FIRST SCHEDULE - APPLICATION FOR GRANT OF CERTIFICATE OF REGISTRATION AS VENTURE CAPITAL FUND SECURITIES AND EXCHANGE BOARD OF INDIA - Securities And Exchange Board of India (Venture Capital Funds) Regulations, 1996

FIRST SCHEDULE-FORM FORM A Securities and Exchange Board of India (Venture Capital Funds) Regulations, 1996 [See regulation 3] APPLICATION FOR GRANT OF CERTIFICATE OF REGISTRATION AS VENTURE CAPITAL FUND SECURITIES AND EXCHANGE BOARD OF INDIA INSTRUCTIONS (i) This form is meant for use by the company or trust (hereinafter referred to as the applicant) for application for grant of certificate of registration as venture capital fund. (ii) The applicant should complete this form, and submit it, along with all supporting documents to the Board at its head office at Mumbai. (iii) This application form should be filled in accordance with these regulations. (iv) The application shall be considered by the Board provided it is complete in all respects. (v) All answers must be legible. (vi) Information which needs to be supplied in more detail may be given on separate sheets which should be attached to the application form. (vii) The application must be signed and all signatures must be original. (viii) The application must be accompanied by an application fee as specified in the Second Schedule to these regulations. 1. Name, address of the registered office, address for correspondence, telephone number(s), fax number(s), telex number(s) of the applicant and the name of the contact person. 2. Please indicate to which of the following categories the applicant belongs. (i) a company established under the Companies Act, 1956 (1 of 1956) (ii) a trust set up under the Indian Trusts Act, 1882 (2 of 1882). 3. Date and place of incorporation or establishment and date of commencement of business (enclose certificate of incorporation, memorandum and articles of association or trust deed in terms of which incorporated or established). 4. (a) Details of members of the Board of Trustees or directors of the trustee company, as the case may be, in case the applicant has been set up as a trust. (b) Details of members of the Board of Directors of the venture capital fund in case the applicant has been set up as a company. 5. Please state whether the applicant, his partner, director or principal officer is involved in any litigation connected with the securities market which has an adverse bearing on the business of the applicant; or has at any time been convicted for any moral turpitude or at any time has been found guilty of any economic offence. In case the applicant is a trust, the above information should be provided for the members of the Board of Trustees or of the above-mentioned persons connected with the trustee company. If yes, the details thereof. 6. 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 or holding company or affiliate may have been subject to economic, or criminal, liability, or suspended from carrying out its operations, or the registration revoked temporarily. 7. Details of asset management company, if any (enclose copy of agreement with the asset management company). 8. Declaration statement (to be given as below). 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 shall notify the Securities and Exchange Board of India immediately any change in the information provided in the application. We further agree that we shall comply with, and be bound by the Securities and Exchange Board of India Act, 1992, and the Securities and Exchange Board of India (Venture Capital Funds) Regulations, 1996, and Government of India guidelines/instructions as may be announced by the Securities and Exchange Board of India from time to time. We further agree that as a condition of registration, we shall abide by such operational instructions/directives as may be issued by the Securities and Exchange Board of India from time to time. For and on behalf of________________________________________ (Name of the applicant) Authorized signatory___________________ ______________________ (Name) (Signature) Date: Place: FORM B [See regulation 7(3)] SECURITIES AND EXCHANGE BOARD OF INDIA (VENTURE CAPITAL FUNDS) REGULATIONS, 1996 CERTIFICATE OF REGISTRATION AS VENTURE CAPITAL FUND 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 venture capital fund subject to the conditions specified in the Act and in the regulations made thereunder. II. The Registration Number of the venture capital fund is IN/VC Date : Place : MUMBAI By Order Sd/- For and on behalf of Securities and Exchange Board of India