Schedule - I - Application Form for Grant of Certificate of Registration as Foreign Venture Capital Investor (FVCI) - Securities and Exchange Board of India (Foreign Venture Capital Investors) Regulations 2000

3 [ FIRST SCHEDULE PART A FORM A Securities and Exchange Board of India (Foreign Venture Capital Investors) Regulations, 2000 [See regulation 3(2)] Application Form for Grant of Certificate of Registration as Foreign Venture Capital Investor (FVCI) 1. Name of the applicant: ( Full expanded name to be mentioned as appearing in proof of identity/ address documents , the name should be provided without any abbreviations ) 2. Have you ever been known by any other name? Yes/No Is yes, please give the other name 3. Date of Incorporation/ Establishment/Formation (DD/MM/YYYY) Particulars Date (DD/MM/YYYY) a) Date of Incorporation / Establishment/Formation b) Date of Commencement of Business 4. Place and Country of Incorporation/ Establishment/ Formation: Particulars Details a) Place b) Country c) ISD Country Code 5. Legal form of the applicant and the law under which it is incorporated, established or registered: 6. Legal Entity Identifier Tax Residency Certificate details: Particulars Details a) Legal Entity Identifier (LEI), if applicable b) Tax Residency Certificate (TRC) No. c) Country of Tax Residency + Add (Add rows at b) and c) in case of Multiple Tax Residency details) 7. Address Communication Details 7.1 . Registered Address of the Applicant: Flat/ Room/ Door/ Block No. Name of Premises/Building/ village Road/ Street/Lane/ Post Office Area/ Locality/ Taluka/ Sub-Division Town/ City/ District State/Union Territory Pin Code/ Zip Code Country 7.2 . Office Address of the Applicant (If applicant has an office in India also, please provide separate entry for the same) : Flat/ Room/ Door/ Block No. Name of Premises/Building/ village Road/ Street/Lane/ Post Office Area/ Locality/ Taluka/ Sub-Division Town/ City/ District State/Union Territory Pin Code/ Zip Code Country 7.3 Address of Communication/Correspondence (Please tick as applicable) Registered address Office address (foreign) Office address (India) 7.4 Contact Details: S.No Particulars Registered address Office address Country Code Area/ STD Code Number Country Code Area/ STD Code Number 1. Telephone Number 2. Fax Number 3. Mobile Number 4. Email ID 5. Website 8. Information pertaining to Investment Manager: Name of entity Type of entity Country Telephone no /Mobile no Fax No. E-mail id 9. Information pertaining to the Compliance officer: Name Job Title Telephone no Fax No. E-mail id 10. Information regarding Ultimate Beneficial Owner (End Natural Person): 10.1. Individual Custodian/ Designated Depository Participant (DDPs) may seek additional documentation/ownership details at a lower threshold than prescribed, based on their independent evaluation and risk classification of the respective FVCI applicants on the basis of multiple parameters such as home jurisdiction, type of entity, nature of business etc. __We declare that there is no natural person/individual who are ultimately holding ___% beneficial ownership directly/indirectly into the entity as well as on controlling basis for companies, Trust General Partner / Limited Partnership structure. We therefore provide details of the senior managing official of the FVCI as under. The list of beneficial owners as per materiality threshold for controlling ownership interest and / or on control basis is provided as under: __ The list of beneficial owners as per materiality threshold for controlling ownership interest and / or on control basis is provided as under: S. No Name Address of the Beneficial Owner (Natural Person) Date of Birth Tax Residency Jurisdiction Nationality Whether acting alone or together, or through one or more natural person as group with their name address Beneficial Owner (BO) Group Percentage Shareholding / Capital/Profit Ownership in the FVCIs Tax Residency Number/ Social Security Number/ Passport Number of BO/ any other Government issued identity document number (example Driving Licence) [Please provide any] (1) (2) (3) (4) (5) (6) (7) (8) 10.2. Does it have few persons or persons of the same family holding beneficial ownership and control? Yes /No 11. Income details Particulars Details Source of Income: Please select the most appropriate: 1) Capital Gains 2) Income from Business/ Profession 3) No Income 4) Income from other Sources 5) Income from House Property b) Code for Business / Profession Code Business/Profession Code Business profession 01 Medical Profession and Business 11 Films, TV and such other entertainment 02 Engineering 12 Information Technology 03 Architecture 13 Builders and Developers 04 Chartered Accountant/ Accountancy 14 Members of Stock Exchange, Share Brokers and Sub-Brokers 05 Interior Decoration 15 Performing Arts and Yatra 06 Technical Consultancy 16 Operation of Ships, Hovercraft, Aircrafts or Helicopters 07 Company Secretary 17 Plying Taxis, Lorries, Trucks, Buses or other Commercial Vehicles 08 Legal Practitioner and Solicitors 18 Ownership of Horses or Jockeys 09 Government Contractors 19 Cinema Halls and Other Theatres 10 Insurance Agency 20 Others c) Gross Annual Income (in INR) d) Net worth (Asset less liabilities) (in INR): as on dd/mm/yyyy 12. Type of applicant: Please select the most appropriate category. Investment company, investment trust, investment partnership, pension fund, mutual fund, endowment fund, university fund, charitable institution or asset management company, investment manager or investment management company; any other investment vehicle incorporated or established outside India or any other entity incorporated or established outside India If any other entity or investment vehicle, please give details: 13. Type of entity: Please select one of the below options: 1) Private Company (R) 2) Public Company (U) 3) Body Corporate (D) 4) Financial Institution (S) 5) Non-Government Organisation (N) 6) Charitable Organisation (C) 14. Documents submitted as Proof of Identity (POI) and Proof of Address (POA) for KYC: Particulars Details a) Proof of identity (POI) b) Proof of Address (POA) 15. Whether the applicant or the applicant's authorized signatories/ Promoters/ Partners/ Trustees/ Whole Time Directors/Office bearer is a) A politically exposed person Yes/No b) Related to a politically exposed person Yes/No 16. Whether the applicant has provided with valid self-certification/ Foreign Account Tax Compliance Act (FATCA) / Common Reporting Standard (CRS) declaration form? Yes /Not applicable 17. Details of Regulatory authority by which the applicant is regulated (If applicable) Name Country Web-site Registration Number/Code with regulator, if any Category / Capacity in which the applicant is Regulated 18. Whether the applicant is coming through Global Custodian? Yes/No If yes, please provide name of Global custodian Name of Regulator Country of Regulator Registration Number/ code with regulator, if any Address 19. Details of the designated depository participant, custodian and Depository Participant: a). Details of Designated Depository Participant Name of the Designated Depository Participant SEBI Registration number for DDP/Custodian b) Details of Custodian Name of the Custodian SEBI Registration number for Custodian c) Details of Depository Participant Name of the Depository Participant SEBI Registration number for Depository Participant 20. Details of the designated bank Name of the Bank and Branch Address 21. Details of Prior association with Indian securities market Whether the applicant is/was anytime associated with Indian securities market in any capacity? Yes/No Name of the Entity Registered/ associated as SEBI Registration No. (if applicable) Period of registration 22. Whether the applicant already holds Permanent Account Number (PAN)? Yes/No If yes, please mention PAN: ------------------------ 2.3 Disciplinary History Whether there has been any instance of violation or non-adherence to the securities laws, code of ethics/conduct, code of business rules, for which the applicant or its parent/holding company or associate/or promoter/investment manager may have been subjected to criminal liability or suspended from carrying out its operations or the registration, has been revoked, temporarily or permanently or any regulatory actions that have resulted in temporary or permanent suspension of investment related operations in jurisdiction where the applicant is operating and has a bearing on obtaining FVCI registration for investing in India? Yes/No If yes, please mention details briefly in below box. For more details, enclose Annexure. Declaration and Undertaking: We_______________________________________, the applicant, in the capacity of _________________, do hereby declare that what is stated in the aforesaid application form (including the enclosed documents/annexures) is complete and true to the best of our information and belief. We undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, we are aware that we may be held liable for it. We hereby apply for registration as Foreign Venture Capital Investor ( FVCI ) in accordance with the Securities and Exchange Board of India (Foreign Venture Capital Investor) Regulations, 2000. Further, we have read and understood the Securities and Exchange Board of India (Foreign Venture Capital Investor) Regulations, 2000, circulars issued thereunder, its operating guidelines, reply to frequently asked questions on FVCI regime provided by the Board and shall abide with any other terms and conditions specified by the Board from time to time. We hereby declare that we fulfil the eligibility criteria under the Securities and Exchange Board of India (Foreign Venture Capital Investor) Regulations, 2000 and we are eligible to register as a FVCI. Place: ------------------------------ Date: ------------------------- For and on behalf of applicant (Name of the applicant) Signature of Authorized Signatory Name of signatory Designation Date Dd/mm/yyyy ANNEXURE TO APPLICATION FORM A: Declaration Undertaking: 1. We have read and understood the extant Indian laws, rules, regulations including Securities and Exchange Board of India (Foreign Venture Capital Investors) Regulations, 2000, Foreign Exchange Management Act, 1999 (Act No. 42 of 1999) and rules regulations made thereunder, Depository and Depository Participants Regulations, circulars, guidelines issued therein and shall in relation to our activities as FVCI, at all times, comply with and subject ourselves to any other terms and conditions specified by the Board, Reserve Bank of India (RBI), Depository or any other regulators from time to time. 2. We undertake to provide additional information/documents (including KYC documents exempted by the Securities and Exchange Board of India and Reserve Bank of India)/ declarations and undertakings as may be required by you/demand from any regulator/law enforcement agency/exchange without delay to ensure compliance with the Prevention of Money Laundering Act, 2002 (Act No. 15 of 2003) and rules and regulations prescribed thereunder, FATF standards and circulars issued from time to time by the Board, RBI or any other regulators in compliance with said requirement. 3. We undertake to abide by operational instructions/ directives as may be issued by Securities and Exchange Board of India, Reserve Bank of India or any other authority from time to time under provisions of the Act or any other applicable law. 4. We authorize custodian to operate the account through Power of Attorney (PoA) and not to receive credits automatically into our account. 5. We authorize custodian to send statement of account in electronic form and we will ensure the confidentiality of the password of the email, as applicable 6. We authorize custodian to maintain appropriate house account details on depository platforms for the purpose of collection of monetary corporate benefits and any other similar activities on our behalf. B: Additional information 1. If segregated portfolio is maintained for each sub-funds or share classes/ equivalent structures of the applicant, names of such sub-funds or share classes/ equivalent structures that intend to invest in India. Sr. No. Name of sub-funds or share classes/ equivalent structures that intend to invest in India (BO declaration at point 10 of application form is required for each fund/sub-fund/share class/equivalent structure that invests in India) 2. Bank or subsidiary of bank declaration __ We are not a bank or a subsidiary of a bank __We are a bank or a subsidiary of a bank and we/ group companies have a branch office or representative office in India Name of entity __We are a bank or a subsidiary of a bank and we/group companies do not have any branch office or representative office in India 3. Does FVCI wish KRAs to seek consent prior to permitting any intermediary to download their KYC information? Yes/No If Yes, please provide below information Name of authorized representative of FVCI (optional) Email id 1 (Mandatory) : Email id 2 (Optional) : Email id 3 (Optional) : Mobile number (optional): 4. Information in respect of Authorized signatories to Form/ senior management of FVCI applicant Sr. No. Name Relations hip with Applicant (i.e. promoters, directors, Signatory etc.) PAN (if applicable) Nationality /Country of Residence Date of Birth (DD/MM/Y YYY Residential/ Registered Address Any Government issued identity document number (example driving license) (1) (2) (3) (4) (5) (6) (7) (8) 1. 5. Information regarding Intermediate Material Shareholder/ Owner Entity (For determining Beneficial owner details as per circular issued by the Board from time to time) a) Details on the basis of ownership or entitlement: __ We declare that there is no entity holding = __% of ownership/ entitlement through shares/units, economic benefit participation etc. including cumulative direct / indirect holding held through single or multiple entities. OR __ Details of entities holding = ------ % of ownership/ entitlement through shares/units, economic benefit participation etc. including cumulative direct / indirect holding held through single or multiple entities are provided as under: Name of Beneficial owner Direct / Indirect Stake Names of the entity(ies) through which the stake in the FVCI is held indirectly Country of Incorporation / Nationality Percentage stake held in the applicant Individual /Non- Individual b) Beneficial Ownership by Control: __ We declare that there is no entity who controls through means like voting rights, agreements, arrangements, etc. OR __ Details of controlling entity is provided as under: Name of Beneficial owner Method of Control (Give Details including names of the intermediate structures, if any, through which control is exercised ) Country of Incorporation / Nationality Percentage control on the applicant, if applicable Individual/Non- Individual Date: Name of Applicant: (Signature block for Applicant) Signature(s) of Authorised Person(s) PART B SECURITIES AND EXCHANGE BOARD OF INDIA (FOREIGN VENTURE CAPITAL INVESTORS) REGULATIONS, 2000 [See regulation 3(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 (the Act ), read with the regulations made thereunder the Board hereby grants a certificate of registration to _________________________________ as a foreign venture capital investor, subject to the conditions specified in the Act and in the regulations made thereunder. II. The Registration Number for the foreign venture capital investor is /.../.../.../.... III . The address of the foreign venture capital investor is __________________ IV . This certificate shall be valid till it is suspended, cancelled or surrendered in accordance with the Securities and Exchange Board of India (Foreign Venture Capital Investors) Regulations, 2000. Date: Place: By Order Signature Name and Designation of the Authorized Signatory of Designated depository participant Issued on behalf of Securities and Exchange Board of India ] ************** NOTES:- 1 Inserted by the SEBI (Foreign Venture Capital Investors) (Amendment) Regulations, 2010, w.e.f. 21-12-2010. 2 Substituted for fund by the SEBI (Foreign Venture Capital Investors) (Amendment) Regulations, 2001, w.e.f. 7-6-2001. 3. Substituted vide Notification No. SEBI/LAD-NRO/GN/2024/203 dated 04-09-2024 w.e.f. 01-01-2025 before it was read as, FIRST SCHEDULE FORMS FORM A SECURITIES AND EXCHANGE BOARD OF INDIA (FOREIGN VENTURE CAPITAL INVESTORS) REGULATIONS, 2000 [See Regulation 3] APPLICATION FORM FOR GRANT OF CERTIFICATE OF REGISTRATION AS FOREIGN VENTURE CAPITAL INVESTOR WITH THE SECURITIES AND EXCHANGE BOARD OF INDIA SECURITIES AND EXCHANGE BOARD OF INDIA Mittal Court `B' Wing, 1st Floor Nariman Point, Bombay - 400 021, INDIA 1. Name, address, telephone no., telex no. and fax no. of the applicant. In case the applicant has a representative office in India, the particulars may also be given for that office. 2. Please indicate whether the applicant belongs to any one or more of the following categories: Pension Fund, Mutual Fund, Investment Trust, Investment company, Investment trust, Investment partnership, Asset Management Company, Investment manager, Investment Management Company, Endowment fund, University fund, Charitable institutions or any other investment vehicle incorporated and established outside India 3.(a) The date and place of incorporation of the applicant. (Details of statute under which incorporated). (b) Brief description of the principal activities of the applicant and the year of commencement of such activities. (c) Brief description of the group, if any, to which the applicant belongs. 4. Whether any of the following documents are submitted? i. Copy of certificate of registration with home regulator; or ii. Copy of income tax return filed in the home country; or iii. Copy of bankers certificate fair track record of the applicant 5. Please also state whether there has been any instance of violation or non-adherence to the securities laws, code of ethics/conduct, code of business rules, for which the applicant, or its parent/ holding company or affiliate may have been subjected to economic, or criminal liability or suspended from carrying out its operations, or the registration has been revoked, temporarily or permanently. If no, submit an undertaking. 6. Please indicate the names of the clients on whose behalf you propose to invest in India. 7. Please indicate the manner in which you propose to conduct your investments in India i.e. whether through an establishment in India or through any other office outside India. Please give details, and also the name of the contact person/compliance officer. 8. Name and address of the designated bank branch in India through whom investment is proposed to be made. 9. a) Name, address, telephone no., telex no., and fax no. of the domestic custodian. Please also present the background information on the custodian, including volume of business handled, organisational infrastructure and the number of investment companies for which the domestic custodian is acting, or has acted, as custodian. b) Particulars of the agreement entered into with the domestic custodian. We hereby agree and declare that the information supplied in the application, including the attachment sheets, is complete and true. And we further agree that we will immediately notify the Securities and Exchange Board of India of any change in the information provided in the application. We further agree that we shall comply with the provisions of the Act, and regulations issued thereunder and all other relevant laws. We further agree that as a condition of grant of certificate of registration, we shall abide by such operational instructions/ directives as may be issued by Securities and Exchange Board of India under the provisions of the Act from time to time. 1 [10. Please furnish firm commitment letter(s) from your investors for contribution of an amount aggregating to at least US$ 1 million. 11. Please furnish copies of your financial statements as well as those of your investors' who have provided firm commitment letter(s), for the financial year preceding the one during which this application is being made. 12. Please furnish name, address, contact number and the e-mail address of all your directors. 13. Please furnish name, address, contact number and the e-mail address of all your investor(s) who have provided firm commitment letter(s) required to be furnished under paragraph 10 of this Form.] For and on behalf of _______________________________________ ____________________________________ (Name of the applicant) Authorised Signatory ___________________ ___________________ ______________________________________ (Name) (Signature) Date: Place: Note: 1. Securities and Exchange Board of India (SEBI) reserves the right to call for any further information from the applicant regarding his application. 2. Applications, superscribed Application for Registration of Foreign Venture Capital Investors , should be submitted in duplicate, in sealed envelopes, at Securities and Exchange Board of India's office. Documents to be enclosed with the application: a. Documents to support registration or regulation by a Securities Commission and/or Self Regulatory Organisation, or any other appropriate regulatory/registering authority or b. Copy of income tax return filed in the home country; or c. Copy of bankers certificate for fair track record of the applicant FORM B SECURITIES AND EXCHANGE BOARD OF INDIA (FOREIGN VENTURE CAPITAL INVESTORS) REGULATIONS, 2000 [See Regulation 7(3)] Certificate of Registration as Foreign Venture Capital Investor I. In exercise of the powers conferred by sub-section (1) of section 12 of the Securities and Exchange Board of India Act, 1992, (15 of 1992) read with the regulations made thereunder the Board hereby grants a certificate of registration to ------------------------------------------------------------------------ as a Foreign Venture Capital Investor subject to the conditions specified in the Act and in the regulations made thereunder. II. The Registration Number of the foreign venture capital 2 [investor] is IN/FVCI/ / Date: Place: MUMBAI By order Sd/- For and on behalf of SECURITIES AND EXCHANGE BOARD OF INDIA