Schedule - I - Application for Registration as Registrars to issue or Share Transfer Agents or Both - Securities and Exchange Board of India (Registrars to an Issue and Share Transfer Agents) Regulations, 1993

SCHEDULE I FORM A SECURITIES AND EXCHANGE BOARD OF INDIA (REGISTRARS TO AN ISSUE AND SHARE TRANSFER AGENTS) REGULATIONS, 1993 1 [(Regulation 3)] 2 [APPLICATION FOR REGISTRATION AS REGISTRARS TO ISSUE OR SHARE TRANSFER AGENTS OR BOTH] NAME OF THE APPLICANT (Whether proprietary concern / firm / association of persons /body of persons /body corporate) __________________________________________________ NAME OF THE PRINCIPAL OFFICER AND DESIGNATION__________________________ TELEPHONE NO. __________________________ CATEGORY FOR WHICH CERTIFICATE APPLIED FOR UNDER REGULATION 3 (AS APPLICABLE) ___________________________________________________________ INSTRUCTION: 1. APPLICANT MUST SUBMIT A COMPLETED APPLICATION FORM TOGETHER WITH SUPPORTING DOCUMENTS TO THE SECURITIES AND EXCHANGE BOARD OF INDIA. 2. ALL COLUMNS OF THE APPLICATION SHOULD BE FILLED IN. IN CASE A COLUMN IS NOT RELEVANT OR NOT APPLICABLE, THIS SHOULD BE SPECIFIED. 3. INFORMATION WHICH NEEDS TO BE SUPPLIED IN MORE DETAILS MAY BE WRITTEN ON SEPARATE SHEETS WHICH SHOULD BE ATTACHED TO THE APPLICATION FORM. 4. ORIGINAL COPY OF FORM DULY SIGNED SHOULD BE SUBMITTED. PART - I GENERAL INFORMATION 1. APPLICANTS DETAILS 1.1 Name of the Applicant _____________________________ 1.2 Category applied for ______________________________ 1.3 Address of Applicant ______________________________ Pin Code _____________Telephone No. _____________ Telex No. _____________Fax No. __________________ 1.4 Address of the applicant for Correspondence: Pin Code _____________Telephone No. ____________ Telex No. _____________Fax No. __________________ 1.5 Address of Branch Offices (in India Abroad) of the applicant, if any: (a) _________________________________________ (b) _________________________________________ (c) _________________________________________ (d) _________________________________________ 1.6 Whether any other application under Securities and Exchange Board of India Act, 1992 has been made for grant of Certificate, if so, details thereof: 2. ORGANISATION STRUCTURE: 2.1 Objective of the organisation. (attach the extracts from relevant documents like, Partnership deed, Charter, Memorandum of Association, and Articles of Association in support of objectives of the organisation.) 2.2 Date and Place of Incorporation / Establishment of the organisation of the applicant. Day Month Year Place 2.3 Status of the applicant (specify whether proprietary, partnership, association of persons, body of individuals, limited company - public/private, others. If listed, name of the stock exchange and latest share price: high low). 2.4 Organisation Chart stating the functional responsibility at various levels. 2.5 Particulars of all Proprietors / Partners / Mangers / Officers / Directors:- [Name, Qualification, Experience, Date of Appointment, Other directorship (Name Date of Appointment), Previous positions held.] 2.6 Number of employees (General and for specific Intermediaries activity) 2.7 Name and activities of associate companies / concerns carrying out on activities of a registrar to issue or share transfer agent. Name Address/ Phone nos. Type of activity Status 2.8 In case the applicant is a body corporate, please give list of major shareholders (holding 5% or more voting rights) and percentage of their shareholdings. 3. DETAILS OF INFRASTRUCTURAL FACILITIES 3.1 Office Space (mention the extent of area available) 3.2 Office Equipment (mention the details of electronic office equipment, typewriters, telecommunications equipment etc.) 3.3 Whether Data Processing capacity facility is available (a) In house or (b) outside, please give details. 3.4 Computer facility: (a) Hardware Configuration (b) Software Environment 4. BUSINESS PLAN (FOR THREE YEARS) (a) History, Major achievements and present activity (b) Projected Profitability (Next three years) (Physical targets, Modus Operandi to achieve targets, Resultant Income) 5. FINANCIAL INFORMATION 5.1 Capital structure (Rs. In lakhs) Current Year Subsequent second year (estimated) Subsequent third year (estimated) (a) Paid up Capital (b) Free reserves (excluding revaluation reserves) (c) Total (a) + (b) (d) Loans (Details) Note:─In case of partnership or proprietary concerns, please indicate capital minus drawings. 5.2 Deployment of Resources (Rs. In lakhs) Current Year Subsequent second year (estimated) Subsequent third year (estimated) (a) Fixed Assets (b) Plant Machinery And office equipment (c) Investment (Details Should be given separately) (d) Others 5.3 Net Profit for the last three financial years (Rs. In lakhs) First Year Second Year Third year 5.4 Estimated profit from various sources. (Rs. In lakhs) Current Year Subsequent second year (estimated) Subsequent third year (estimated) 5.5 In the case of body corporate, please enclose three years of audited annual accounts and where unaudited reports are submitted, give reasons. 5.6 Name and Address of Principal Bankers 5.7 Name and Address of the Auditors (Internal, External Tax auditor, if any). (As applicable) 6 OTHER INFORMATION 6.1 Details of all pending disputes: Nature of dispute Name of the party Names Places of Court / Tribunal where disputes are pending 6.2 Indictment of involvement in any offence relating to moral turpitude /economic offences in the last three years. 6.3 Any significant awards or recognition, collective grievances against the services rendered by the company. 6.4 Any other information considered relevant to the nature of services rendered by the company. 6.5 Name of two references. (For applicants other than institutions corporate bodies) Part II 7. BUSINESS INFORMATION 7.1 Describe present activities and proposed activity in case of new organisation. 7.2 Existing / proposed facilities for redressal of Investor Grievances. (Furnish number and type of complaints received, follow-up with the companies, average time taken in resolving the complaints and overall system of handling complaints.) 7.3 Enclose a copy of typical contract entered with a person making the issue or share transfer agent. 7.4 Details of facilities for processing of application, collection and dispatch of documents, refund orders, allotment letters, space for safe custody of refund orders, certificates, reconciliation with the collecting banks. 8. EXPERIENCE 8.1 Experience in handling the activities during the last three years. (Name of the corporate body, particulars of issues handled, size of issues etc.) for: (a) Registrars to Issue (b) Share Transfer Agents 8.2 Experience in other financial services (period, area, and commencement of activity). DECLARATION ___________________________________________________ THIS DECLARATION MUST BE SIGNED BY PRINCIPAL OFFICER / SOLE PROPRIETOR, AS APPLICABLE. I / We hereby apply for GRANT OF CERTIFICATE OF REGISTRATION by the Board, I/ We warrant that I/We will carry out my /our duties in accordance with the Act, Rules and Regulations. I/We warrant that I/We have truthfully and fully answered the questions above and provided all the information which might reasonably be considered relevant for the purposes of my/our grant of Certificate for registration and I/We will promptly notify the Board of any changes in the information during the period that my / our registration is being considered and if my/our registration is accepted, thereafter. I/We understand that misleading or attempting to mislead the Board shall render the applicant liable to disciplinary proceedings. I/We certify that the above information and information supplied in the application form is true, complete and correct. For and on behalf of -------------------------------------------- (Name of Applicant) PLACE Date FORM B SECURITIES AND EXCHANGE BOARD OF INDIA (REGISTRAR TO AN ISSUE AND SHARE TRANSFER AGENT) REGULATIONS 1993 3 [(Regulation 8 4 [***])] Certificate of 5 [***] Registration I. In exercise of 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 registrars to an issue and share transfer agent in Category I* / registrar to an issue*/ share transfer agent* in Category II subject to the conditions in the rules and in accordance with the regulations to carry out the activities as specified therein. II. Registration Code for registrar to an issue and share transfer agent is ________________ III. 6 [This certificate of registration shall be valid unless it is suspended or cancelled by the Board.] Date: By Order For and on behalf of Securities and Exchange Board of India *Delete whichever is not applicable. ************ NOTES:- 1 Substituted for the words Regulation 3/Regulation 8A 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 3/Regulation 8A were substituted for the words and number Regulation 3 , by the SEBI (Registrars to an Issue and Share Transfer Agents) (Amendment) Regulations, 2011, w.e.f. 5-7-2011. 2 Substituted for the words Application for Initial/ Permanent Registration as Registrars to Issue or Share Transfer Agents or both 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 Application for Initial/ Permanent Registration as Registrars to Issue or Share Transfer Agents or both were substituted for the words APPLICATION FOR REGISTRATION AS REGISTRARS TO ISSUE OR SHARE TRANSFER AGENTS OR BOTH , ibid. 3 Substituted for the word and number Regulation 8 by the SEBI (Registrars to an Issue and Share Transfer Agents) (Amendment) Regulations, 2011, w.e.f. 5-7-2011. 4 The words /Regulation 8A 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. 5 The words Initial/Permanent was 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 Initial/Permanent were substituted for the words Certificate of Registration by the SEBI (Registrars to an Issue and Share Transfer Agents) (Amendment) Regulations, 2011, w.e.f. 5-7-2011. 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 read as under: This certificate of registration shall be valid, from to /for permanent, unless suspended or cancelled by the Board. Prior to above paragraph III was substituted for Unless renewed, the certificate of registration is valid from .. to by the SEBI (Registrars to an Issue and Share Transfer Agents) (Amendment) Regulations, 2011, w.e.f. 5-7-2011.