Schedule - I - Application for grant of certificate of registration - Securities and Exchange Board of India {KYC (Know Your Client) Registration Agency} Regulations, 2011

SCHEDULE I SECURITIES AND EXCHANGE BOARD OF INDIA {KYC (KNOW YOUR CLIENT) REGISTRATION AGENCY} REGULATIONS, 2011 [Regulation 3] FORM A Application for grant of certificate of 1 [***] registration INSTRUCTIONS FOR FILLING UP FORM 1. Applicants must submit to the Board a completed application form together with appropriate supporting documents and applicable application fees. Supporting documents should be attested as true by a notary public. 2. This application form should be filled in accordance with the regulations. 3. Application for registration will be considered, only if it is complete in all respects. 4. All answers must be typed. 5. Information which needs to be supplied in more detail may be given on separate sheets which should be attached to the application form. 6. All signatures on the application must be original. 7. Every page of the form as well as every additional sheet must be initialed by the authorised signatory of the applicant. Part I 1. General details of the applicant and its affiliates: Management Compliance Matrix/Structure 1.1. Name of the applicant: 1.2. Address of the registered office, address for correspondence, telephone numbers, fax numbers, e-mail, website, name and telephone number of the contact person, address of branch office, if any: 1.3. Date and place of incorporation/establishment and registration number given by the Registrar of Companies or any other authority: 1.4. Legal status of the applicant and the law, under which it is incorporated, established or registered, if any including where the applicant is a listed entity, the details of the exchanges(whether in India or abroad) where the applicant is listed: 1.5. Brief description of the principal activity of the applicant: (along with copies of the constitutional documents of the applicant) 1.6. Year of commencement of such activities ( if applicable): 1.7. Shareholding pattern of the applicant (please set out the names of all such persons who hold whether directly or indirectly more than 5% of the shareholding or voting rights in the company): Name of the shareholder No. of Shares [% of shareholding] / [% of voting rights] Where control over the applicant is exercised by a person by way of an agreement or arrangement, details and documentation in relation to such agreement or arrangement as the case may be. 1.8. Details of significant affiliates of the applicant operating in India or abroad and activities carried out by them including details as regards the legal status of each such affiliates and the law, under which it is incorporated, established or registered, if any. Legal Status and details of registration Name Address Telephone no Fax No E mail address 1.9 The Category to which the applicant belongs in terms of Regulation 6: 1.10 Networth of the applicant for the past three financial years(enclose copy of balance sheet and a copy of the latest networth certified by a practicing chartered accountant 5 [ having a valid certificate of practice under sub section (1) of section 6 of the Chartered Accountants Act, 1949 (38 of 1949) ] ) 1.11 Whether any disciplinary /penal action has been taken by SEBI/any other statutory authority in the last five years against the applicant or its parent company: If so, furnish details including status of the proceedings and whether the penalty has been paid FORM B SECURITIES AND EXCHANGE BOARD OF INDIA {KYC (KNOW YOUR CLIENT) REGISTRATION AGENCY} REGULATIONS, 2011 [Regulations 7 2 [***]] Certificate of Registration I. In exercise of the powers conferred by sub-section (1A) of section 12 of the Securities and Exchange Board of India Act, 1992, read with the regulations made thereunder the Board hereby grants an 3 [***] certificate of registration to _________________________________ as a KYC Registration Agency, subject to the conditions specified in the Act and in the regulations made thereunder. II. Registration Number for the KYC Registration Agency is IN/....../ ./ ..../.... III. 4 [This certificate of registration shall be valid unless it is suspended or cancelled by the Board.] Date: Place: Mumbai By Order For and on behalf of Securities and Exchange Board of India Authorised Signatory ************** NOTES:- 1 The words initial or permanent Omitted by the Securities and Exchange Board of India (Change In Conditions Of Registration Of Certain Intermediaries) (Amendment) Regulations,2016 w.e.f. 08-12-2016. 2 The words and 8 Omitted by the Securities and Exchange Board of India (Change In Conditions Of Registration Of Certain Intermediaries) (Amendment) Regulations,2016 w.e.f. 08-12-2016. 3 The words initial/permanent omitted by the Securities and Exchange Board of India (Change In Conditions Of Registration Of Certain Intermediaries) (Amendment) Regulations,2016 w.e.f. 08-12-2016. 4 Substituted by the Securities and Exchange Board of India (Change In Conditions Of Registration Of Certain Intermediaries) (Amendment) Regulations,2016 w.e.f. 08-12-2016. Prior to substitution paragraph III read as under: III. This certificate of registration shall be valid from . to ./ for permanent , unless suspended or cancelled by the Board. 5. Inserted vide Notification No. SEBI/LAD-NRO/GN/2022/72 dated 28-01-2022