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TMI BlogApplication for grant of certificateX X X X Extracts X X X X X X X X Extracts X X X X ..... t 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/establish ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... registration / recognition of the applicant with the Board and with other regulatory authorities or with stock exchanges or self regulatory organization (whether in India or abroad): The Regulator/ SRO Details of registration Registration No. Period of validity 1.10. Details of registration / recognition of each affiliates of the applicant with the Board or with other regulatory authorities or with stock exchanges or self regulatory organizations (whether in India or abroad): The Regulator/ SRO Details of registration Registration No. Period of validity 1.11 Details of the Compliance Officer: 1.12 Details of principal officers Name Job Title Business Address Telephone no Fax No E-mail address 1.12 Details of principal officers: Name Of Per ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... licant Directorships in other entities Controlling interest in other entities 4.2 Names of Promoters of the Applicant should be provided. Part II 5. Financial Reporting and Disclosure (where the intermediary is active): 5.1 Audited balance sheets and profit and loss account statements for the past three years (including notes to accounts); 5.2 Net Worth of the applicant for the past three years; segment wise turnover of the applicant (where necessary) [for eg. where the applicant is a stock broker, then the segment wise turnover i.e. turnover under the cash segment, the derivative segment, the commodities segment etc. may be provided) 6. Details of the taxation authority: 6.1 Please provide details of the authority where the applicant is su ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... , guidelines, notifications, circulars, and any other directions as may be passed by the Securities and Exchange Board of India from time to time, issued thereunder and applicable to us, and all other relevant laws including guidelines issued by the Reserve Bank of India and the Government of India. 5 We further undertake that as a condition of grant of certificate, we shall abide by such operational instructions/ directives as may be issued by Securities and Exchange Board of India from time to time under provisions of the Act or any other law for the time being in force. For and on behalf of (Name of the applicant) Name of the applicant Signature Name of signatory Position Date dd/mm/yyyy Notes: - - statute, statutory provisions legisla ..... X X X X Extracts X X X X X X X X Extracts X X X X
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