Annexure 3

Applicants Details and Confirmations (on the letter head duly stamped and signed)

Sr. / Particulars / Details
1 / Name of the Applicant
2 / Correspondence Address of the Applicant / Addr :
City :
Pincode :
State :
3 / Permanent/Registered Address of the Applicant / Addr :
(if same as correspondence please mentioned as
‘Same as above’) / City :
Pincode :
State :
4 / Firm Type / Status (Please tick)
a) Individual
b) Body Corporate
c) Regd. Partnership Firm
d) LLP
e) Trust
f) Financial Institution
g) HUF
h) Bank
i) Society
j) Others (Please specify)
5 / Names of all Directors/Partners/Trustees with details :
Names of all Directors /Partners/Trustees / PAN / Mobile No. / Email id/s
6 / Date of Birth (in case of individual)
7. / Date of Incorporation / Registration & CIN (in case of Corporate)
CIN :
Date of Incorporation :
8. / PAN of Applicant
9. / ARN Code of Applicant
10. / Applicant Landline Nos.
11. / Applicants Email id
12. / Whether any case/claim/arbitration pending against the applicant in any court/stock exchanges (if yes, provide details) / Yes / No.
13. / Whether a citizen of India? / Yes / No.
14. / Have you been involved in any civil or criminal litigation, suit or proceeding? If so, give particulars / Yes / No.
15. / Have you been involved in any financial liability of contingent or
Unascertainednature? If so, give particulars / Yes / No.
16. / Have you, at any time, been convicted of an offence involving fraud or dishonesty? If so, give particulars / Yes / No.
17. / Have you at any time been :
a) rejected by any commodity or similar exchange or
commercial organization for membership?
b) expelledby any such exchange or commercial organization from membership?
c) declared a defaulter by any such exchange or commercial organization ?
If so, give particulars. / Yes / No.
Yes / No.
Yes / No.
18. / Have you at any time been adjudged bankrupt or has a receiving order in bankruptcy been made against you or have you been proved to be insolvent?
If so, give particulars. / Yes / No
19. / Any disciplinary action has been taken by AMFI / SEBI in the preceding 12 months against the applicant? If yes, please provide the details / Yes / No

Details provided above are true and correct to the best of my knowledge

Signature(s):

(alongwith stamp)

The following self-attested copies of documents are required along with applications (as applicable):

1 / Copy of the valid ARN and AMFI certification (Individual and proprietorship)
Other entities minimum two valid ARNs one in name of entity and other in name of employee/ partner/director as applicable.
2 / For Individual MFDs :
a) Self Certified PAN card
b) Address Proof (any one of the following : Telephone bill / Aadhar Card / Passport )
For Corporate MFDs/Financial institutions :
a) Certificate of Incorporation
b) Certified PAN card
c) Copy of the last audited annual report
d) Certified copy of Board resolution making application for
MFDs along with authorized Signatory List with Specimen Signatures.
e) Address Proof
f) Proof of TAN allotment / Annexure A
For Partnership Firms/LLPs
a) Partnership Deed
b) Address proof
c) Certified PAN card
d) Copy of the last audited Balance Sheet and Profit and Loss A/c
alongwith schedules
e) Certified copy of Partnership resolution making application for
MFDs along with authorized Signatory List with Specimen Signatures.
f) Proof of TAN allotment / Annexure A
Hindu Undivided Family
a) Address proof
b) Certified PAN card
c) Authorized signatory list
d) Proof of TAN allotment
Trusts/Societies
a) Certificate of Registration
b) Address proof.
c) Certified copy of Trust/ Society resolution making application for MFDs along with authorized Signatory List with Specimen Signatures.
d) Proof of TAN allotment / Annexure A
Banks
a) Certified copy of Bank resolution making application for
MFDs along with authorized Signatory List with Specimen Signatures.
b) Proof of TAN allotment / Annexure A

Annexure A

FORMAT OF BOARD RESOLUTION

CERTIFIED TRUE COPY OF THE RESOLUTION PASSED AT THEMEETING OF THE BOARD OF DIRECTORS OF ______HELDON ______AT ______AT THE REGISTERED OFFICE OF THECOMPANY AT ______AND DULY RECORDED IN THE MINUTEBOOK OF THE COMPANY.

Resolved that the Company hereby apply to BSE Ltd. to obtain registration forMutual Fund Distributorship and that the approval of the Board of Directors be and is hereby given to Company to make necessary application and the execution of thepower of attorney(s), undertaking(s), deeds, agreements, papers and all otherdocuments etc. necessary for the purpose of Company obtain registration for MutualFund Distributorship and to participate in the BSE StAR MF and for all mattersincidental thereto as may be considered necessary and expedient.

FURTHER resolved that (name with designation) and / or (name with designation) are authorized to execute individually/jointly the documents necessary for enablement in BSE StAR MF on behalf of the company and for all matters incidental thereto as may be considered necessary and expedient.

CERTIFIED TRUE COPY

FOR ______(NAME OF THE COMPANY)

Director Director

(Names of authorized signatories along with specimen signatures and rubber stamp of Applicant Company).

Place:

Date: