Schedule - I - Application for Grant of Certificate of Registration as Banker to the Issue - Securities and Exchange Board of India (Bankers to an Issue) Regulations, 1994

SCHEDULE I FORMS FORM A [ 1 [Regulation 3]] Securities and Exchange Board of India (Bankers to an Issue) Regulations, 1994 2 [Application for Grant of Certificate of 3 [***] Registration as Banker to the Issue] Name:....................................................................................................................................................................... Name of person to contact:..................................................................................................................................... Designation:.............................................................................................................................................................. Telephone No.:........................................................................................................................................................ 1. Applicants must submit a completed application form together with appropriate supporting documents to the Securities and Exchange Board of India. 2. It is important that this application form should be read in conjunction with rules and regulations and the code of conduct for the banker to an issue. 3. Applications for registration will only be considered provided all questions are answered. 4. Answers must be typed/printed. 5. Information which needs to be supplied in more details may be written on separate sheets which should be attached to the application form. 6. All signatures must be original. PART I GENERAL INFORMATION 1. Applicants Details 1.1 Name 1.2 Address of registered office of the Bank : Pin code: ......................................... Telephone No. :........................................ Telex No.: ....................................... Fax No. :...................................................... Address for correspondence : Pin code : ......................................... Telephone No. :........................................ Telex No. : ....................................... Fax No. :...................................................... 1.3 Application to Securities and Exchange Board of India for other intermediary activity: .................................................... 2. Organisation Structure: 2.1 Date and Place of Incorporation Day Month Year Place 2.2 Organisation Chart : General Organisation and specific activity (i.e., applied for registration). Also state the functional responsibility. 2.3 Particulars of all Directors and key management personnel:-[for other than public sector banks only Name; Qualification; Experience Ownership details; (date of appointment) other directorship; (Name date of appointment); previous positions held.] 2.4 Number of employees 2.5 List of major shareholders (holding 5% or more voting shares) Name, Shareholding pattern i.e. No. of shares and its % to total capital) 3.0 Details of infrastructural facilities (To be used for specific activity) 3.1 Data processing capacity (a) Inhouse: (b) Others : 3.2 Computer facility : (a) Hardware configuration (b) Software used 3.3 Communication and manpower facilities available at controlling branch/head office and at various branches 4.0 Financial Information 4.1 Capital Structure (Rs. in lakhs) Year prior to the Preceding year of Current year Preceding year current year (a) Paid-up Capital (b) Free reserves (excluding revaluation reserves) (c) Total (a) + (b) (d) Deposits (e) Working Funds 4.2 Net Profit first year second year third year 4.3 Income (From specific activity of Banker to an issue) 5.0 Other information (For specific activity of Banker to an issue) 5.1 Details of all settled and pending disputes : Nature of dispute Name of the party Pending/settled 5.2 Indicate involvement in any economic and criminal offences in the last three years (For directors) 5.3 Any other information considered relevant to the nature of services rendered by the company 5.4 Name and Address of the Auditors PART II SPECIFIC INFORMATION AS TO BANKER TO AN ISSUE 6.0 Business information 6.1 Indicate type of activities carried on/proposed to be carried on. (Collection Bankers for : Application money and/or Allotment money, Refund Bankers, Paying Bankers for payment of dividend/interest warrant). 6.2 Describe modus operandi for handling applications, processing them and for co-ordination between branches, remittance of money, collection and accounting for funds, function of refund bankers. 6.3 Enclose a copy of typical contract entered with the client for the services rendered. 6.4 Enclose list of centres at which the bank has branches out of centre notified by the Ministry of Finance. 7.0 Experience 7.1 Experience as bankers as to the issue (period to be indicated) (Services provided during last year) 7.2 List of clients (Corporate clients only) (For specific activity) Name Services rendered Declaration THIS DECLARATION MUST BE SIGNED BY TWO AUTHORISED OFFICIALS OF THE APPLICANT We hereby apply for registration. We warrant that we have truthfully and fully answered the questions above and provided all the information which might reasonably be considered relevant for the purposes of our registration. We hereby declare that the information furnished is true and correct and neither the applicant nor any of its Directors and key-executive personnel have been involved in or convicted of economic offences during the last three years or by the Reserve Bank for violation of the provisions of the Reserve Bank of India Act, 1934 and Banking Regulation Act, 1949. For and on behalf of .................................................................................................................................. (Name of Applicant) ....................................................... . ...................................................... Director/Officer Director/Officer ....................................................... ....................................................... Name in Block Letters Name in Block Letters ....................................................... ....................................................... Place : Place : Date : Date : FORM B [ 4 [Regulation 7]] Securities and Exchange Board of India (Bankers to an Issue) Regulations, 1994 5 [Certificate of Registration] I. In exercise of the powers conferred by sub-section (1) of section 12 of the Securities and Exchange Board of India Act, 1992, read with the rules and regulations made thereunder the Board hereby grants a certificate of registration to................as a banker to an issue subject to the conditions in the rules and in accordance with the regulations. II. Registration Code for the Banker to an issue in BI / / / 6 [III. This certificate of registration shall be valid unless it is suspended or cancelled by the Board.] Date : Place : By Order For and on behalf of Securities and Exchange Board of India Authorised Signatory ************** NOTES:- 1 The words /Regulation 7A were 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. Prior to this the words and figure Regulation 3 were substituted for the words Regulation 3/ Regulation 7A by the Securities and Exchange Board of India (Bankers to an Issue) (Amendment) Regulations, 2011, w.e.f. 05-07-2011. 2 Substituted the words and sign Application for grant / renewal of certificate of registration as bankers to issue by the Securities and Exchange Board of India (Bankers to an Issue) (Amendment) Regulations, 2011, w.e.f. 05-07-2011. 3 The words initial/permanent were 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 for the words Regulation 7/ 7A 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 this, the words Regulation 7/ 7A substituted the word Regulation 7 by the Securities and Exchange Board of India (Bankers to an Issue) (Amendment) Regulations, 2011, w.e.f. 05-07-2011. 5 Substituted for the words Certificate of Initial/Permanent Regulation 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 this, the words Certificate of Initial/Permanent Regulation substituted the words Certificate of Registration by the Securities and Exchange Board of India (Bankers to an Issue) (Amendment) Regulations, 2011, w.e.f. 05-07-2011. 6 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 as substituted by the Securities and Exchange Board of India (Bankers to an Issue) (Amendment) Regulations, 2011, w.e.f. 05-07-2011. read as under: III. This certificate of registration shall be valid from .. to . / for permanent, unless suspended or cancelled by the Board.] Prior to the above, paragraph III was by the Securities and Exchange Board of India (Bankers to an Issue) (Amendment) Regulations, 2011, w.e.f. 05-07-2011. Prior to the substitution the paragraph read as under: III. Unless renewed, the certificate of registration is valid from................to...........