(On the letterhead of the applicant member)

Application Form for Membership of NSE IFSC Limited /NSE IFSC

Clearing Corporation Limited
To,
The Managing Director
NSE IFSC Limited /NSE IFSC Clearing Corporation Limited
Unit No. 46 - 53,
1st Floor, GIFT Aspire One Business Centre,
Block 12, Road 1-D - Zone 1,
GIFT SEZ, Gandhinagar
382355

Dear Madam/Sir,

We are desirous to become the Member of NSE IFSC Limited and/or NSE IFSC Clearing
Corporation Limited and submit requisite details as under:

Category of Membership Tick

Trading Member (TM)
Trading cum self-clearing Member (TMSCM)
Trading cum clearing Member (TMCM)
Professional Clearing Member (PCM)

I. APPLICANT DETAILS:

Sr. Particulars
1. Name of Applicant
2. Trade name of Applicant
3. Form of Organization Corporate
4. Permanent Account No. of the Applicant
5. Date of Incorporation/ Registration , as
applicable (DD/MON/YYYY)
6. Corporate Identity No. (CIN), if applicable
7. Brief description of principal activity of the
applicant
8. Brief description of group, if any, to which the
applicant belongs
II. OFFICE DETAILS:

1. Registered /Correspondence Office details:

Type of office  Registered Office Correspondence office
Address
City    
District    
State/Union Territory    
Pincode    
STD Code    
Telephone No.    
Fax    
E-mail ID    
Website    NA

2. Details of Infrastructure / Office: (In case the applicant has any other offices, the details of the
same can be given in similar format)
Particulars  Infrastructure/Office 1 Infrastructure/Office 2
Address
City    
District
State/Union Territory    
Pincode    
STD Code
Telephone    
Fax    
Carpet Area of office in sq.
feet
Ownership / Leased, etc.
Contact Person /
Authorised Signatory and
designation

III. PERSONNEL DETAILS:

1. Details of the Chief Executive Officer /Managing Director/and Compliance /Designated Officer:
Particulars CEO/Managing Director  Compliance/ Designated Officer
(appointed under regulation 9(2)
of the SEBI IFSC guidelines 2015)
Name
Designation    
Tel. No.    
Fax No.    
Mobile No.    
E-mail ID    
PAN    
IV ADDITIONAL DETAILS

1. Is the applicant entity listed on any stock exchange?

YES / NO: ; In case yes, kindly provide following details:

Sr. Name of Stock Exchange Date since Current Status (Active/ Date of Suspension/
where listed when Listed Suspended/ Delisted Delisting, if applicable

2. Details of the approval received from Development Commissioner for setting up a unit in SEZ GIFT
SEZ IFSC.

V. FINANCIAL DETAILS

1. Net-worth as per the requirement of the Exchange (Rs):

2. Name and address of the bankers and the facilities availed from such banks. (Please enclose
reference letters from each bank)

VI. OTHER INFORMATION/DISCLSOURE:

Please give the following details of the applicant (If Yes, please provide complete details)
Sr. Particulars Yes/No
In case you have been engaged in any business other than that of securities, whether
a)  
you have compounded with its creditors for less than full discharge of debts?
b) Have you committed any act which may render you liable to be wound – up?  
Have you had a provisional liquidator or receiver or official liquidator appointed to it
c)  
by a competent court?
Are you aware that on admission of membership of the IFSC Exchange/IFSC Clearing
d) Corporation the applicant will have to severe connection with any fund based  
business?
Whether the applicant or its directors/officers have been at any time convicted of any
e)
economic offence?
Whether the applicant has been declared defaulter or expelled in IFSC exchange in
f)
India?
Whether the director/officers has been declared insolvent or declared defaulter or
g)
expelled in IFSC exchange in India?
Whether the applicant or its directors/ officers, have been rejected by any IFSC Stock
h)
exchange for membership?

VII. DECLARATION

We hereby undertake / state that:

 the above-mentioned particulars are true, correct and complete to the best of our knowledge
and information and there is no misstatement or misrepresentation or suppression of facts in
connection with this application or breach of any undertaking or condition of admission to
 trading and/or clearing membership or of trading cum clearing membership that entails
rejection of application.
 we have disclosed and reported all the details in regard to inquiry / investigation, if any, that
has been conducted by any authorities including government agencies against applicant /
promoters / directors etc., during past 10 years and the findings of the concerned agencies
available with us have been disclosed fully along with this application.
 we shall pay the required fee and deposits to the NSE IFSC Ltd/ NSE IFSC CC Ltd and
submit the necessary documents as required by the NSE IFSC Exchange for our seeking the
trading and/or clearing membership of the NSE IFSC Exchange/ NSE IFSC Clearing
Corporation and as required from time to time.
 we will notify the NSE IFSC Exchange/NSE IFSC Clearing Corporation within 15 days of
any change in information provided in the application.
 to conform to and to abide by the Memorandum & Articles of Association and the Rules, Bye-
Laws, Regulations, Business-Rules, Circular, Notifications and office orders, issued by the
NSE IFSC Exchange/NSE IFSC Clearing Corporation from time to time. to be liable for all
contracts and transactions in the exchange entered by us or by our authorized representatives
and comply with all requirements of the Exchange relating to settlement thereof and also
confirm to abide by all decisions of the NSE IFSC Exchange/NSE IFSC Clearing Corporation
with respect to the operation of the NSE IFSC Exchange/NSE IFSC Clearing Corporation and
would perform accordingly in meeting our financial, regulatory and operational responsibility
as decided by the NSE IFSC Exchange/NSE IFSC Clearing Corporation from time to time.
 we declare that the information given in this form is true and in the event of any information
furnished found to be false, misleading or suppression of facts; certificate of registration is
liable to be cancelled by SEBI without assigning any reasons whatsoever and the membership
is liable to be cancelled by the NSE IFSC Exchange/ NSE IFSC Clearing Corporation without
assigning any reasons whatsoever.

Affix photo and also Affix photo and also

sign across the photo sign across the photo

Stamp:

Date:
Place:

Sign: _______________________ _____________________

Name of the signatory: _______________________ _____________________

Note: Should be signed by the designated directors

 FORM A

SECURITIES AND EXCHANGE BOARD OF INDIA

(Stock Brokers and Sub-Brokers) Regulations 1992
(Regulation 3)

APPLICATION FORM FOR REGISTRATION AS STOCK BROKER WITH SECURITIES AND

EXCHANGE BOARD OF INDIA

Table 1:

Sl. No. Particulars Details

1 Name of Member with Code No.

 
2 Trade name of Member
 
Name of the Stock Exchange/ segment of which the applicant
3
is the member  NSE IFSC LTD
4 Date of admission to exchange/ segment
 

5 Address of Member
 

Fax Number(s), Phone Number(s) of office and residence and

6
email address
 

Form of Organization - Sole proprietorship, partnership,

7
corporate body, financial institution, others (please specify)
 
8 Net worth along with supporting document
 

9 PAN of the applicant

 
Table 2: Details of proprietor/ partners/ directors
Experience in derivatives
Educational trading or securities market, as
Sl. No. Names Age PAN Qualifications applicable

       
   

Table 3: Details of sales personnel or approved user who has passed any certification programme

Sl. No. Name Date of test Percentage Certificate No.

     
   

Other details:

1. Please furnish a copy of the memorandum and articles of association or the partnership deed, as the
case may be.

2. If the applicant intends to clear and settle his trades through a clearing member, the applicant is
required to furnish the name and details of the clearing member along with a copy of MoU/ agreement/
contract with them for the same.

3. Whether the application is accompanied by a requisite fee as per Schedule V of the Regulations as
applicable to the applicant.

Undertaking:

4. Whether the applicant or its director or partners, any time convicted of any economic offence? If so,
furnish the details.

5. Whether the applicant or its directors or partners, declared insolvent or declared defaulter by any
exchange? If so, furnish details.

6. Whether the applicant or its directors or partners at any time subjected to any proceedings or penalty by
the Board under SEBI Act or any of the regulations framed under the SEBI Act? If so, furnish the details.

7. Whether any disciplinary action has been initiated/ taken or penalty has been imposed by SEBI/ stock
exchange(s)/ clearing corporation(s) or any other regulatory authority? If yes, furnish details. Also
provide the details of corrective steps taken thereon.
Declaration:

I declare that the information given in this form is true and in the event of any information furnished is
false, misleading or suppression of facts, my certificate of registration is liable to be cancelled by SEBI
without assigning any reasons whatsoever.

Dated ____________ Signature

______________________________________________________________________________

RECOMMENDATION OF THE STOCK EXCHANGE

This is to certify that ______________________________ is a member of this Stock Exchange and is

recommended for registration with the Securities and Exchange Board of India.

Signature:

Name:

Designation:
 FORM AD

SECURITIES AND EXCHANGE BOARD OF INDIA

(Stock Brokers and Sub-Brokers) Regulations 1992
(Regulation 10A)

APPLICATION FORM FOR REGISTRATION AS CLEARING MEMBER WITH SECURITIES

AND EXCHANGE BOARD OF INDIA
Table 1:
Sl. No. Particulars Details
1 Name of Member with Code No.  
2 Trade name of Member  
Name of the Clearing Corporation of which the applicant is the  NSE IFSC Clearing Corporation
3
member Ltd
4 Date of admission to Clearing Corporation  
5 Address of Member
 
Fax Number(s), Phone Number(s) of office and residence and
6
email address  
Form of Organization - Sole proprietorship, partnership,
7
corporate body, financial institution, others (please specify)  
8 Net worth along with supporting document  
9 PAN of the applicant  

Table 2: Details of proprietor/ partners/ directors

Experience in derivatives
Educational trading or securities market, as
Sl. No. Names Age PAN Qualifications applicable

       
   

Other details:

1. Please furnish a copy of the memorandum and articles of association or the partnership deed, as the
case may be.

2. Whether the application is accompanied by a requisite fee as per Schedule V of the regulations as
applicable to the applicant.

Undertakings:

3. Whether the applicant or its director or partners, any time convicted of any economic offence? If so,
furnish the details.
4. Whether the applicant or its directors or partners, declared insolvent or declared defaulter by any
exchange? If so, furnish details.

5. Whether the applicant or its directors or partners at any time subjected to any proceedings or penalty by
the Board under SEBI Act or any of the regulations framed under the SEBI Act? If so, furnish the details.

6. Whether any disciplinary action has been initiated/ taken or penalty has been imposed by SEBI/ stock
exchange(s)/ clearing corporation(s) or any other regulatory authority? If yes, furnish details. Also
provide the details of corrective steps taken thereon.

Declaration:

I declare that the information given in this form is true and in the event of any information furnished is
false, misleading or suppression of facts, my certificate of registration is liable to be cancelled by SEBI
without assigning any reasons whatsoever.

Dated ___________ Signature

______________________________________________________________________________

RECOMMENDATION OF THE CLEARING CORPORATION

This is to certify that ___________________________is a member of this Clearing Corporation and is

recommended for registration with the Securities and Exchange Board of India.

Signature:

Name:

Designation:
 ANNEXURE – H -2

ADDITIONAL INFORMATION TO BE SUBMITTED AT THE TIME OF REGISTRATION OF

STOCK BROKER WITH SEBI

1. Name of the Stock Exchange

2.a) Name of the Applicant Member Broker

b) Exchange Clearing Code No. (If allotted by

the Stock Exchange)

3. Trade Name of Member

4. Address of Member

Tel. No. (O)

Tel. No. (R)

5. Form of Organisation : Please tick the relevant entity

a) Sole Proprietorship b) Partnership

c) Corporate Body I) Financial Institution

II) Others

III) Foreign Joint Ventures

(If an Indian Company is holding more than 25% of total equity in the joint venture, please give details of
top five shareholders of Indian Company).
Name of Indian Company
% Holding
1.
2.
3.
4.
5.
FIPB Approval, if applicable

6.A) Sole Proprietorship:

Name of Proprietor Educational Age (on the date of Experience (specify the
Qualification filing of application) nature and years)
B) Partnership :

Name of Partners Age on the Educational Experience In case of Partner(s)

date of filing Qualification (specify the is/are registered with
of application nature & years) SEBI, give SEBI Reg.
No.

C) Corporate Body (Financial Institution/Others) :

i) MOA Object Clause contains stock broking as one of the object in

a) Main Object

b) Other Object

c) Incidental Object

(If stock broking clause appears in other object, please attach a copy of special resolution to amend the
MOA to incorporate Stock Broking in main object clause)

ii) Mention relevant Clause No.

(Please enclose copy of the relevant clause of the MOA duly certified by the Stock Exchange. If certified
copy is not enclosed, application would be returned).

iii) Information regarding directors :

Name of directors Percentage of Educational Experience Whether directors
with Designation Share holding Qualification (specify nature in other corporate
(whether whole- and years) bodies engaged in
time/designated/ capital markets
additional (please give
names and SEBI
Reg. No.)

iv) Details of top five shareholders:

Name of Share Percentage of Educational Experience Whether Share holders in
holders Share holding Qualification (specify nature other corporate bodies
and years) engaged in capital markets
(please give names and SEBI
Reg. No.)
7. a) Date of admission to Membership of the Stock Exchange

b) Mode of Acquiring Membership

(Please attach old SEBI Regn. Certificate in all cases other than the case of new membership)

i) New Membership
ii) Conversion
iii) Succession
iv) Auction Purchase
(In case member has become defaulter)
v) Market Purchase
vi) Transfer of another company under same management
(please specify reasons)
vii) Others Please specify

c) Please give the following information in all the cases other than the case of new membership
i) Name of the previous holder of the card

ii) SEBI Regn. No.

iii) Date of Regn. No.

d) Whether applicant is member of more than one Stock Exchange?

YES NO
e) If yes, please give name(s) of the stock exchange(s) with Code No. and SEBI Regn. No.

Name of Exchange(s)
SEBI Regn. No.

8.a) Whether any of the Associate Companies/Partnership/Proprietorship Firm is/are having

direct/indicate interest (*as defined below) in capital market
YES NO

* The member is deemed to have direct/indirect interest in the following conditions:

i) Where he is individual, he or any of his relative being a broker/any intermediary, he or any of his
relative being a partner in a broking firm/any intermediary, he or any of his relative being a director
in a broking company/any intermediary or he or any of his relative clubbed together holding
substantial equity in any broking company/any intermediary engaged in capital market.
ii) Where it is partnership firm/company, the relative(s) of partner(s)/director(s) in the firm(s)/corporate
body being a broker/any intermediary or being partners(s)/ director(s) in any broking/intermediary
engaged in capital market.
iii) Relative shall mean husband, wife, brother, unmarried sister or any linear ascendant or descendant of
any individual.

b) If yes, please give details (you may attach separate sheet, if required)
Name Form of Type of Inter- Whether registered Nature of
Organisation mediary # with SEBI (give interest
SEBI Reg. No.)

# Merchant Banker, Portfolio Manager, Registrar to Issue & Share Transfer Agent, Banker to an Issue,
Mutual Fund, Venture Capital, Underwriter, Debenture Trustee, FII.

9. Disciplinary Action initiated/taken against the Associate entities, as indicated in 8(b) above. (Please
state details of nature of violation, action initiated/taken and by which authority)

a) Disciplinary action taken by SEBI (If yes, please attach details mentioning nature of violation and
action taken)

YES NO

b) Disciplinary action taken by any other authority (Please specify details of nature of violation and

action initiated)

YES NO

c) Disciplinary action initiated by SEBI (please attach details of nature of violation and action initiated)
YES NO

d) Disciplinary action initiated by any other authority (please attach details of nature of violation and

action initiated)

YES NO

10. a) Net-worth as per the requirement of the Exchange (Rs. In Lakhs)

b) Applicant’s net-worth in accordance with formula

Prescribed by concerned stock exchange (Rs. In Lakhs)
(Certificate from a qualified C.A. certifying the above should be enclosed)

b) Please indicate the net-worth as per the following formula (Rs. In Lakhs)
i) Paid up capital
ii) Free Reserves (Exclusive of Revaluation Reserves)
iii) Less: Misc. Expenditure not written off

Total Net-worth (i+ii=iii)

I/We declare that the information given in this form is true to the best of my knowledge and belief.

Date : Signature
Name and address of the applicant
List of Enclosures:

1. Copy of relevant clause of MOA duly certified by the stock exchange.

2. Certificate from the qualified Chartered Accountant certifying the networth and paid up capital

Certification of the Exchange

The above details have been scrutinized as per record made available to the stock exchange.

SIGNATURE :
NAME :
DESIGNATION :
SEAL OF STOCK EXCHANGE :
 Annexure: C-1

NETWORTH CERTIFICATE

This is to certify that the Net worth of M/s. ______________________as on _____________as per the
statement of computation of even date annexed to this report is (Rs. In Lakhs) ______________ only).

We further certify that:

 M/s._________________ is not engaged in any fund-based activities or business other than that of
securities. Existing fund based assets, if any have been divested from the books of account and have
not been included for the purpose of calculation of networth.

 the computation of networth based on my / our scrutiny of the books of accounts, records and
documents is true and correct to the best of my / our knowledge and as per information provided to
my / our satisfaction.

 the computation of networth is in accordance with the method of computation prescribed by SEBI as
per Schedule VI of Securities and Exchange Board of India (Stock Brokers and Sub-brokers) (Second
Amendment) Regulations, 2013 (strike off whichever is not applicable).

Place:
For (Name of Accounting Firm)
Date:

Name of Partner/Proprietor
Chartered Accountant
Membership Number
 Annexure C- 1A.

Computation of Networth as part of Membership Requirements

The method of computation of Networth as prescribed by Dr. L.C. Gupta Committee is as follows

Capital + Frees Reserves

Less Non-allowable assets viz.,
(a) Fixed Assets
(b) Pledged Securities
(c) Member’s card
(d) Non-allowable securities (unlisted securities),
(e) Bad deliveries
(f) Doubtful Debts and Advances*
(g) Prepaid expenses, losses
(h) Intangible Assets
(i) 30% of Marketable securities

*Explanation:

Includes debts/advances overdue for more than three months or given to associates

For (Name of Accounting Firm)

Name of Partner/Proprietor
Chartered Accountant
Membership Number
 UNDERTAKING
(To be given on the letterhead of the applicant)

We, M/s. ______________, hereby undertake / declare / confirm that:

1. no enquiry/investigation/ has been initiated/pending against us or any of the shareholders/ directors
by any Stock Exchange/SEBI.
2. no enquiry/adjudication/prosecution or any other action including consent proceedings,
administrative warning, caution or advisory letter, etc., have been initiated against us or any of our
associate company or any of our directors. Or
the details of enquiry/adjudication/prosecution initiated by SEBI against us or our associate
company or our directors alongwith the details of corrective steps taken by us to prevent the
recurrence of such irregularities or to improve our systems are enclosed.
3. no any action in respect of deviations in our stock broking operations has been initiated against us
by the stock exchange pursuant to inspection/audit, etc. Or
the details of action initiated by the Exchange against us for deviations observed in our stock
broking operations pursuant to inspection/audit, etc. alongwith the details of corrective steps taken
by us to prevent the recurrence of such irregularities are enclosed.
4. we have not, at any point, introduced any fake / forged/ stolen shares in the market.
5. our designated directors Mr./Ms. _________ and Mr./Ms. _____________meet the eligibility
requirements as prescribed in Securities Contracts (Regulation) Rules, 1957 (Rule 8(4A) and other
relevant provisions) and SEBI (Stock Brokers & Sub-brokers) Regulations, 1992.
6. we shall ensure that the above individuals or whosoever as identified by us as designated directors,
in future, till the time corporate is registered as a member or the Exchange will continue to meet the
eligibility requirements as per Securities Contracts (Regulation) Rules, 1957 and SEBI (Stock
Brokers & Sub-brokers) Regulations, 1992.
7. Necessary infrastructure like adequate office space, equipment’s and man power to
effectively discharge his activities is available with us.
8. As long as the corporate is engaged in stock broking as a member of any recognized Stock
Exchange in India, it will engage itself in only such business as a member of a recognized Stock
Exchange is permitted to engage in under the securities and contracts (Regulation) Rules, 1957, and
the Rules, Bye-laws & regulations of the Stock Exchange.
Further, we are aware and acknowledge that if we engage in any other business the Exchange will
be entitled to take disciplinary action (including fine, suspension &/or expulsion) against us.

(Stamp and signature of authorised signatories)

Date:
Place:

Note:
1. Undertaking to be stamped & signed by two designated directors or authorised signatory(ies) as per
Board Resolution mentioning names and designations.
2. In case the applicant has to furnish any details pertaining to the above mentioned confirmations, the
same can be provided as annexure (duly stamped and signed by the authorised signatories) to the
undertaking.
 UNDERTAKING WITH RESPECT TO DESIGNATED DIRECTORS

TO WHOMSOEVER IT MAY CONCERN

(To be certified by a practicing chartered accountant/ practicing company secretary)

This is with reference to the application of M/s _____________________ (applicant company) for
seeking provisional membership of the NSE IFSC Ltd/NSE IFSC Clearing Corporation Ltd and
subsequent application for registration of application with SEBI in IFSC.

Based on the information, explanation and documents given to us, we state that the designated directors
Mr./Ms. ________________ and Mr./Ms. _____________ (names of designated directors) meet the
eligibility requirements as prescribed in Securities Contracts (Regulation) Rules, 1957 (Rule 8(4A) and
other relevant provisions) and SEBI (Stock Brokers & Sub-brokers) Regulations, 1992.

This confirmation has been issued on the request of the applicant company for submitting to the NSE
IFSC/NSE IFSC CC/SEBI.

For M/s
Chartered Accountant

Stamp and Signature

Membership No.

Place :
Date :
 DECLARATION REGARDING ASSOCIATION / NON-ASSOCIATION WITH OTHER
RECOGNIZED STOCK EXCHANGES / COMMODITY EXCHANGES / CLEARING
CORPORATION
(On the letter head of the applicant)

We, M/s (Name of applicant), hereby declare the following:

(a) Are you a member of any other recognized Stock Exchange(s) or Commodity Exchange(s) or
Clearing Corporation (s)?

YES NO

(b) Incase yes, kindly provide the following details:

Sr. Name of Exchange Trading Authority granting Registration Registration

No segment registration number date

(c) I/we (Name of applicant), hereby declare that we have as of date cleared all our dues to SEBI in
respect of all the SEBI registrations that we hold including SEBI fees, sub broker fee etc, and that we
do not have any dues to SEBI outstanding for payment in respect of all our SEBI registrations.

Place :
Date :
For M/s. (name of company)

Stamp and Signature of Authorised Signatory

 ‘FIT & PROPER PERSON’ UNDERTAKING
(To be given on the letterhead of the applicant)

I / We, M/s ____________ (name of the applicant) hereby declare that I/we am/are ‘fit and proper person’
as per Securities and Exchange Board of India (Intermediaries) Regulations, 2008 We confirm the
following in this regard:

(a) the applicant or the intermediary, as the case may be or its whole time director has not been convicted
by a Court for any offence involving moral turpitude, economic offence, securities laws or fraud;

(b)   no order for winding up has been passed against the applicant or the intermediary;

(c)  the applicant or the intermediary, or its whole time director, has not been declared insolvent and has
been discharged;

(d) no order, including an order of suspension of certificate of registration as an intermediary, restraining,

prohibiting or debarring the applicant or the intermediary, or its whole time director from dealing in
securities in the capital market or from accessing the capital market has been passed by the Board or any
other regulatory authority wherein a period of three years from the date of the expiry of the period
specified in the order has not elapsed;

(e) no order canceling the certificate of registration of the applicant or the intermediary has been passed
by the Board on the ground of its indulging in insider trading, fraudulent and unfair trade practices or
market manipulation wherein a period of three years from the date of the order has not elapsed;

(f) no order withdrawing or refusing to grant any license / approval to the applicant or the intermediary, or
its whole time director which has a bearing on the capital market, has been passed by the Board or any
other regulatory authority wherein a period of three years from the date of the order has not elapsed;

(g) the applicant or the intermediary, is financially sound;

(h) there is no other reason, recorded in writing by the Board, which in the opinion of the Board, renders
such applicant or the intermediary, or its whole time director unfit to operate in the capital market.

(Stamp and signature of authorised signatories)

Date:
Place:

Note:
1. Undertaking to be stamped & signed by two designated directors mentioning names.
2. In case the applicant wishes to furnish any details pertaining to the above mentioned confirmations,
the same can be provided as annexure (duly stamped and signed by the authorised signatories) to the
undertaking.
 Annexure: C-3

DETAILS OF DIRECTORS AS ON _______________

Sr Name$ FathersDesignatioDate of EducationPAN Director Residential DesignateShare holding *Directorships

No Name n Birth IdentificatioAddress & d / / controlling
@ n Number Telephone directors shareholding
(DIN) Nos. (Yes/No) in other cos.
#
No. Amt % of
total
1
2
3
4
5
NOTES :

@ Please clearly state whether the Director is a Managing Director or Whole-time Director or Executive
Director or Non-Executive Director or Executive Chairman or Non-Executive Chairman

# Identify atleast two designated directors (A designated director is one who is a HSC by qualification
(or CA, ICWA or CS or equivalent) and possesses atleast 2 years of experience pertaining to
securities market. They, essentially, look after the stock market operations of a trading member entity.
Every trading member corporate should have atleast 2 such directors who meet the aforesaid norms.)

$ All initials to be expanded

Date:
Place:
Authorised Signatory/Director (s)

CERTIFICATE (for corporate only)

This is to certify that the details of directors of M/s. ______________ as given above, based on my/ our
scrutiny of the books of accounts, records and documents is true and correct to the best of my/our
knowledge and as per information provided to my/our satisfaction.

Place:
For (Name of Accounting Firm)
Date:

Name of Partner/Proprietor

Chartered Accountant

Membership Number
 Annexure: C-6

SHARE HOLDING PATTERN of _____________________ as on ______

EQUITY / PREFERENCE (Please indicate and use separate sheets for equity/preference shares)
Sr No. Name * Number of Face value Amt Paid up % of total
shares held per share (In US $)
1
2
3
4
5
6
7
8
Others
TOTAL 100%
* All initials to be expanded

NOTES:
1. In case of bodies corporate holding not less than 51% of the paid up capital in the trading member
entity, the details of their shareholding shall also be furnished in the same format as given above
2. In case of HUF holding not less than 51% of paid up capital of trading member entity, the details
of Karta and co-parceners to be provided
3. Persons holding 2% or more of the paid up capital should be shown separately and not clubbed in
Others.

Date:
Place: Authorised Signatory/Director (s)

CERTIFICATE

This is to certify that the shareholding in M/s. ______________ as given above, based on my/ our
scrutiny of the books of accounts, records and documents is true and correct to the best of my/our
knowledge and as per information provided to my/our satisfaction.

Place:
For (Name of Accounting Firm)
Date:
Name of Partner/Proprietor
Chartered Accountant
Membership Number
 Annexure: C-7

Sr Name of Person (s) Relation Residential No. of Total % of Total % of PAN CIN (incase
No dominant supporting $ address (with PINshares Amt @ Total of corporat
shareholder dominant code) and contact held paid
shareholder no. up @
Self Relatives
1 A
A1
A2
2 B
B1
B2
3 C

TOTAL
DETAILS OF DOMINANT GROUP as on _____

$ Please specify relation of person supporting dominant shareholder

@ : For arriving at the shareholding of persons constituting the dominant group, the shareholding of
close relatives, namely parents, spouse, children and their descendants, brothers and sisters only may also
be counted.

Date:
Place:
Authorised Signatory/Director(s)

CERTIFICATE

This is to certify that the shareholding in M/s. ______________ as given above, based on my/ our
scrutiny of the books of accounts, records and documents is true and correct to the best of my/our
knowledge and as per information provided to my/our satisfaction..

Place:
For (Name of Accounting Firm)
Date:

Name of Partner/Proprietor
Chartered Accountant
Membership Number
 DISCLOSURE OF PAN DETAILS
(On the letter head of the applicant)

Sr. Category Name of person/entity PAN

No.
1. Promoters
2. Associate(s) / Group companies
3. Principal officer(s) /
Key management person(s)
4. All entities / persons falling within
the verticals of applicant, both from
bottom to top (e.g. holding company)
and top to bottom (e.g. subsidiary
company), irrespective of whether
they are registered with SEBI or any
other regulatory authority
Note: Kindly attach certified copy of PAN card for each of the PANs disclosed above.

For M/s. (name of applicant)

Stamp and Signature of Applicant/Authorised Signatory

Place :
Date :
 UNDERTAKING REGARDING VIOLATIONS/NON-ADHERENCE TO SECURITIES MARKET
RELATED REGULATIONS
(On the letter head of the applicant)

(a) Are there any instances of violation or non-adherence to any securities market related regulations
by the applicant or its associate(s) / group companies in India or abroad?

YES NO

(b) Whether any action has been taken by a regulatory agency in this regard?

YES NO

For M/s. (name of applicant)

Stamp and Signature of Applicant/Authorised Signatory

Place :
Date :

If yes, kindly provide the following additional information as an Annexure:

a. Top 10 monetary penalties in case of foreign entities and all monetary penalties in case of Indian entities,
imposed against the applicant or any associate of the applicant (for irregularities/ violations in the
financial services sector or for defaults in respect of shareholders / debenture holders and depositors, by
any financial regulatory body or government authority or settlement arrived with any financial regulatory
body during the last five years and details thereof). Penalties awarded for economic offences may be
disclosed only in case of the applicant.

b. Details of all cases of suspensions and cancellation of certificate of registration (for irregularities /
violations in financial services sector or for defaults in respect of shareholders, debenture holders and
depositors) of the applicant or any associate of the applicant shall be disclosed for the last 10 years.

All disclosures on penalties and action taken as per (a) and (b) above against foreign entities may be limited
to the jurisdiction of the country where the principal activities (in terms of income / revenue) of the
applicant / associate companies are carried out or where the headquarters is situated.
 DECLARATION REGARDING ASSOCIATION / NON-ASSOCIATION WITH POLITICALLY
EXPOSED PERSONS
(On the letter head of the member)

We, M/s (Name of member), hereby declare that none of our Directors /Dominant Shareholders /
Associates are ‘Politically Exposed Persons’ (PEP).
OR
We, M/s (Name of member), hereby declare that our Directors /Dominant Shareholders /
Associates are ‘Politically Exposed Persons’ (PEP) as per the details given below -
Sr. Full Name of PAN of Address of Details of Date since Relationship
No the PEP PEP the PEP Function /position when position of PEP with
held by PEP held as PEP the Member

For M/s. (name of company) For M/s. (name of company)

Stamp and Signature of Stamp and Signature of

Authorised Signatory3 Authorised Signatory3

Place :
Date :

Note:
1. As per SEBI master circular ISD/AML/CIR-1/2010 dated February 12, 2010, ‘Politically Exposed
Persons’ (PEP) are individuals who are or have been entrusted with prominent public functions in a
foreign country, e.g., Heads of States or of Governments, senior politicians, senior
government/judicial/military officers, senior executives of state-owned corporations, important
political party officials, etc.
2. ‘Associate’ has the same definition as given under Section 2(1)(b) of the SEBI (Intermediaries)
Regulations, 2008.
3. The current undertaking has to be stamped & signed by two designated directors or authorised
signatory(ies) as per Board Resolution mentioning names and designations.
4. A revised undertaking stamped & signed by two designated directors or authorised signatory(ies) as
per Board Resolution mentioning names and designations need to be submitted as and when there is
change in any of the details submitted vide current undertaking.
 CHECKLIST OF REQUIREMENTS FOR NEW MEMBERSHIP (CORPORATES)
SR.
PARTICULARS Remarks
NO.
-
Approval of Development
1 Commissioner of Kandla
SEZ authority
2 Exchange Application 1. To be given on letterhead of the applicant.
Form 2. All details to be filled in.
3. Each page should be stamped and initialed by the authorized signatories.
The last page should be dated, stamped and signed by the authorized
signatories.
3 Application form for 1. To be given on plain paper.
registration - Form A/ AD 2. Each page should be signed and stamped by authorized signatories as
per Board Resolution
3. Declaration of the trading member and the Recommendation of the
Exchange should be on the same page.
4. Date of admission to Membership should be left blank
5. Form A to be provided for trading membership and Form AD for
clearing membership

4 Form H2 - Additional 1. To be given on plain paper.

information 2. Each page should be stamped and signed by the authorized signatories
as per Board Resolution.
3. Declaration of the trading member and the Certification of the Exchange
should be on the same page.
4. Point no. 2b should be left blank.
5. Date of admission to Membership of the Stock Exchange should be kept
blank.

5 Annexure C1 - Networth 1.Networth Certificate and the relevant computation should be as per the
Certificate format prescribed by the Exchange/SEBI/Sectorial regulator as applicable.
2. To be duly certified by Chartered Accountant.
3. Networth of the applicant to meet the minimum networth requirements
as applicable.
4. Certification of Chartered Accountant should not be older than 6 months
from the date of submission of application.

7 Annexure C6 - Share 1. To be given as per the format prescribed by the Exchange.

holding pattern of 2. To be dated, stamped and signed by the authorized signatories.
applicant 3. To be duly certified by Chartered Accountant.
4. Certification of Chartered Accountant should not be older than 6 months
from the date of submission of application.
8 Annexure C7 - Details of 1. To be given as per the format prescribed by the Exchange.
Dominant Promoter Group 2. To be dated, stamped and signed by the authorized signatories.
of applicant 3. To be duly certified by Chartered Accountant.
4. Certification of Chartered Accountant should not be older than 6 months
from the date of submission of application.
 5. To provide an undertaking as per the format prescribed by the
Exchange, in case, of relatives/corporates providing an irrevocable,
unconditional support for arriving at the dominant promoter group.
(template attached herewith for reference)

Annexure 8_Relative
support undertaking.docx

9 Age & Education Proof of 1. Age proof (PAN card) and educational qualification proof of the
Designated Directors designated directors to be provided and to be cross attested.
2. Directors to be not less than 21 years of age.
3. Designated directors to be atleast HSC or equivalent.
10 Experience proof of 1. To be on the letterhead of the entity certifying experience and dated.
Designated Directors 2. The name and designation of the person signing the experience
certificate should be mentioned.
3. The designated directors should possess atleast 2 years of experience in
(i)dealing in securities business or(ii)as an investment consultant or(iii)as a
portfolio manager.
11 Undertaking 1. To be on the letterhead of the applicant.
2. To be given as per the format prescribed by the Exchange.
3. To be dated, stamped and signed by authorized signatories.
12 Undertaking regarding 1. To be on the letterhead of the applicant
association/non association 2. Undertaking regarding association / non-association with other
recognized stock exchanges /commodity exchanges/clearing corporations
to be in prescribed format.
3. To be signed by authorized signatory (ies).
4. Incase applicant is a member of other stock exchange, kindly submit
latest status report/conduct certificate issued by concerned stock exchange
and attested copy of the SEBI Registration Certificate.

13 Fit & Proper Person 1. To be on the letterhead of the applicant.

Undertaking 2. To be given as per the format prescribed by the Exchange.
3. To be dated, stamped and signed by authorized signatories.
14 Undertaking from CA reg. 1. To be given as per the format prescribed by the Exchange.
eligibility of Designated 2. To be certified by a practicing Chartered Accountant.
Directors
15 Board Resolution 1. To be on the letterhead of the applicant.
2. Should mention the category of membership applied for.
3. To mention the names and designation of authorized signatory(ies) and
whether jointly/severally, etc.
4. The specimen sign of authorized signatory(ies) to be provided.
5. Board Resolution to be signed by two designated directors
6. Should mention correct Exchange / Clearing Corporation name for
trading / Clearing membership respectively
16 Certificate of 1. To be certified true, stamped and signed by the authorized signatories.
Incorporation, MOA and 2. The main objects of the Memorandum of Association should not contain
AOA clauses not pertaining to securities business.
17 Annual Accounts 1. Balance Sheet and Profit & Loss Account to be given as on the date of
Networth Certificate.
2. To be certified by the practicing Chartered Accountant with a mention
of the name of Partner of CA firm signing and his/her membership no.
18 SWIFT for Application 1. Amount of USD 500 towards processing Fees
fees 2. Payment of Application Fees to be done through SWIFT as per below
bank account details:
 a) Beneficiary Name – NSE IFSC LIMITED
b) Name of the Bank -
c) Name of the Branch -
d) Nature of Account -CURRENT
e) Account number -
f) IFSC Code of the Bank/Branch -
19 DD of INR 50,000/- 1. 1. DD of INR 50,000 to be given in favour of SEBI payable at Mumbai
towards application money towards application money.
2. DD of INR 50,000/- in favour of SEBI payable at Mumbai (incase
DD of INR 50,000/- opting for Self clearing/clearing membership/Professional Clearing
towards clearing member)
membership
20 Membership Module 1. Any one Designated Director or Compliance Officer to clear the
Examination module(s) as given below:
- Securities Market (Basic) Module or
- Compliance Officer's (Brokers) Module or
- Relevant certification as applicable to the derivatives market/products,
the applicant entity is trading in.
21 User/Dealer certification 1. Atleast 2 dealers of the applicant to possess valid certification as
mentioned below:

Equity Derivatives - NISM Series- VIII: Equity Derivatives Certification

Examination /NISM Continuing Professional Education for Equity
Derivatives/
Currency Derivatives - NISM Series-I: Currency Derivatives
Certification Examination/ NISM Continuing Professional Education for
Currency Derivatives
Interest Rate Futures – NISM Series-IV: IRD certification

#Kindly note, NISM Series XIII: Common Derivatives Certification

Examination ("Series-XIII: CDCE") can be provided for Equity
Derivatives/Currency Derivatives/Interest Rate Futures.

Declaration for
Dealer Certification.docx

2. To be attested true (not self-attested), stamped and signed by the

authorised signatories.
22 Disclosure of PAN details 1. To be on letterhead of applicant.
2. To be stamped and signed by authorized signatory (ies).
3. PAN card copies for all PANs disclosed to be provided.
4. PAN card copies to be stamped and certified (not to be self-attested)
5. To provide certified copy of the PAN card of the applicant entity.

23 Undertaking regarding 1. To be on letterhead of applicant.

violations/non-adherence 2. To be stamped and signed by authorized signatory (ies).
to securities market related 3. Incase yes, additional information to be provided.
regulations
 24 Declaration Regarding 1. To be on letterhead of applicant.
Association / Non- 2. To be stamped and signed by authorized signatory (ies).
Association With 3. Incase yes, additional information to be provided.
Politically Exposed
Persons

25 Clearing Member 1. To be original / Photocopy attested by authorised signatory

confirmation 2. Applicable only if applied for Trading Membership

Expansion of Abbreviations used:

TM - Trading Membership
CM - Clearing Membership
SCM - Self Clearing Membership
PCM - Professional Clearing Membership