Application for grant of certificate

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....ion will be considered, only if it 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 offic....

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....   Fax No   E-mail address   Nature of interest of the applicant in the affiliate, if any   Nature of interest of such affiliate in the applicant, if any   1.9. Details of 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 o....

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....adverse effect on the functioning of the intermediary and investor complaints. 2.1 Complaints pending for over three months:   S. No. Name of the complainant Date of receipt of complaint Short description of complaint Current status           2.2 Arbitration / litigation cases:   Forum Name of the Petitioner Short description of issue Current stage of proceedings Details of interim orders passed Details of final award / order 3 Brief description of the group 3.1 Brief description of the group, if any, to which the applicant belongs. Please confirm the details of the company and the group, tracing them down to the individual persons in contro....

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....and contact details (including telephone numbers, email, fax etc.) of the applicant's management personnel as specified in Clause 4.1 of Part I of the Form. 7.3 Provide Director's Identification Number of the directors of the applicant 8.Details of any show cause notices received by the applicant from any regulatory authority. Sr. No. Date of Notice Details of alleged violation Current status         9.Undertaking and Declarations: We hereby represent, warrant and declare that: 1 The information supplied in the application, including the attachment sheets thereto, is complete, true and accurate in all respects; 2 We are in compliance with, and have adhered to and fulfilled, all t....