Form for Informant’s Reward Claim to be submitted to the Board within the time specified in the intimation of prima facie eligibility to receive an Informant Reward.

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..... he Board within the time specified in the intimation of prima facie eligibility to receive an Informant Reward. All fields are mandatory I . PERSONAL INFORMATION A. Informant: Last name:--------------------- First Name:------------------------ Title:----------------- Address: City / State: PIN: Telephone (with State code): Mobile: E-Mail Address: Employment Details: Permanent Account Number: II OR .....

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..... at I/we may not get any Reward at all. I/we would be bound by the decisions that the authority competent to grant reward may take; I/we accept that the Securities and Exchange Board of India is under no obligation to pay any reward or enter into any correspondence regarding action or inaction taken as a result of this communication. I/we accept that the reward would be an ex-gratia payment which, .....

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..... e it is not so found. I/we fully understand that I/we may be subject to action under securities laws as well as Section 182 of the Indian Penal Code, 1860 (45 of 1860) and ineligible for an Informant Reward if, in my/our submission of information or in any other dealings with the Board, I/we knowingly and wilfully make any false, fictitious, or fraudulent statements or representations, or use any .....

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