ANY OTHER INFORMATION. SECTION E DECLARATION I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I 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, I am aware I may be held liable for it. CLIENT’S SIGNATURE[2] X PLACE DATE(DD/MM/YYYY) 01-Sep-2018 FOR OFFICE USE ONLY O ORIGINALS VERIFIED TRUE COPIES OF DOCUMENTS RECV. O SELF ATTESTED SELF CERTIFIED COPIES RECV. EMPLOYEE SIGNATURE DATE (DD/MM/YYYY) TRADING ACCOUNT RELATED DETAILS SECTION A PRIMARY BANKING ACCOUNT BANK NAME & ADDRESS CITY/TOWN/VILLAGE PIN CODE STATE COUNTRY ACCOUNT NUMBER MICR NUMBER ACCOUNT TYPE O CURRENT O SAVING O OTHER IFSC CODE SECTION B SECONDARY BANKING ACCOUNT BANK NAME BRANCH ADDRESS CITY/TOWN/VILLAGE PIN CODE STATE COUNTRY ACCOUNT NUMBER MICR NUMBER ACCOUNT TYPE O CURRENT O SAVING O OTHER IFSC CODE SECTION C PRIMARY DEPOSITORY ACCOUNT DEPOSITORY PARTICIPANT NAME DP TYPE (NSDL/CDSL) DEPOSITORY PARTICIPANT ID BENEFICIARY NAME BENEFICIARY ID (BO ID) SECTION D SECONDARY DEPOSITORY ACCOUNT DEPOSITORY PARTICIPANT NAME DP TYPE (NSDL/CDSL) DEPOSITORY PARTICIPANT ID BENEFICIARY NAME BENEFICIARY ID (BO ID) SECTION E PAST ACTIONS □ Details of any action/proceedings initiated/pending/ taken by FMC/ SEBI / Stock exchange / Commodity exchange/any Other authority against the client during the last 3 years SECTION F DEALINGS THROUGH OTHER TRADING MEMBERS (BROKERS) □ IF CLIENT IS DEALING THROUGH ANY OTHER MEMBER, PLEASE PROVIDE THE FOLLOWING DETAILS (IN CASE DEALING WITH MULTIPLE MEMBERS, PROVIDE DETAILS OF ALL IN A SEPARATE SHEET) MEMBER/AUTHORIZED PERSON NAME EXCHANGE EXCHANGE REGISTRATION NO. CONCERNED MEMBER’S NAME WITH WHOM AP IS REGISTERED CLIENT CODE REGISTERED OFFICE ADDRESS CITY STATE COUNTRY TEL FAX EMAIL ID WEBSITE DETAILS SECTION G VAT DETAILS (AS APPLICABLE, STATE WISE) LOCAL SALES VAT REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) NAME OF THE STATE OTHER SALES VAT REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) NAME OF THE STATE CLIENT’S SIGNATURE [3] X SECTION H SALES TAX REGISTRATION DETAILS LOCAL SALES TAX STATE REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) NAME OF THE STATE CENTRAL SALES TAX STATE REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) OTHER SALES TAX STATE REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) NAME OF THE STATE SECTION I INVESTMENT/TRADING EXPERIENCE AND ADDITIONAL DETAILS PRIOR EXPERIENCE IN TRADING/INVESTMENT O YES O NO NUMBER OF YEARS OF COMMODITIES EXPERIENCE YEARS OF EXPERIENCE IN OTHER INVESTMENT FIELDS CONTRACT NOTE PREFERENCES O✔ ELECTRONIC CONTRACT NOTE (ECN) O PHYSICAL CONTRACT NOTE EMAIL ADDRESS SECTION J INTRODUCER DETAILS NAME OF THE INTRODUCER RELATIONSHIP WITH THE INTRODUCER INTRODUCER’S STATUS ✔ EXISTING CLIENT O AUTHORIZED PERSON O SUB‐BROKER O REMISIER O OTHERS, PLEASE SPECIFY INTRODUCER’S ADDRESS INTRODUCER’S PHONE NUMBER INTRODUCER’S CLIENT ID INTRODUCER’S SIGNATURE SECTION K NOMINATION DETAILS (FOR INDIVIDUALS ONLY) O I WISH TO NOMINATE THE FOLLOWING PERSON O I DO NOT WISH TO HAVE A NOMINEE NOMINEE’S NAME RELATIONSHIP NOMINEE’S ADDRESS NOMINEE’S PHONE NUMBER NOMINEE’S PAN CARD NUMBER NOMINEE’S DATE OF BIRTH (DD/MM/YYYY) IF NOMINEE IS A MINOR, PLEASE PROVIDE DETAILS OF HIS/HER GUARDIAN GUARDIAN’S NAME GUARDIAN’S ADDRESS GUARDIAN’S PHONE NUMBER GUARDIAN’S SIGNATURE TWO WITNESSES ARE REQUIRED TO ATTEST IF YOU WANT TO NOMINATE A PERSON PRIMARY WITNESS’ NAME PRIMARY WITNESS’ ADDRESS PRIMARY WITNESS’ SIGNATURE SECONDARY WITNESS’ NAME SECONDARY WITNESS’ ADDRESS SECONDARY WITNESS’ SIGNATUR PLEASE SIGN BELOW ATTESTING TO ALL THE INFORMATION ON THIS PAGE CLIENT’S NAME CLIENT SIGNATURE[4] X PLACE DATE(DD/MM/YYYY) 01-Sep-2018 O
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ANY OTHER INFORMATION. SECTION E DECLARATION I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I 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, I am aware I may be held liable for it. CLIENT’S SIGNATURE[2] X PLACE DATE(DD/MM/YYYY) 01-Sep-2018 FOR OFFICE USE ONLY O ORIGINALS VERIFIED TRUE COPIES OF DOCUMENTS RECV. O SELF ATTESTED SELF CERTIFIED COPIES RECV. EMPLOYEE SIGNATURE DATE (DD/MM/YYYY) TRADING ACCOUNT RELATED DETAILS SECTION A PRIMARY BANKING ACCOUNT BANK NAME & ADDRESS CITY/TOWN/VILLAGE PIN CODE STATE COUNTRY ACCOUNT NUMBER MICR NUMBER ACCOUNT TYPE O CURRENT O SAVING O OTHER IFSC CODE SECTION B SECONDARY BANKING ACCOUNT BANK NAME BRANCH ADDRESS CITY/TOWN/VILLAGE PIN CODE STATE COUNTRY ACCOUNT NUMBER MICR NUMBER ACCOUNT TYPE O CURRENT O SAVING O OTHER IFSC CODE SECTION C PRIMARY DEPOSITORY ACCOUNT DEPOSITORY PARTICIPANT NAME DP TYPE (NSDL/CDSL) DEPOSITORY PARTICIPANT ID BENEFICIARY NAME BENEFICIARY ID (BO ID) SECTION D SECONDARY DEPOSITORY ACCOUNT DEPOSITORY PARTICIPANT NAME DP TYPE (NSDL/CDSL) DEPOSITORY PARTICIPANT ID BENEFICIARY NAME BENEFICIARY ID (BO ID) SECTION E PAST ACTIONS □ Details of any action/proceedings initiated/pending/ taken by FMC/ SEBI / Stock exchange / Commodity exchange/any Other authority against the client during the last 3 years SECTION F DEALINGS THROUGH OTHER TRADING MEMBERS (BROKERS) □ IF CLIENT IS DEALING THROUGH ANY OTHER MEMBER, PLEASE PROVIDE THE FOLLOWING DETAILS (IN CASE DEALING WITH MULTIPLE MEMBERS, PROVIDE DETAILS OF ALL IN A SEPARATE SHEET) MEMBER/AUTHORIZED PERSON NAME EXCHANGE EXCHANGE REGISTRATION NO. CONCERNED MEMBER’S NAME WITH WHOM AP IS REGISTERED CLIENT CODE REGISTERED OFFICE ADDRESS CITY STATE COUNTRY TEL FAX EMAIL ID WEBSITE DETAILS SECTION G VAT DETAILS (AS APPLICABLE, STATE WISE) LOCAL SALES VAT REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) NAME OF THE STATE OTHER SALES VAT REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) NAME OF THE STATE CLIENT’S SIGNATURE [3] X SECTION H SALES TAX REGISTRATION DETAILS LOCAL SALES TAX STATE REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) NAME OF THE STATE CENTRAL SALES TAX STATE REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) OTHER SALES TAX STATE REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) NAME OF THE STATE SECTION I INVESTMENT/TRADING EXPERIENCE AND ADDITIONAL DETAILS PRIOR EXPERIENCE IN TRADING/INVESTMENT O YES O NO NUMBER OF YEARS OF COMMODITIES EXPERIENCE YEARS OF EXPERIENCE IN OTHER INVESTMENT FIELDS CONTRACT NOTE PREFERENCES O✔ ELECTRONIC CONTRACT NOTE (ECN) O PHYSICAL CONTRACT NOTE EMAIL ADDRESS SECTION J INTRODUCER DETAILS NAME OF THE INTRODUCER RELATIONSHIP WITH THE INTRODUCER INTRODUCER’S STATUS ✔ EXISTING CLIENT O AUTHORIZED PERSON O SUB‐BROKER O REMISIER O OTHERS, PLEASE SPECIFY INTRODUCER’S ADDRESS INTRODUCER’S PHONE NUMBER INTRODUCER’S CLIENT ID INTRODUCER’S SIGNATURE SECTION K NOMINATION DETAILS (FOR INDIVIDUALS ONLY) O I WISH TO NOMINATE THE FOLLOWING PERSON O I DO NOT WISH TO HAVE A NOMINEE NOMINEE’S NAME RELATIONSHIP NOMINEE’S ADDRESS NOMINEE’S PHONE NUMBER NOMINEE’S PAN CARD NUMBER NOMINEE’S DATE OF BIRTH (DD/MM/YYYY) IF NOMINEE IS A MINOR, PLEASE PROVIDE DETAILS OF HIS/HER GUARDIAN GUARDIAN’S NAME GUARDIAN’S ADDRESS GUARDIAN’S PHONE NUMBER GUARDIAN’S SIGNATURE TWO WITNESSES ARE REQUIRED TO ATTEST IF YOU WANT TO NOMINATE A PERSON PRIMARY WITNESS’ NAME PRIMARY WITNESS’ ADDRESS PRIMARY WITNESS’ SIGNATURE SECONDARY WITNESS’ NAME SECONDARY WITNESS’ ADDRESS SECONDARY WITNESS’ SIGNATUR PLEASE SIGN BELOW ATTESTING TO ALL THE INFORMATION ON THIS PAGE CLIENT’S NAME CLIENT SIGNATURE[4] X PLACE DATE(DD/MM/YYYY) 01-Sep-2018 O
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ANY OTHER INFORMATION. SECTION E DECLARATION I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I 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, I am aware I may be held liable for it. CLIENT’S SIGNATURE[2] X PLACE MUMBAI DATE(DD/MM/YYYY) 0123-Sep-2018 Apr-2014 FOR OFFICE USE ONLY O ORIGINALS VERIFIED TRUE COPIES OF DOCUMENTS RECV. O SELF ATTESTED SELF CERTIFIED COPIES RECV. EMPLOYEE SIGNATURE DATE (DD/MM/YYYY) o o o o o TRADING ACCOUNT RELATED DETAILS SECTION A PRIMARY BANKING ACCOUNT BANK NAME & ADDRESS HDFC Bank Ltd Sandoz Branch Sandoz Branch Mumbai CITY/TOWN/VILLAGE PIN CODE STATE COUNTRY ACCOUNT NUMBER 123456789 MICR NUMBER 123456789 ACCOUNT TYPE O CURRENT O ✔ SAVING O OTHER IFSC CODE HDFC0000240 SECTION B SECONDARY BANKING ACCOUNT BANK NAME BRANCH ADDRESS CITY/TOWN/VILLAGE PIN CODE STATE COUNTRY ACCOUNT NUMBER MICR NUMBER ACCOUNT TYPE O CURRENT O SAVING O OTHER IFSC CODE SECTION C PRIMARY DEPOSITORY ACCOUNT DEPOSITORY PARTICIPANT NAME DP TYPE (NSDL/CDSL) DEPOSITORY PARTICIPANT ID BENEFICIARY NAME BENEFICIARY ID (BO ID) SECTION D SECONDARY DEPOSITORY ACCOUNT DEPOSITORY PARTICIPANT NAME DP TYPE (NSDL/CDSL) DEPOSITORY PARTICIPANT ID BENEFICIARY NAME BENEFICIARY ID (BO ID) SECTION E PAST ACTIONS □ Details of any action/proceedings initiated/pending/ taken by FMC/ SEBI / Stock exchange / Commodity exchange/any Other authority against the client during the last 3 years SECTION F DEALINGS THROUGH OTHER TRADING MEMBERS (BROKERS) □ IF CLIENT IS DEALING THROUGH ANY OTHER MEMBER, PLEASE PROVIDE THE FOLLOWING DETAILS (IN CASE DEALING WITH MULTIPLE MEMBERS, PROVIDE DETAILS OF ALL IN A SEPARATE SHEET) MEMBER/AUTHORIZED PERSON NAME EXCHANGE EXCHANGE REGISTRATION NO. CONCERNED MEMBER’S NAME WITH WHOM AP IS REGISTERED CLIENT CODE REGISTERED OFFICE ADDRESS CITY STATE COUNTRY TEL FAX EMAIL ID WEBSITE DETAILS SECTION G VAT DETAILS (AS APPLICABLE, STATE WISE) LOCAL SALES VAT REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) NAME OF THE STATE OTHER SALES VAT REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) NAME OF THE STATE CLIENT’S SIGNATURE [3] X O SECTION H SALES TAX REGISTRATION DETAILS LOCAL SALES TAX STATE REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) NAME OF THE STATE CENTRAL SALES TAX STATE REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) OTHER SALES TAX STATE REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) NAME OF THE STATE SECTION I INVESTMENT/TRADING EXPERIENCE AND ADDITIONAL DETAILS PRIOR EXPERIENCE IN TRADING/INVESTMENT O YES O NO NUMBER OF YEARS OF COMMODITIES EXPERIENCE YEARS OF EXPERIENCE IN OTHER INVESTMENT FIELDS CONTRACT NOTE PREFERENCES O✔ ELECTRONIC CONTRACT NOTE (ECN) O PHYSICAL CONTRACT NOTE EMAIL ADDRESS SECTION J INTRODUCER DETAILS NAME OF THE INTRODUCER RELATIONSHIP WITH THE INTRODUCER INTRODUCER’S STATUS ✔ O EXISTING CLIENT O AUTHORIZED PERSON O SUB‐BROKER O REMISIER O OTHERS, PLEASE SPECIFY INTRODUCER’S ADDRESS INTRODUCER’S PHONE NUMBER 0 INTRODUCER’S CLIENT ID INTRODUCER’S SIGNATURE SECTION K NOMINATION DETAILS (FOR INDIVIDUALS ONLY) O ✔ I WISH TO NOMINATE THE FOLLOWING PERSON O I DO NOT WISH TO HAVE A NOMINEE NOMINEE’S NAME Nitin RELATIONSHIP Brother NOMINEE’S ADDRESS A 000-000, Xxxxxxxx Xxxxxxxx Xxxxx Xxxxxxx Xxxx, Xxx. Marol Fire Brigade, NOMINEE’S PHONE NUMBER NOMINEE’S PAN CARD NUMBER ABCDE123A NOMINEE’S DATE OF BIRTH (DD/MM/YYYY) IF NOMINEE IS A MINOR, PLEASE PROVIDE DETAILS OF HIS/HER GUARDIAN GUARDIAN’S NAME GUARDIAN’S ADDRESS GUARDIAN’S PHONE NUMBER 0 GUARDIAN’S SIGNATURE TWO WITNESSES ARE REQUIRED TO ATTEST IF YOU WANT TO NOMINATE A PERSON PRIMARY WITNESS’ NAME PRIMARY WITNESS’ ADDRESS PRIMARY WITNESS’ SIGNATURE SECONDARY WITNESS’ NAME SECONDARY WITNESS’ ADDRESS SECONDARY WITNESS’ SIGNATUR PLEASE SIGN BELOW ATTESTING TO ALL THE INFORMATION ON THIS PAGE CLIENT’S NAME XXXX XXXXX CLIENT SIGNATURE[4] X PLACE PLACEMUMBAI DATE(DD/MM/YYYY) 0123-Sep-2018 Apr-2014 O O
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ANY OTHER INFORMATION. SECTION E DECLARATION I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I 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, I am aware I may be held liable for it. CLIENT’S SIGNATURE[2] X PLACE DATE(DD/MM/YYYY) 0130-Sep-2018 Jun-2017 FOR OFFICE USE ONLY O ORIGINALS VERIFIED TRUE COPIES OF DOCUMENTS RECV. O SELF ATTESTED SELF CERTIFIED COPIES RECV. EMPLOYEE SIGNATURE DATE (DD/MM/YYYY) TRADING ACCOUNT RELATED DETAILS SECTION A PRIMARY BANKING ACCOUNT BANK NAME & ADDRESS CITY/TOWN/VILLAGE PIN CODE STATE COUNTRY ACCOUNT NUMBER MICR NUMBER ACCOUNT TYPE O CURRENT O SAVING O OTHER IFSC CODE SECTION B SECONDARY BANKING ACCOUNT BANK NAME BRANCH ADDRESS CITY/TOWN/VILLAGE PIN CODE STATE COUNTRY ACCOUNT NUMBER MICR NUMBER ACCOUNT TYPE O CURRENT O SAVING O OTHER IFSC CODE SECTION C PRIMARY DEPOSITORY ACCOUNT DEPOSITORY PARTICIPANT NAME DP TYPE (NSDL/CDSL) DEPOSITORY PARTICIPANT ID BENEFICIARY NAME BENEFICIARY ID (BO ID) SECTION D SECONDARY DEPOSITORY ACCOUNT DEPOSITORY PARTICIPANT NAME DP TYPE (NSDL/CDSL) DEPOSITORY PARTICIPANT ID BENEFICIARY NAME BENEFICIARY ID (BO ID) SECTION E PAST ACTIONS □ Details of any action/proceedings initiated/pending/ taken by FMC/ SEBI / Stock exchange / Commodity exchange/any Other authority against the client during the last 3 years SECTION F DEALINGS THROUGH OTHER TRADING MEMBERS (BROKERS) □ IF CLIENT IS DEALING THROUGH ANY OTHER MEMBER, PLEASE PROVIDE THE FOLLOWING DETAILS (IN CASE DEALING WITH MULTIPLE MEMBERS, PROVIDE DETAILS OF ALL IN A SEPARATE SHEET) MEMBER/AUTHORIZED PERSON NAME EXCHANGE EXCHANGE REGISTRATION NO. CONCERNED MEMBER’S NAME WITH WHOM AP IS REGISTERED CLIENT CODE REGISTERED OFFICE ADDRESS CITY STATE COUNTRY TEL FAX EMAIL ID WEBSITE DETAILS SECTION G VAT DETAILS (AS APPLICABLE, STATE WISE) LOCAL SALES VAT REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) NAME OF THE STATE OTHER SALES VAT REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) NAME OF THE STATE CLIENT’S SIGNATURE [3] X SECTION H SALES TAX REGISTRATION DETAILS LOCAL SALES TAX STATE REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) NAME OF THE STATE CENTRAL SALES TAX STATE REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) OTHER SALES TAX STATE REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) NAME OF THE STATE SECTION I INVESTMENT/TRADING EXPERIENCE AND ADDITIONAL DETAILS PRIOR EXPERIENCE IN TRADING/INVESTMENT O YES O NO NUMBER OF YEARS OF COMMODITIES EXPERIENCE YEARS OF EXPERIENCE IN OTHER INVESTMENT FIELDS CONTRACT NOTE PREFERENCES O✔ ELECTRONIC CONTRACT NOTE (ECN) O PHYSICAL CONTRACT NOTE EMAIL ADDRESS SECTION J INTRODUCER DETAILS NAME OF THE INTRODUCER RELATIONSHIP WITH THE INTRODUCER INTRODUCER’S STATUS ✔ EXISTING CLIENT O AUTHORIZED PERSON O SUB‐BROKER O REMISIER O OTHERS, PLEASE SPECIFY INTRODUCER’S ADDRESS INTRODUCER’S PHONE NUMBER INTRODUCER’S CLIENT ID INTRODUCER’S SIGNATURE SECTION K NOMINATION DETAILS (FOR INDIVIDUALS ONLY) O I WISH TO NOMINATE THE FOLLOWING PERSON O I DO NOT WISH TO HAVE A NOMINEE NOMINEE’S NAME RELATIONSHIP NOMINEE’S ADDRESS NOMINEE’S PHONE NUMBER NOMINEE’S PAN CARD NUMBER NOMINEE’S DATE OF BIRTH (DD/MM/YYYY) IF NOMINEE IS A MINOR, PLEASE PROVIDE DETAILS OF HIS/HER GUARDIAN GUARDIAN’S NAME GUARDIAN’S ADDRESS GUARDIAN’S PHONE NUMBER GUARDIAN’S SIGNATURE TWO WITNESSES ARE REQUIRED TO ATTEST IF YOU WANT TO NOMINATE A PERSON PRIMARY WITNESS’ NAME PRIMARY WITNESS’ ADDRESS PRIMARY WITNESS’ SIGNATURE SECONDARY WITNESS’ NAME SECONDARY WITNESS’ ADDRESS SECONDARY WITNESS’ SIGNATUR PLEASE SIGN BELOW ATTESTING TO ALL THE INFORMATION ON THIS PAGE CLIENT’S NAME CLIENT SIGNATURE[4] X PLACE DATE(DD/MM/YYYY) 0130-Sep-2018 Jun-2017 O
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