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TMI BlogApplication Form for Grant of Certificate of Registration as Foreign Venture Capital Investor (FVCI)X X X X Extracts X X X X X X X X Extracts X X X X ..... cy 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. Inform ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... 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-Governmen ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... ry 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 o ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... ntain 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 F ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... o _________________________________ 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, 2 ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... ease 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 ..... X X X X Extracts X X X X X X X X Extracts X X X X
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