the last three financial years; (f) In case of a foreign body corporate applicant, include details relating to incorporation, place of business, registration details with any non-Indian financial sector regulatory authority. (g) In case of a non-resident applicant, include details relating to passport and national identity document, if any. (h) Any other relevant document (s)/submissions. (Signature of the applicant) (Stamp and Seal of body corporate applicant) Verification I, son/daughter/wife of (Name in block letters) Shri ..being the applicant/authorised representative (in case of body corporate) of . do hereby verify and affirm on oath that this application and the contents thereof are true to my knowledge and belief and as per the records and that I have not suppressed any material facts and shall keep the Board informed without delay, of any other relevant information that may come to my notice. (Signature of the applicant) Date: Place : Part-B Every applicant under Chapter II of these regulations shall pay a non-refundable processing fee of fifteen thousand rupees, 1 [ **** ] by way of 4 [ payment through the dedicated payment gateway provided for the purpose: ] . Provided that, where the applicant is a body corporate, the non-refundable processing fee shall be Twenty-five thousand rupees. Part-C Undertakings and Waivers Format Undertaking to be submitted by each applicant, along with the 6 [ self-attested ] application with stamp duty duly paid 5 [ **** ] . I/We, , the applicant(s) herein, as a condition for making the enclosed application to the Board for examining and consideration of the application, hereby declare that I/we agree and undertake that: (1) I/We admit the jurisdiction and right of the Securities and Exchange Board of India to initiate appropriate proceedings in respect of the alleged default. (2) I/We further agree and undertake that the time spent during the settlement proceedings shall be excluded for computing the limitation period or laches, if any, for initiating or continuing or restoring any legal proceedings, if any, against me/us, and waive any objections in this regard. (3) The Securities and Exchange Board of India may enforce any claims against me/us arising from or/in relation to any violation of the settlement order passed pursuant to this application. (4) Nothing in the settlement order shall preclude any other person from pursuing any other legal remedy to which such person may be entitled against me/us as per law. (5) The settlement proposed by me/us does not limit or create any private rights or remedies for any person who is not a party to these proceedings, against me/us. (6) The settlement amount including legal costs, if any, shall be paid by me/us to the Board within the period stipulated by the Board. (7) The settlement order shall be construed and enforced in accordance with the Securities and Exchange Board of India (Settlement Proceedings) Regulations, 2018 , as amended from time to time. (8) I/We agree that subsequent to the passing of the settlement order, I/We shall not take any action or make or permit to be made any public statement denying, directly or indirectly, any finding of the Board including that recorded in the settlement order or creating impression that the settlement order is without factual basis. (9) I/We hereby declare that nothing in the waiver and undertaking given by me/us shall affect my/our (i) testimonial obligations, or (ii) right to take legal or factual positions in defence of litigation or in defense of a claim or in any other legal proceeding in which the Board is not a party. (10) I/We for the limited purpose of settlement under these regulations admit the findings of fact and conclusions of law or neither admit nor deny the findings of fact and conclusions of law (strike off whichever is not applicable), and agree to abide by the settlement order as may be passed in accordance with the Securities and Exchange Board of India (Settlement Proceedings) Regulations, 2018 and guidelines and circulars issued by the Board in that regard: Provided that, in relation to defaults related to disclosures other than relating to a prospectus or a letter of offer or a similar such document required to be made in relation to an issue of securities, I/we do not deny the alleged default. (11) I/We waive my/our right of taking any legal proceedings against the Securities and Exchange Board of India concerning any of the issue covered in the settlement order that may be passed. (12) I/We further waive the following: (a) the findings of fact and conclusions of law; (b) the proceedings before the Board or any officer of the Board; (c) the right to all post-hearing procedures; (d) appeal/review before the Tribunal/courts; (e) any plea relating to such provisions of the regulations or other requirements of law, including conflict of interest, as may be construed to prevent any member or officer of the Securities and Exchange Board of India from participating in the proceedings, including settlement proceedings or assisting or advising the Internal Committee, High Powered Advisory Committee or Panel of Whole Time Members, as to, any order, opinion, finding of fact, or conclusion of law, etc.; (f) any plea of bias or pre-judgment by the Securities and Exchange Board of India, the officers or the High Powered Advisory Committee, based on the consideration of or discussions concerning settlement of all or any part of the internal proceedings; and (g) any plea of limitation or laches for initiating or restoring of the proceedings, if the applicant violates the settlement order. (13) I/We undertake as a condition of settlement to not seek, directly or indirectly, any set-off, reimbursement by way of indemnification, insurance coverage or any other form of non-tax reimbursement. (Signature of the applicant with stamp and seal of the body corporate) Before me. Notary. ************ NOTES:- 1. Omitted vide Notification No. SEBI/LAD-NRO/GN/2020/24 dated 22-07-2020 before it was read as, by way of a demand draft in favour of Securities and Exchange Board of India payable at Mumbai or 2. Inserted vide Notification No. SEBI/LAD-NRO/GN/2020/24 dated 22-07-2020 3. Inserted vide Notification No. SEBI/LAD-NRO/GN/2022/62 dated 14-01-2022 4. Substituted vide Notification No. SEBI/LAD-NRO/GN/2022/62 dated 14-01-2022 before it was read as, direct credit in the bank account through NEFT/RTGS/IMPS or any other 2 [ electronic ] mode allowed by RBI 5. Omitted vide F. No. SEBI/LAD-NRO/GN/2024/212 dated 28-11-2024 before it was read as, and duly notarized at the time of execution 6. Inserted vide F. No. SEBI/LAD-NRO/GN/2024/212 dated 28-11-2024