online share market trading in india with sushil finance - … · 2014. 9. 22. · sushil financial...
TRANSCRIPT
Instructions for DP Account:
1. Signatures can be in English, Hindi or any of thelanguages contained in the 8th Schedule of theConstitution of India. Thumb impression andsignatures other than the above mentionedlanguages must be attested by a Magistrate or aNotary Public or a Special Executive Magistrateunder his/her official seal.
2. Details of the Name, Address and Tel. No. of theMagistrate / Notary Public / Special ExecutiveMagistrate are to be provided in case of attestationdone by them.
3. For Demat Account, documents need to signed byall the holders i.e. DP Agreement, POA, TariffSheet.
4. In case of additional signatures, seperate annexureshould be attested to the application form.
5. In case of applications under Power of Attorney, therelevant Power of Attorney or the certified andnotarised copy thereof, must be lodged withapplication.
6. All Correspondence / Queries shall be addressed tothe First / Sole Applicants only.
7. Demat Account is for the Equity Product only.
8. For OCB and NRI Category. Please provide IndianAddress and Foreign Address. Please mention oneof them as a correspondence Address as required.Both address proof are mandatory.
9. Minor can open only DP Account as a Single holder.
General Instructions for Filling up the Form:
1. Please fill all the details in BLOCK LETTERS /CAPITAL LETTERS and only in English.
2. Please use Black Ink for the Signatures and to fill upthe form.
3. Please write name as per PAN CARD. Please writeaddress as per the proof attached.
4. Please sign all the documents as per signatureshown on PAN CARD or signature to be verified byBank.
5. Trading Account will be opened in the name ofSole/First Holder Only.
6. For non residents clients the KYC documents shouldbe attested by anyone of the following entities -Notary Public, Court, Magistrate, Judge, LocalBanker, Indian Embassy / Consulate General in theCountry where the client resides.
7. If any information to be given does not fit in theform, an Annexure may be Used.
8. Telephone / Electricity Bill should not be more than3 months old.
9. Strike off whatever is not applicable.
10. Contact details : Email ID, Mobile No., ResidenceTel. No., Office Tel. No. is mandatory for UCC data.
11. Please do not use whitener.
12. This information is the sole property of the tradingmember / brokerage house and would not bedisclosed to anyone unless required by law orexcept with the express permission of clients.
13. As per SEBI directions, the FIIS and NRIS are notpermitted to deal in Currency Derivatives.
ABBREVIATIONS IN KYC FOR MANDATORY & VOLUNTARY INFORMATION
INSTRUCTIONS FOR FILLING OF THE FORMS
Mandatory for Equity / Future & Option / Currency Derivatives / DP.#Mandatory for Equity / Future & Option / Currency Derivaties Trading Account at BSEL / NSEIL / MCX-SX.
*Applicable for Demat Account to be opened with Sushil Financial Services Private Limited.**
Voluntary / Optional.
Full signature required where XX marked
IMPORTANT NOTE
Signature of First Holder
Signature of Second Holder
Signature of Third Holder T 1 - T 5�
S 1 - S 5
F 1 - F 30�
Branch / Franchisee Head Office
1.
2.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
1.
2.
3.
4.
5.
6.
7.
8.
1.
2.
1.
1.
2.
3.
4.
Latest passport size photograph affixed & signed the photograph across
Proof of the identity of the client - Copy of the Pan card (Mandatory)
Address Proof
Bank passbook
Ration Card
Passport (Please provide renewal copy after expire of the same.)
Driving License (Please provide renewal copy after expire of the same.)
Telephone / Electricity / Gas Bill (should not be more than three months old)
Voter ID
Agreement of sale
Rent Agreement (Please provide renewal copy after expire of the same.)
Latest original Bank statement with Original cancelled cheque or
verified copy of the statement with Bankers seal and signature.
Flat Maintenance Bill
Insurance Copy
Aadhar Card
Identity card / Document with address, issued by :
Central / State Government and its Departments,
Statutory / Regulatory Authorities,
Public Sector Undertakings,
Scheduled Commercial Banks,
Public Financial Institutes,
Colleges affiliated to universities,
Professional bodies such as ICAI, ICWAI, ICSI, Bar Council etc.,
to their Members
Aadhar Card
Proof of Bank account :
Copy of the bank passbook / latest bank statement or personalized
cancelled cheque.
MICR AND IFSC code : Copy of cancelled cheque leaf showing the same.
For Trading Account :
For DP Proof (if DP account not opened with SFSPL) DP statement
reflecting DP ID, Client ID and Name of the client with DP official seal
and signature.
NRI
Copy of RBI approval letter (Primary Banks are also allowed).
Indian & Foreign address of client along with the proof.
NRI bank account proof / bank passbook / bank account statment and
one cancelled cheque leaf (showing NRE / NRO status)
NRI / PIS account opened with bank
KYC CHECKLIST
Accepted if the checklist is completed (Please mark YES against the document attached)
INDIVIDUAL / NRI
Date : YY Y Y/ /MD D M
IN PERSON VERIFICATION / UCC
Name of the Employee
Employee Code
Designation of the employee
Date
Signature
Documents verified withOriginals
Client Interviewed ByIn-Person Verification
done by
I/We undertake that we have made the client aware of 'Policy and Procedures', tariff sheet and all the non-mandatorydocuments. I/We have also made the client aware of 'Rights and Obligations' document(s), RDD and Guidance Note. I/We have given/sent him a copy of all the KYC documents. I/We undertake that any change in the 'Policy andProcedures', tariff sheet and all the non-mandatory documents would be duly intimated to the clients. I/We alsoundertake that any change in the 'Rights and Obligations' and RDD would be made available on my/our website, if any,for the information of the clients.
Signature of the Authorised Signatory
Seal / Stamp of the stock broker
Branch / Franchisee Head Office
1.
2.
3.
4.
5.
6.
7.
8.
9.
Copy of ITR acknowledgement
Copy of annual Accounts
Copy of form 16 in case of salaried person
Networth certificate
Salary slips
Bank account holding statements for last six months.
Any other relevant documents substantiating owner of assets.
Self declaration along with relevant supporting documents.
Copy of demat account holding statement
NOTE : All copies of proof/supporting documents must be sign by the client.
Valid documentary proof for Financial Details (Mandatory for client in F&O and Currency Segment)
I N D E X
Authority for Running Account
Undertaking Cum authority
Letter
Authority letter for adjustment for
funds and securities in different
Segment & Exchanges
Authorization for receipt of
contract notes, bills statement of
funds and Securities etc in
digitally signed Electronic Form
Authority letter for maintaining running account with Broker
for both funds and securities by clients.
General authority to broker to facilitate ease of operation
while trading
Authority to broker for adjustment for funds and securities in
different Segment and Exchanges.
Authorization for receipt of contract notes, bills, Statements
of Funds and Securities etc. in digitally signed Electronic
Form.
Voluntary
Page No.Particulars Significance
Mandatory
Page No.
1-19
Particulars
Know Your Client KYC Formand Tariff Sheet
Proprietary Trading Disclosure
Rights and Obligations for opening Demat Account
Significance
Profile of Client with Photograph along with details ofBanking & DP, Annual Income, Experience and PreferredSegment of Dealing by Client as well as Introducers’ detailsand Document detailing the rate/amount of brokerage andother charge(s)
Disclosure of properietary trading to clients by Broker
Rights and Obligations of Beneficial Owner and DepositoryParticipant
20
21-22
23
24
25
26
Bank verification Format of letter to be obtained from bank for verification of
signature, address, identity and bank details.
F1 XX
I / We have fully understood the distinction and details regarding the Mandatory / Voluntary and do hereby enter
and sign the same and agree not to call into question the validity, enforce the ability and applicability of any
voluntary agreement(s) / documents(s) or clauses within any voluntary / optional agreement(s) / document(s)
under any circumstances whatsoever.
Client Signature
Voluntary
Page No.Particulars Significance
Format for registration for
availing SMS Facility
Client Defaulter Declaration
Format for registration for Mutual
Fund Service System (MFSS)
Facility
Registration form for availing SMS facility pertaining to
trading account.
Undertaking by client that he has not been declared as
defaulter by SEBI / Various Exchanges / Regulatory bodies /
CIBIL etc.
Registration form for availing Mutual Fund facility.
DP Tariff (Mandatory for DP) DP Tariff Structure
27
28
29
30
31
�
CLIENT PROFILE
*,*** Investment Experience : No Prior Experience
Years in Commodities
Years in Stocks
Years in any other investment related field.
Years in Derivatives
Branch Code
Sub Broker SEBI Regn. No. NSE (For CM Segment)
Sub Broker SEBI Regn. No. BSE (For CM Segment)
I N S -
I N S -
Name
Regd. Office Address
Savashare ClientsType of Product : WEB (EXE application having one time license fee.)
Equity : Speculative Hedging Investment
I here by authorize you to register me/us in below mentioned segment, duly signed by me (Please sign in the relevantboxes where you wish to trade. The segment not chosen should be struck off by the client)
Mandatory
BSEL NSEIL*(CM)Capital Market XX F2
*Derivative Market(F&O)
XX F4
*CurrencyDerivatives
XX F6
*Mutual Fund XX F8
*(CM)Capital Market XX F3
*Derivative Market(F&O)
XX F5
*CurrencyDerivatives
XX F7
*Mutual Fund XX F9
TRADING PREFERENCES
1
Phone No. Fax No.
Website
In future the clients wants to trade in any new segment/new exchange, separate authorisation/letter should be provided.
Dealing through Sub Broker/Remiser/Authorised Person/BranchWhether you wish to avail of the facility of internet trading / wireless technology if Yes No
For registration of below segment agreement need to be signed.
XX F14BSEL SLB XX F15NSEIL SLB
**DP Account XX F13
MCX–SXCurrencyDerivatives
XX F12
MCX–SXCapital Market (CM)
XX F10MCX–SXDerivative Market(F&O)
XX F11
MCX-SX
�
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2
(For Office Use Only)
Registration Date :
DP ID No. : Client BO ID No.1 2 0 2 8 9 0
MD YY Y Y/ /MD Client Code :
Existing Trading A/c.
Date
Signature
MD YY Y Y/ /MD
Relation with clients
Phone No.
Relation with TM.
Existing DP Account : BO ID No. 1 2 0 2 8 9 0
Introduction (Optional)
The details furnished by Applicant is true to the best of my knowledge and belief.
Name
Address
(Introducer Signature)In case of Firm, Corporateplease affix company seal
Introducer Status : Sub Broker Ramiser Autiorised Person Existing Client Others
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"Know Your Client (KYC)Application form (For Individuals Only)
Please fill in ENGLISH and in BLOCK LETTERS with black ink
A. Identity Details (please see guidelines overleaf)
1. Name of Applicant (As appearing in supporting identification document).
Name
Father's/Spouse Name
PHOTOGRAPH
Please affix
the recent passport
size photograph and
sign across it
2. Gender Male Female B. Marital status Single Married C. Date of Birth d d / m m / y y y y
3. Nationality Indian Other (Please specify)
4. Status Please tick ( �) Resident Individual Non Resident Foreign National (Passport Copy Mandatory for NRIs & Foreign Nationals)
5. PAN Please enclose a duly attested copy of your PAN Card
Unique Identification Numbar (UID)/Aadhaar, if any:
6. Proof of Identity submitted for PAN exempt cases Please Tick (�)
UID (Aadhaar) Passport Voter ID Driving Licence Others (Please see guideline 'D' overleaf)
DECLARATIONI hereby declare that the details furnished above are true and correct to the best of my/our knowledge and beliefand I undertake to inform you of any changes therein, immediately. In case any of the above information is foundto be false or untrue or misleading or misrepresenting, I am/we are aware that I/we may be held liable for it.
Place: Date:
SIGNATURE OF APPLICANT
FOR OFFICE USE ONLY IPV Done on / /d d m m y y y y
(Originals Verified) Self Certified Document copies received
SUSHIL FINANCIAL SERVICES PVT. LTD.
(Attested) True copies of documents received
Main Intermediary
Seal/Stamp of the intermediary should containStaff NameDesignation
Name of the OrganizationSignature
Date
Application No. :
AMC/Intermediary name OR code
�
FIRST HOLDER
3
Seal/Stamp of the intermediary should containStaff NameDesignation
Name of the OrganizationSignature
Date
XX F16
A. Address Details (please see guidelines overleaf)
1. Address for Correspondence
City / Town / Villeage
State
2. Contact Details
Tel. (Off.)
Mobile
E-Mail Id.
(ISD) (STD
(ISD) (STD
Pin Code
Country
Tel. (Res.)
Fax
(ISD) (STD
(ISD) (STD
3. Proof of address to be provided by Applicant. Please submit ANY ONE of the following valid documents & tick (�) against the document attached.
Passport Ration Card Registered Lease/Sale Agreement of Residence Driving License Voter Identity Card *Latest Bank A/c Statement/Passbook
*Latest Telephone Bill (only Land Line) *Latest Electricity Bill *Latest Gas Bill Others (Please specify)
*Not more than 3 Months old. Validity/Expiry date of proof of address submitted d d / m m / y y y y
4. Permanent Address of Resident Applicant if different from above B1 OR Overseas Address (Mandatory) for Non-Resident Applicant
City / Town / Villeage
State CountryPin Code
5. Proof of address to be provided by Applicant. Please submit ANY ONE of the following valid documents & tick (�) against the document attached.
Passport Ration Card Registered Lease/Sale Agreement of Residence Driving License Voter Identity Card *Latest Bank A/c Statement/Passbook
*Latest Telephone Bill (only Land Line) *Latest Electricity Bill *Latest Gas Bill Others (Please specify)
*Not more than 3 Months old. Validity/Expiry date of proof of address submitted d d / m m / y y y y
6. Any other information
�
XX F17
INSTRUCTIONS / CHECK LIST FOR FILLING KYC FORM
A. IMPORTANT POINTS:
1. Self attested copy of PAN card is mandatory for all clients.
2. Copies of all the documents submitted by the applicant
should be self-attested and accompanied by originals for
verification. In case the original of any document is not
produced for verification, then the copies should be properly
attested by entities authorized for attesting the documents,
as per the below mentioned list.
3. If any proof of identity or address is in a foreign language,
then translation into English is required.
4. Name & address of the applicant mentioned on the KYC
form, should match with the documentary proof submitted.
5. If correspondence & permanent address are different, then
proofs for both have to be submitted.
6. Sole proprietor must make the application in his individual
name & capacity.
7. For non-residents and foreign nationals,(allowed to trade
subject to RBI and FEMA guidelines), copy of
passport/PIOCard/OCICard and overseas address proof is
mandatory.
8. For foreign entities, CIN is optional; and in the absence of DIN
no. for the directors, their passport copy should be given.
9. In case of Merchant Navy NRI's, Mariner's declaration or
certified copy of CDC (Continuous Discharge Certificate) is to
be submitted.
10. For opening an account with Depository participant or
Mutual Fund, for a minor, photocopy of the School Leaving
Certificate/Mark sheet issued by Higher Secondary
Board/Passport of Minor/Birth Certificate must be provided.
11. Politically Exposed Persons (PEP) are defined as 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.
B. Proof of ldentity (POI): List of documents admissible as
Proof of Identity:
1. PAN card with photograph. This is a mandatory requirement
for all applicants except those who are specially exempt from
obtaining PAN (listed in Section D).
2. Unique Identification Number (UID) (Aadhaar) / Passport /
Voter lD card / Driving license.
3. Identity card/document with applicant's Photo, issued by any
of the following: Central/State Government and its
Departments, Statutory/Regulatory Authorities, Public
Sector Undertakings, Scheduled Commercial Banks, Public
Financial Institutions, Colleges affiliated to Universities,
Professional Bodies such as ICAI, ICWAI, ICSI, Bar Council
etc., to their Members; and Credit cards/Debit cards issued
by Banks.
C Proof of Address (POA): List of documents admissible as
Proof of Address: (*Documents having an expiry date
should be valid on the date of submission.)
1. Passport / Voters Identity Card / Ration Card / Registered
Lease or Sale Agreement of Residence / Driving License /
Flat Maintenance bill / Insurance Copy.
2. Utility bills like Telephone Bill (only land line), Electricity bill or
Gas bill - Not more than 3 months old.
3. Bank Account Statement/Passbook - Not more than 3
months old.
4. Self-declaration by High Court and Supreme Court judges,
giving the new address in respect of their own accounts.
5. Proof of address issued by any of the following: Bank
Managers of Scheduled Commercial Banks / Scheduled Co-
Operative Bank / Multinationa Foreign Banks / Gazetted
Officer / Notary public/Elected representatives to the
Legislative Assembly / Parliament / Documents issued by any
Govt. or Statutory Authority.
6. Identity card/document with address, issued by any of the
following: Central / State Government and its Departments,
Statutory / Regulatory Authorities, Public Sector
Undertakings, Scheduled Commercial Banks, Public Financial
Institutions, Colleges affiliated to Universities and
Professional Bodies such as ICAI, ICWAI, ICSI, Bar Council etc.
to their Members.
7. For Fll/sub account, Power of Attorney given by Fll/sub-
account to the Custodians (which are duly notarized and/or
apostiled or consularised) that gives the registered address
should be taken.
8. The proof of address in the name of the spouse may be
accepted.
D. Exemptions/clarifications to PAN
(*Sufficient documentary evidence in support of such
claims to be collected.)
1. In case of transactions undertaken on behalf of Central
Government and/or State Government and by officials
appointed by Courts e.g. Official liquidator, Court receiver
etc.
2. Investors residing in the state of Sikkim.
3. UN entities/multilateral agencies exempt from paying
taxes/filing tax returns in India.
4. SIP of Mutual Funds uptoRs 50,000/-p.a.
5. In case of institutional clients, namely, Flls, Mfs, VCFs, FVCIs,
Scheduled Commercial Banks, Multilateral and Bilateral
Development Financial Institutions, State Industrial
Development Corporations, Insurance Companies registered
with IRDA and Public Financial Institution as defined under
section 4A of the Companies Act, 1956, Custodians shall
verify the PAN card details with the original PAN card and
provide duly certified copies of such verified PAN details to
the intermediary.
E. List of people authorized to attest the documents:
1. Notary Public, Gazetted Officer, Manager of a Scheduled
Commercial/Co-operative Bank or Multinational Foreign
Banks (Name, Designation & Seal should be affixed on the
copy).
2. In case of NRIs, authorized officials of overseas branches of
Scheduled Commercial Banks registered in India, Notary
Public, Court Magistrate, Judge, Indian Embassy/Consulate
General in the country where the client resides are permitted
to attest the documents.
4 Signature
Print if Required
"Ple
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KYC
ap
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tio
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rman
do
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ruct
ion
ssh
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ted
on
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ep
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pri
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para
tely
then
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es
sho
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"Know Your Client (KYC)Application form (For Individuals Only)
Please fill in ENGLISH and in BLOCK LETTERS with black ink
A. Identity Details (please see guidelines overleaf)
1. Name of Applicant (As appearing in supporting identification document).
Name
Father's/Spouse Name
PHOTOGRAPH
Please affix
the recent passport
size photograph and
sign across it
2. Gender Male Female B. Marital status Single Married C. Date of Birth d d / m m / y y y y
3. Nationality Indian Other (Please specify)
4. Status Please tick ( �) Resident Individual Non Resident Foreign National (Passport Copy Mandatory for NRIs & Foreign Nationals)
5. PAN Please enclose a duly attested copy of your PAN Card
Unique Identification Numbar (UID)/Aadhaar, if any:
6. Proof of Identity submitted for PAN exempt cases Please Tick (�)
UID (Aadhaar) Passport Voter ID Driving Licence Others (Please see guideline 'D' overleaf)
DECLARATIONI hereby declare that the details furnished above are true and correct to the best of my/our knowledge and beliefand I undertake to inform you of any changes therein, immediately. In case any of the above information is foundto be false or untrue or misleading or misrepresenting, I am/we are aware that I/we may be held liable for it.
Place: Date:
SIGNATURE OF APPLICANT
FOR OFFICE USE ONLY IPV Done on / /d d m m y y y y
(Originals Verified) Self Certified Document copies received
SUSHIL FINANCIAL SERVICES PVT. LTD.
(Attested) True copies of documents received
Main Intermediary
Seal/Stamp of the intermediary should containStaff NameDesignation
Name of the OrganizationSignature
Date
Application No. :
AMC/Intermediary name OR code
SECOND HOLDER
5
Seal/Stamp of the intermediary should containStaff NameDesignation
Name of the OrganizationSignature
Date
XX S1
A. Address Details (please see guidelines overleaf)
1. Address for Correspondence
City / Town / Villeage
State
2. Contact Details
Tel. (Off.)
Mobile
E-Mail Id.
(ISD) (STD
(ISD) (STD
Pin Code
Country
Tel. (Res.)
Fax
(ISD) (STD
(ISD) (STD
3. Proof of address to be provided by Applicant. Please submit ANY ONE of the following valid documents & tick (�) against the document attached.
Passport Ration Card Registered Lease/Sale Agreement of Residence Driving License Voter Identity Card *Latest Bank A/c Statement/Passbook
*Latest Telephone Bill (only Land Line) *Latest Electricity Bill *Latest Gas Bill Others (Please specify)
*Not more than 3 Months old. Validity/Expiry date of proof of address submitted d d / m m / y y y y
4. Permanent Address of Resident Applicant if different from above B1 OR Overseas Address (Mandatory) for Non-Resident Applicant
City / Town / Villeage
State CountryPin Code
5. Proof of address to be provided by Applicant. Please submit ANY ONE of the following valid documents & tick (�) against the document attached.
Passport Ration Card Registered Lease/Sale Agreement of Residence Driving License Voter Identity Card *Latest Bank A/c Statement/Passbook
*Latest Telephone Bill (only Land Line) *Latest Electricity Bill *Latest Gas Bill Others (Please specify)
*Not more than 3 Months old. Validity/Expiry date of proof of address submitted d d / m m / y y y y
6. Any other information
XX S2
Print if Required
INSTRUCTIONS / CHECK LIST FOR FILLING KYC FORM
A. IMPORTANT POINTS:
1. Self attested copy of PAN card is mandatory for all clients.
2. Copies of all the documents submitted by the applicant
should be self-attested and accompanied by originals for
verification. In case the original of any document is not
produced for verification, then the copies should be properly
attested by entities authorized for attesting the documents,
as per the below mentioned list.
3. If any proof of identity or address is in a foreign language,
then translation into English is required.
4. Name & address of the applicant mentioned on the KYC
form, should match with the documentary proof submitted.
5. If correspondence & permanent address are different, then
proofs for both have to be submitted.
6. Sole proprietor must make the application in his individual
name & capacity.
7. For non-residents and foreign nationals,(allowed to trade
subject to RBI and FEMA guidelines), copy of
passport/PIOCard/OCICard and overseas address proof is
mandatory.
8. For foreign entities, CIN is optional; and in the absence of DIN
no. for the directors, their passport copy should be given.
9. In case of Merchant Navy NRI's, Mariner's declaration or
certified copy of CDC (Continuous Discharge Certificate) is to
be submitted.
10. For opening an account with Depository participant or
Mutual Fund, for a minor, photocopy of the School Leaving
Certificate/Mark sheet issued by Higher Secondary
Board/Passport of Minor/Birth Certificate must be provided.
11. Politically Exposed Persons (PEP) are defined as 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.
B. Proof of ldentity (POI): List of documents admissible as
Proof of Identity:
1. PAN card with photograph. This is a mandatory requirement
for all applicants except those who are specially exempt from
obtaining PAN (listed in Section D).
2. Unique Identification Number (UID) (Aadhaar) / Passport /
Voter lD card / Driving license.
3. Identity card/document with applicant's Photo, issued by any
of the following: Central/State Government and its
Departments, Statutory/Regulatory Authorities, Public
Sector Undertakings, Scheduled Commercial Banks, Public
Financial Institutions, Colleges affiliated to Universities,
Professional Bodies such as ICAI, ICWAI, ICSI, Bar Council
etc., to their Members; and Credit cards/Debit cards issued
by Banks.
C Proof of Address (POA): List of documents admissible as
Proof of Address: (*Documents having an expiry date
should be valid on the date of submission.)
1. Passport / Voters Identity Card / Ration Card / Registered
Lease or Sale Agreement of Residence / Driving License /
Flat Maintenance bill / Insurance Copy.
2. Utility bills like Telephone Bill (only land line), Electricity bill or
Gas bill - Not more than 3 months old.
3. Bank Account Statement/Passbook - Not more than 3
months old.
4. Self-declaration by High Court and Supreme Court judges,
giving the new address in respect of their own accounts.
5. Proof of address issued by any of the following: Bank
Managers of Scheduled Commercial Banks / Scheduled Co-
Operative Bank / Multinationa Foreign Banks / Gazetted
Officer / Notary public/Elected representatives to the
Legislative Assembly / Parliament / Documents issued by any
Govt. or Statutory Authority.
6. Identity card/document with address, issued by any of the
following: Central / State Government and its Departments,
Statutory / Regulatory Authorities, Public Sector
Undertakings, Scheduled Commercial Banks, Public Financial
Institutions, Colleges affiliated to Universities and
Professional Bodies such as ICAI, ICWAI, ICSI, Bar Council etc.
to their Members.
7. For Fll/sub account, Power of Attorney given by Fll/sub-
account to the Custodians (which are duly notarized and/or
apostiled or consularised) that gives the registered address
should be taken.
8. The proof of address in the name of the spouse may be
accepted.
D. Exemptions/clarifications to PAN
(*Sufficient documentary evidence in support of such
claims to be collected.)
1. In case of transactions undertaken on behalf of Central
Government and/or State Government and by officials
appointed by Courts e.g. Official liquidator, Court receiver
etc.
2. Investors residing in the state of Sikkim.
3. UN entities/multilateral agencies exempt from paying
taxes/filing tax returns in India.
4. SIP of Mutual Funds uptoRs 50,000/-p.a.
5. In case of institutional clients, namely, Flls, Mfs, VCFs, FVCIs,
Scheduled Commercial Banks, Multilateral and Bilateral
Development Financial Institutions, State Industrial
Development Corporations, Insurance Companies registered
with IRDA and Public Financial Institution as defined under
section 4A of the Companies Act, 1956, Custodians shall
verify the PAN card details with the original PAN card and
provide duly certified copies of such verified PAN details to
the intermediary.
E. List of people authorized to attest the documents:
1. Notary Public, Gazetted Officer, Manager of a Scheduled
Commercial/Co-operative Bank or Multinational Foreign
Banks (Name, Designation & Seal should be affixed on the
copy).
2. In case of NRIs, authorized officials of overseas branches of
Scheduled Commercial Banks registered in India, Notary
Public, Court Magistrate, Judge, Indian Embassy/Consulate
General in the country where the client resides are permitted
to attest the documents.
6 Signature
Print if Required
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"Know Your Client (KYC)Application form (For Individuals Only)
Please fill in ENGLISH and in BLOCK LETTERS with black ink
A. Identity Details (please see guidelines overleaf)
1. Name of Applicant (As appearing in supporting identification document).
Name
Father's/Spouse Name
PHOTOGRAPH
Please affix
the recent passport
size photograph and
sign across it
2. Gender Male Female B. Marital status Single Married C. Date of Birth d d / m m / y y y y
3. Nationality Indian Other (Please specify)
4. Status Please tick ( �) Resident Individual Non Resident Foreign National (Passport Copy Mandatory for NRIs & Foreign Nationals)
5. PAN Please enclose a duly attested copy of your PAN Card
Unique Identification Numbar (UID)/Aadhaar, if any:
6. Proof of Identity submitted for PAN exempt cases Please Tick (�)
UID (Aadhaar) Passport Voter ID Driving Licence Others (Please see guideline 'D' overleaf)
DECLARATIONI hereby declare that the details furnished above are true and correct to the best of my/our knowledge and beliefand I undertake to inform you of any changes therein, immediately. In case any of the above information is foundto be false or untrue or misleading or misrepresenting, I am/we are aware that I/we may be held liable for it.
Place: Date:
SIGNATURE OF APPLICANT
FOR OFFICE USE ONLY IPV Done on / /d d m m y y y y
(Originals Verified) Self Certified Document copies received
SUSHIL FINANCIAL SERVICES PVT. LTD.
(Attested) True copies of documents received
Main Intermediary
Seal/Stamp of the intermediary should containStaff NameDesignation
Name of the OrganizationSignature
Date
Application No. :
AMC/Intermediary name OR code
THIRD HOLDER
7
Seal/Stamp of the intermediary should containStaff NameDesignation
Name of the OrganizationSignature
Date
XX T1
A. Address Details (please see guidelines overleaf)
1. Address for Correspondence
City / Town / Villeage
State
2. Contact Details
Tel. (Off.)
Mobile
E-Mail Id.
(ISD) (STD
(ISD) (STD
Pin Code
Country
Tel. (Res.)
Fax
(ISD) (STD
(ISD) (STD
3. Proof of address to be provided by Applicant. Please submit ANY ONE of the following valid documents & tick (�) against the document attached.
Passport Ration Card Registered Lease/Sale Agreement of Residence Driving License Voter Identity Card *Latest Bank A/c Statement/Passbook
*Latest Telephone Bill (only Land Line) *Latest Electricity Bill *Latest Gas Bill Others (Please specify)
*Not more than 3 Months old. Validity/Expiry date of proof of address submitted d d / m m / y y y y
4. Permanent Address of Resident Applicant if different from above B1 OR Overseas Address (Mandatory) for Non-Resident Applicant
City / Town / Villeage
State CountryPin Code
5. Proof of address to be provided by Applicant. Please submit ANY ONE of the following valid documents & tick (�) against the document attached.
Passport Ration Card Registered Lease/Sale Agreement of Residence Driving License Voter Identity Card *Latest Bank A/c Statement/Passbook
*Latest Telephone Bill (only Land Line) *Latest Electricity Bill *Latest Gas Bill Others (Please specify)
*Not more than 3 Months old. Validity/Expiry date of proof of address submitted d d / m m / y y y y
6. Any other information
�
�
XX T2
Print if Required
INSTRUCTIONS / CHECK LIST FOR FILLING KYC FORM
A. IMPORTANT POINTS:
1. Self attested copy of PAN card is mandatory for all clients.
2. Copies of all the documents submitted by the applicant
should be self-attested and accompanied by originals for
verification. In case the original of any document is not
produced for verification, then the copies should be properly
attested by entities authorized for attesting the documents,
as per the below mentioned list.
3. If any proof of identity or address is in a foreign language,
then translation into English is required.
4. Name & address of the applicant mentioned on the KYC
form, should match with the documentary proof submitted.
5. If correspondence & permanent address are different, then
proofs for both have to be submitted.
6. Sole proprietor must make the application in his individual
name & capacity.
7. For non-residents and foreign nationals,(allowed to trade
subject to RBI and FEMA guidelines), copy of
passport/PIOCard/OCICard and overseas address proof is
mandatory.
8. For foreign entities, CIN is optional; and in the absence of DIN
no. for the directors, their passport copy should be given.
9. In case of Merchant Navy NRI's, Mariner's declaration or
certified copy of CDC (Continuous Discharge Certificate) is to
be submitted.
10. For opening an account with Depository participant or
Mutual Fund, for a minor, photocopy of the School Leaving
Certificate/Mark sheet issued by Higher Secondary
Board/Passport of Minor/Birth Certificate must be provided.
11. Politically Exposed Persons (PEP) are defined as 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.
B. Proof of ldentity (POI): List of documents admissible as
Proof of Identity:
1. PAN card with photograph. This is a mandatory requirement
for all applicants except those who are specially exempt from
obtaining PAN (listed in Section D).
2. Unique Identification Number (UID) (Aadhaar) / Passport /
Voter lD card / Driving license.
3. Identity card/document with applicant's Photo, issued by any
of the following: Central/State Government and its
Departments, Statutory/Regulatory Authorities, Public
Sector Undertakings, Scheduled Commercial Banks, Public
Financial Institutions, Colleges affiliated to Universities,
Professional Bodies such as ICAI, ICWAI, ICSI, Bar Council
etc., to their Members; and Credit cards/Debit cards issued
by Banks.
C Proof of Address (POA): List of documents admissible as
Proof of Address: (*Documents having an expiry date
should be valid on the date of submission.)
1. Passport / Voters Identity Card / Ration Card / Registered
Lease or Sale Agreement of Residence / Driving License /
Flat Maintenance bill / Insurance Copy.
2. Utility bills like Telephone Bill (only land line), Electricity bill or
Gas bill - Not more than 3 months old.
3. Bank Account Statement/Passbook - Not more than 3
months old.
4. Self-declaration by High Court and Supreme Court judges,
giving the new address in respect of their own accounts.
5. Proof of address issued by any of the following: Bank
Managers of Scheduled Commercial Banks / Scheduled Co-
Operative Bank / Multinationa Foreign Banks / Gazetted
Officer / Notary public/Elected representatives to the
Legislative Assembly / Parliament / Documents issued by any
Govt. or Statutory Authority.
6. Identity card/document with address, issued by any of the
following: Central / State Government and its Departments,
Statutory / Regulatory Authorities, Public Sector
Undertakings, Scheduled Commercial Banks, Public Financial
Institutions, Colleges affiliated to Universities and
Professional Bodies such as ICAI, ICWAI, ICSI, Bar Council etc.
to their Members.
7. For Fll/sub account, Power of Attorney given by Fll/sub-
account to the Custodians (which are duly notarized and/or
apostiled or consularised) that gives the registered address
should be taken.
8. The proof of address in the name of the spouse may be
accepted.
D. Exemptions/clarifications to PAN
(*Sufficient documentary evidence in support of such
claims to be collected.)
1. In case of transactions undertaken on behalf of Central
Government and/or State Government and by officials
appointed by Courts e.g. Official liquidator, Court receiver
etc.
2. Investors residing in the state of Sikkim.
3. UN entities/multilateral agencies exempt from paying
taxes/filing tax returns in India.
4. SIP of Mutual Funds uptoRs 50,000/-p.a.
5. In case of institutional clients, namely, Flls, Mfs, VCFs, FVCIs,
Scheduled Commercial Banks, Multilateral and Bilateral
Development Financial Institutions, State Industrial
Development Corporations, Insurance Companies registered
with IRDA and Public Financial Institution as defined under
section 4A of the Companies Act, 1956, Custodians shall
verify the PAN card details with the original PAN card and
provide duly certified copies of such verified PAN details to
the intermediary.
E. List of people authorized to attest the documents:
1. Notary Public, Gazetted Officer, Manager of a Scheduled
Commercial/Co-operative Bank or Multinational Foreign
Banks (Name, Designation & Seal should be affixed on the
copy).
2. In case of NRIs, authorized officials of overseas branches of
Scheduled Commercial Banks registered in India, Notary
Public, Court Magistrate, Judge, Indian Embassy/Consulate
General in the country where the client resides are permitted
to attest the documents.
8Signature
9
Details of Brokerage (Tariff)DP Scheme and
DP Scheme
Brokerage andLevies
Scheme Code1st LEG
(%)MIN - 1st LEG
Rs. / Paise2nd LEG
(%)MIN - 2nd LEG
Rs. / Paise
Min Brok. Amt.(Option)
CashTrading
Delivery
DerivativesFuture
Trading
Settlement
DerivativesOption
Trading
Settlement
MFSS
SLB
Trading
Trading
Settlement
Settlement
CurrencyFuture
Trading
Settlement
DP Details : (Mandatory for Equity Segment of BSEL.
Default (SUSHIL DP is mandatory for the E-Broking)
CDSL Client / B.O. ID
DP ID DP Name
NSDL Client / B.O. ID
DP Name
Optional
CDSL Client / B.O. ID
DP ID DP Name
NSDL Client / B.O. ID
DP Name
DP ID I N
DP ID I N
10
OPTIONAL
Bank Account Type : Savings
Bank Name :
Current NRI Others
IFSC Code (For NEFT / RTGS) :
Bank BranchAddress
City : State :
Pin Code :
Bank AccountNo.
Account Opening Date
MICR Code
MD YY Y Y/ /MD
Address
City : State :
Pin Code :
# Bank Details : (This will be default details For Trading Account of Sole / First Account Holder in whose name DP account will be open)Default
Bank Account Type : Savings
Bank Name :
Current NRI Others
IFSC Code (For NEFT / RTGS) :
Bank Branch
Bank AccountNo.
Account Opening Date
MICR Code
MD YY Y Y/ /MD
or MICR Code not available
NRE NRO
hi spac i i te ti n llye
n
T se s n n o a
k pt bla k
1st Holder NameFirst Name Middle Name Last Name
Mr. Mrs. Miss M/s. Suffix
First Holder's Details
Status
Individual
11
PAN No. Date of Birth D D M M Y Y Y Y
Individual Resident
Individual Director Relative
Individual Promoter
Individual Margin Trading Account A/C (MANTRA)
Sub-Status
NRI
Foreign National
NRI Repatriable
NRI Repatriable Promoter
NRI Depository Receipts
Foreign National
Others (Specify)_____________
Individual-Director
Individual HUF / AOP
Minor
Others (specify)_____________
NRI Non-Repatriable
NRI Non-Repatriable Promoter
Others (Specify)_____________
Foreign National - Depository Receipts
Name of Employer Establishment (if self employed / business / professional / others)(if employed) /
City
State
Pin Code
Country
Tel. No. Fax No.
Designation
Address
Name of Employer /Establishment
# Detail of any action taken/Pending/Intiated by SEBI / Stock exchange or any other regulatory Authority during last
three years. No Action taken Action taken
Please give the details if any :..........................................................
# Please provide valid documentary proof refer Checklist: Mandatory for client in F&O/Currency Segment
Nature of Business : (Products / Services Provided)
** Account Statement Required Daily Weekly Fortnightly Monthly
Yes
Yes
No
No** above through ECS ? Do you wish to receive dividend / interest directly into your bank account given
** from me / us. [Default Yes] I / We authorised you to receive credits in my / our accounts without any instruction
**Educational Qualification: ProfessionalPost GraduateGraduateUnder Graduate
Other Details
# Gross Annual Income Details (Please tick (�):Below 1 Lac 1-5 Lac 5-10 Lac 10-25 Lac > 25 Lacs
Net-worth in `. as on (date)(*Net worth should not be older than 1 year) d d / m m / y y y y
Government Service Business Professional Self Employee Agriculturist
Retired Housewife Student Forex Dealer Others (Please specify)
# Occupation (Please tick (�) any one and give brief details):
# Please tick, if applicable : Politically Exposed Person Related to a Politically Exposed Person
For definition of PEP, please refer guideline overleaf
# Any other information:
OR
Private Sector Service Public Sector
# Gross Annual Income Details (Please tick (�):Below 1 Lac 1-5 Lac 5-10 Lac 10-25 Lac > 25 Lacs
Net-worth in `. as on (date)(*Net worth should not be older than 1 year) d d / m m / y y y y
Government Service Business Professional Self Employee Agriculturist
Retired Housewife Student Forex Dealer Others (Please specify)
# Occupation (Please tick (�) any one and give brief details):
# Please tick, if applicable : Politically Exposed Person Related to a Politically Exposed Person
For definition of PEP, please refer guideline overleaf
# Any other information:
OR
Private Sector Service Public Sector
12
2nd Holder NameFirst Name Middle Name Last Name
Mr. Mrs. Miss M/s. Suffix
Second Holder's Details
PAN No. Date of Birth D D M M Y Y Y Y
Name of Employer Establishment (if self employed / business / professional / others)(if employed) /
City
State
Pin Code
Country
Tel. No. Fax No.
Designation
Address
Name of Employer /Establishment
# Detail of any action taken/Pending/Intiated by SEBI / Stock exchange or any other regulatory Authority during last
three years. No Action taken Action taken
Please give the details if any :..........................................................
# Please provide valid documentary proof refer Checklist: Mandatory for client in F&O/Currency Segment
Nature of Business : (Products / Services Provided)
** Account Statement Required Daily Weekly Fortnightly Monthly
Yes
Yes
No
No** above through ECS ? Do you wish to receive dividend / interest directly into your bank account given
** from me / us. [Default Yes] I / We authorised you to receive credits in my / our accounts without any instruction
**Educational Qualification: ProfessionalPost GraduateGraduateUnder Graduate
Other Details
13
3rd Holder NameFirst Name Middle Name Last Name
Mr. Mrs. Miss M/s. Suffix
Third Holder's Details
PAN No. Date of Birth D D M M Y Y Y Y
Name of Employer Establishment (if self employed / business / professional / others)(if employed) /
City
State
Pin Code
Country
Tel. No. Fax No.
Designation
Address
Name of Employer /Establishment
# Detail of any action taken/Pending/Intiated by SEBI / Stock exchange or any other regulatory Authority during last
three years. No Action taken Action taken
Please give the details if any :..........................................................
# Please provide valid documentary proof refer Checklist: Mandatory for client in F&O/Currency Segment
Nature of Business : (Products / Services Provided)
** Account Statement Required Daily Weekly Fortnightly Monthly
Yes
Yes
No
No** above through ECS ? Do you wish to receive dividend / interest directly into your bank account given
** from me / us. [Default Yes] I / We authorised you to receive credits in my / our accounts without any instruction
**Educational Qualification: ProfessionalPost GraduateGraduateUnder Graduate
Other Details
# Gross Annual Income Details (Please tick (�):Below 1 Lac 1-5 Lac 5-10 Lac 10-25 Lac > 25 Lacs
Net-worth in `. as on (date)(*Net worth should not be older than 1 year) d d / m m / y y y y
Government Service Business Professional Self Employee Agriculturist
Retired Housewife Student Forex Dealer Others (Please specify)
# Occupation (Please tick (�) any one and give brief details):
# Please tick, if applicable : Politically Exposed Person Related to a Politically Exposed Person
For definition of PEP, please refer guideline overleaf
# Any other information:
OR
Private Sector Service Public Sector
**Terms And Conditions-cum-Registration / Modification Form for receiving
SMS Alerts from CDSL
Definitions:
In these Terms and Conditions the terms shall have following meaning unless indicated otherwise:
1. “Depository” means Central Depository Services (India) Limited a company incorporated in India under theCompanies Act 1956 and having its registered office at 17th Floor, PJ. Towers, Dalal Street, Fort, Mumbai 400001and all its branch offices and includes its successors and assigns.
2. ‘DP’ means Depository Participant of CDSL. The term covers all types of DPs who are allowed to open demataccounts for investors.
3. ‘BO’ means an entity that has opened a demat account with the depository. The term covers all types of demat accounts, which can be opened with a depository as specified by the depository from time to time.
4. SMS means “Short Messaging Service”
5. “Alerts” means a customized SMS sent to the BO over the said mobile phone number.
6. “Service Provider” means a cellular service provider(s) with whom the depository has entered / will be entering into an arrangement for providing the SMS alerts to the BO.
7. “Service” means the service of providing SMS alerts to the BO on best effort basis as per these terms andconditions.
Availability:
1. The service will be provided to the BO at his / her request and at the discretion of the depository. The service will beavailable to those accountholders who have provided their mobile numbers to the depository through their DP.The services may be discontinued for a specific period / indefinite period, with or without issuing any prior noticefor the purpose of security reasons or system maintenance or for such other reasons as may be warranted. Thedepository may also discontinue the service at any time without giving prior notice for any reason whatsoever.
2. The service is currently available to the BOs who are residing in India.
3. The alerts will be provided to the BOs only if they remain within the range of the service provider’s service area orwithin the range forming part of the roaming network of the service provider.
4. In case of joint accounts and non-individual accounts the service will be available, only to one mobile number i.e.to the mobile number as submitted at the time of registration / modification.
5. The BO is responsible for promptly intimating to the depository in the prescribed manner any change in mobilenumber, or loss of handset, on which the BO wants to receive the alerts from the depository. In case of change inmobile number not intimated to the depository, the SMS alerts will continue to be sent to the last registered mobilephone number. The BO agrees to indemnify the depository for any loss or damage suffered by it on account of SMSalerts sent on such mobile number.
Receiving Alerts:
1. The depository shall send the alerts to the mobile phone number provided by the BO while registering for theservice or to any such number replaced and informed by the BO from time to time. Upon such registration /change, the depository shall make every effort to update the change in mobile number within a reasonable periodof time. The depository shall not be responsible for any event of delay or loss of message in this regard.
2. The BO acknowledges that the alerts will be received only if the mobile phone is in ‘ON’ and in a mode to receivethe SMS. If the mobile phone is in ‘Off” mode i.e. unable to receive the alerts then the BO may not get / get afterdelay any alerts sent during such period.
3. The BO also acknowledges that the readability, accuracy and timeliness of providing the service depend on many
14
factors including the infrastructure, connectivity of the service provider. The depository shall not be responsible forany non-delivery, delayed delivery or distortion of the alert in any way whatsoever.
4. The BO further acknowledges that the service provided to him is an additional facility provided for hisconvenience and is susceptiDle to error, omission and/ or inaccuracy. In case the BO observes any error in theinformation provided in the alert, the BO shall inform the depository and/ or the DP immediately in writing and thedepository will make best possible efforts to rectify the error as early as possible. The BO shall not hold thedepository liable for any loss, damages, etc. that may be incurred/ suffered by the BO on account of opting to availSMS alerts facility.
5. The BO authorizes the depository to send any message such as promotional, greeting or any other message that the1depository may consider appropriate, to the BO. The BO agrees to an ongoing confirmation for use of name, email
address and mobile number for marketing offers between CDSL and any other entity,
6. The BO agrees to inform the depository and DP in writing of any unauthorized debit to his BO account/unauthorized transfer of securities from his BO account, immediately, which may come to his knowledge onreceiving SMS alerts. The BO may send an email to CDSL at [email protected]. The BO is advised not toinform the service provider about any such unauthorized debit to/ transfer of securities from his BO account by sending a SMS back to the service provider as there is no reverse communication between the service provider andthe depository.
7. The information sent as an alert on the mobile phone number shall be deemed to have been received by the BOand the depository shall not be under any obligation to confirm the authenticity of the person(s) receiving the alert.
8. The depository will make best efforts to provide the service. The BO cannot hold the depository liable for non-availability of the service in any manner whatsoever.
9. If the BO finds that the information such as mobile number etc., has been changed with out proper authorization,the BO should immediately inform the DP in writing.
Fees:
Depository reserves the right to charge such fees from time to time as it deems fit for providing this service to the BO.
Disclaimer:
The depository shall make reasonable efforts to ensure that the BO’s personal information is kept confidential. Thedepository does not warranty the confidentiality or security of the SMS alerts transmitted through a service provider.Further, the depository makes no warranty or representation of any kind in relation to the system and the network or theirfunction or their performance or for any loss or damage whenever and howsoever suffered or incurred by the BO or byany person resulting from or in connection with availing of SMS alerts facility. The Depository gives no warranty withrespect to the quality of the service provided by the service provider. The Depository will not be liable for anyunauthorized use or access to the information and/ or SMS alert sent on the mobile phone number of the BO or forfraudulent, duplicate or erroneous use/ misuse of such information by any third person.
Liability and Indemnity:
The Depository shall not be liable for any breach of confidentiality by the service provider or by any third person due tounauthorized access to the information meant for the BO. In consideration of the depository providing the service, theBO agrees to indemnify and keep safe, harmless and indemnified the depository and its officials from any damages,claims, demands, proceedings, loss, cost, charges and expenses whatsoever which a depository may at any time incur,sustain, suffer or be put to as a consequence of or arising out of interference with or misuse, improper or fraudulent use ofthe service by the BO.
Amendments:
The depository may amend the terms and conditions at any time with or without giving any prioi notice to the BOs. Anysuch amendments shall be binding on the BOs who are already registered as user of this service.
15
Governing Law and Jurisdiction:
Providing the Service as outlined above shall be governed by the laws of India and will be subject to the exclusivejurisdiction of the courts in Mumbai.
I/We wish to avail the SMS Alerts facility provided by the depository on my/our mobile number provided in theregistration form subject to the terms and conditions mentioned below. I/ We consent to CDSL providing to the serviceprovider such information pertaining to account/transactions in my/our account as is necessary for the purposes ofgenerating SMS Alerts by service provider, to be sent to the said mobile number.
I/We nave read and understood the terms and conditions mentioned above and agree to abide by them and anyamendments thereto made by the depository from time to time. I / we further undertake to pay fee/ charges as may belevied by the depository from time to time.
I / We further understand that the SMS alerts would be sent for a maximum four ISINs at a time. If more than four debitstake place, the BOs would be required to take up the matter with their DP.
I/We am/ are aware that mere acceptance of the registration form does not imply in any way that the request has beenaccepted by the depository for providing the service.
16
**I/We provide the following information for the purpose of REGISTRATION / MODIFICATION for receiving SMS Alertsfrom CDSL (Please cancel out what is not applicable).
Mobile Number on which messages are to be sent (Please write only the mobile number without prefixing country code or zero)
The mobile number is registered in the name of:
Mr/Mrs.
Email ID:
(Please write only ONE valid email ID on which communication; if any, is to be sent)
+91
# Registration with Other Broker / Exchanges
Broker Name Exchange Client Code
The information furnished above is true to the best of my/our knowledge and belief. I/We undertake to inform changes ifany of the above points in writing immediately to the Broker/Exchange
1
2
3
4
# DECLARATION
I/We have read the DP-BO agreement, including the Schedules there to and the terms & Conditions and agree to abide
the Bye laws as are in force from time to time.
1. I/We hereby declare that the details furnished above are true and correct to the best of my/our knowledge and
belief and I/we 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/we are aware that I/we may be held liable for
it.
2. I/We confirm having read/been explained and understood the contents of the document on policy and
procedures of the stock broker and the tariff sheet.
3. I/We further confirm having read understood the contents of the 'Rights and Obligations' document(s) and 'Risk
Disclosure Document'. I/We do hereby agree to be bound by such provisions as outlined in these documents. I/We
have also been informed that the standard set of documents has been displayed for information on stock broker's
designated website, if any.
I/We hereby declared that I/we are/were complied with and will continue to comply with FEMA regulations and
other applicable laws as per the requirement (Applicable for NRI clients)
PLEASE SIGN ACROSS PHOTOGRAPH WITH BLACK INK ONLY
First Name Middle Name Last Name
FirstHolderName
SecondHolderName
ThirdHolderName
*
**
**
*1st Holder Signature
F18 XX
**2nd Holder Signature
S3 XX
**3rd Holder Signature
T3 � XX
Place :
Date : MD YY Y Y/ /MD
17
�
18
BO Account Details
Name of the Sole / First Holder :
Name of the Second Holder :
Name of the Third Holder :
Nominee Details : (If nominee is a minor, provide copy of Birth Certificate.)
Mr. Mrs. Miss
First Name
Middle Name
Last Name
PAN No. of NomineePhone No. of Nominee
Relationship with the BO (if any)
Date of Birth MD YY Y Y/ /MD
#
I/We the sole holder / Joint holders / Guardian (in case of minor) hereby declare that:
I/We do not wish to nominate any one of these demat/trading account. (If not mark, default will be no)
(Strike out whichever is not applicable) (signature of all account holders should be obtained on these forms)
I/We nominate the following person who is entitled to received to receive security/balances lying in my/our account
particulars where of are given below, in the event of the death of the Sole holder or the death of all the Joint Holders.
Nomination Form:
DP ID No.
Client Code
1 2 0 2 8 9 0 Client BO ID No.
Date MD YY Y Y/ /MDNominee Registration No.
Office / Gala / Flat No.
Name of the
Premises
Name of the
Road, Street
Town/Village City
Pin Code
ISD Code
Office
Mobile Email
State
STD Code
Extn
Country
Residence
Fax
Address :
F19 XX
S4 XX
T4 � XX
19
Guardian Details As the nominee / account holder is a minor as on date. I / We appoint following person to act as Guardian :
Mr. Mrs. Miss
First Name
Middle Name
Last Name
Relationship with the applicant
Date of Birth D D M M YY Y Y/ /
PAN No. of Guardian
Office / Gala Flat No.Name of the PremisesName of the Road /StreetTown / Village
Pin State Country
City
Address :
To receive the securities in this account on behalf of the nominee in the event of the death of the Sole holder / all Joint holders.The nomination is in accordance with section 109A of the companies Act, 1956, and shall supersede any prior nominationmade by me / us and also testamentary document executed by me/us.
Signature of Guardian
XXPlace :
Date : MD YY Y Y/ /MD
Telephone No.
Mobile
Fax No.
Emial ID
First Name Middle Name Last Name
FirstHolderName
SecondHolderName
ThirdHolderName
*
**
**
Speci-menSign.
WITNESS1) Signature
Name
Address
2) Signature
Name
Address
Pin
State
Country
Pin
State
Country
City City
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Ts S
pac ise
tlan
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Disclosure Information (For PRO Account Trading)
To,
Client Code :______________________
Client Name :_____________________________________
Dear Sir,
This is to inform you that we do client based trading and Pro-account trading in National Stock Exchange of India Ltd. (NSE)/Bombay Stock Exchange Ltd.(BSE)/MCX Stock Exchange Ltd. (MCX-SX)
Thanks and best regards,
For Sushil Financial Services Pvt. Ltd.
Authorised Signatory
_________________________________________________________________________________________________
I acknowledge the receipt of information given above by M/s. Sushil Financial Services Pvt. Ltd. that they do client based trading and Pro-Account trading.
(Client Signature)
Note :- To be signed by the client only and not by any authorised person on his behalf or any holder of their power of attorney.
F20 XX
Mandatory
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RIGHTS AND OBLIGATIONS OF BENEFICIAL OWNER AND DEPOSITORY PARTICIPANT
Separate Accounts
9. The DP shall open separate accounts in the name of each of the beneficial owners and securities of each beneficial owner shall be segregated and shall not be mixed up with the securities of other beneficial owners and/or DP’s own securities held in dematerialized form.
10. The DP shall not facilitate the Beneficial Owner to create or permit any pledge and / or hypothecation or any other interest or encumbrance over all or any of such secur i t ies submi t ted for dematerialization and / or held in demat account except in the form and manner prescribed in the Depositories Act, 1996, SEBI (Depositories and Participants) Regulations, 1996 and Bye-Laws / Operating Instructions / Business Rules of the Depositories.
Transfer of Securities
11. The DP shall effect transfer to and from the demat accounts of the Beneficial Owner only on the basis of an order, instruction, direction or mandate duly authorized by the Beneficial Owner and the DP shall maintain the original documents and the audit trail of such authorizations.
12. The Beneficial Owner reserves the right to give standing instructions with regard to the crediting of securities in his demat account and the DP shall act according to such instructions.
Statement of account
13. The DP shall provide statements of accounts to the beneficial owner in such form and manner and at such time as agreed with the Beneficial Owner and as specified by SEBI / depository in this regard.
14. However, if there is no transaction in the demat account, or if the balance has become Nil during the year, the DP shall send one physical statement of holding annually to such BOs and shall resume sending the transaction statement as and when there is a transaction in the account.
15. The DP may provide the services of issuing the statement of demat accounts in an electronic mode if the Beneficial Owner so desires. The DP will furnish to the Beneficial Owner the statement of demat accounts under its digital signature, as governed under the Information Technology Act, 2000. However if the DP does not have the facility of providing the statement of demat account in the electronic mode, then the Participant shall be obliged to forward the statement of demat accounts in physical form.
16. In case of Basic Services Demat Accounts, the DP shall send the transaction statements as mandated by SEBI and/or Depository from time to time.
MANDATORY FOR DP
General Clause
1. The Beneficial Owner and the Depository participant (DP) shall be bound by the provisions of the Depositories Act, 1996, SEBI (Depositories and Participants) Regulations, 1996, Rules and Regulations of Securities and Exchange Board of India(SEBI), irculars / Notifications / Guidelines issued there under, Bye Laws and Business Rules / Operating Instructions issued by the Depositories and relevant notifications of Government Authorities as may be in force from time to time.
2. The DP shall open / activate demat account of a beneficial owner in the depository system only after receipt of complete Account opening form, KYC and supporting documents as specified by SEBI from time to time.
Beneficial Owner information
3. The DP shall maintain all the details of the beneficial owner(s) as mentioned in the account opening form, supporting documents submitted by them and/or any other information pertaining to the beneficial owner confidentially and shall not disclose the same to any person except as required by any statutory, legal or regulatory authority inthis regard.
4. The Beneficial Owner shall immediately notify the DP in writing, if there is any change in details provided in the account opening form as submitted to the DP at the time of opening the demat account or furnished to the DP from time to time.
Fees/Charges/Tariff
5. The Beneficial Owner shall pay such charges to the DP for the purpose of holding and transfer of securities in dematerialized form and for availing depository services as may be agreed to from time to time between the DP and the Beneficial Owner as set out in the Tariff Sheet provided by the DP. It may be informed to the Beneficial Owner that "no charges are payable for opening of demat accounts”
6. In case of Basic Services Demat Accounts, the DP shall adhere to the charge structure as laid down under the relevant SEBI and / or Depository circulars / directions / notifications issued from time to time.
7. The DP shall not increase any charges/tariff agreed upon unless it has given a notice in writing of not less than thirty days to the Beneficial Owner regarding the same.
Dematerialization
8. The Beneficial Owner shall have the right to get the securities, which have been admitted on the Depositories, dematerialized in the form and manner laid down under the Bye Laws, Business Rules and Operating Instructions of the depositories.
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Manner of Closure of Demat account
17. The DP shall have the right to close the demat account of the Beneficial Owner, for any reasons whatsoever, provided the DP has given a notice in writing of not less than thirty days to the Beneficial Owner as well as to the Depository. Similarly, the Beneficial Owner shall have the right to close his/her demat account held with the DP provided no charges are payable by him/her to the DP. In such an event, the Beneficial Owner shall specify whether the balances in their demat account should be transferred to another demat account of the Beneficial Owner held with another DP or to rematerialize the security balances held.
18. Based on the instructions of the Beneficial Owner, the DP shall initiate the procedure for transferring such security balances or rematerialize such security balances within a period of thirty days as per procedure specified from time to time by the depository. Provided further, closure of demat account shall not affect the rights, liabilities and obligations of either the Beneficial Owner or the DP and shall continue to bind the parties to their satisfactory completion.
Default in payment of charges
19. In event of Beneficial Owner committing a default in the payment of any amount provided in Clause 5 & 6 within a period of thirty days from the date of demand, without prejudice to the right of the DP to close the demat account of the Beneficial Owner, the DP may charge interest at a rate as specified by the Depository from time to time for the period of such default.
20. In case the Beneficial Owner has failed to make the payment of any of the amounts as provided in Clause 5&6 specified above, the DP after giving two days notice to the Beneficial Owner shall have the right to stop processing of instructions of the Beneficial Owner till such time he makes the payment along with interest, if any.
Liability of the Depository
21. As per Section 16 of Depositories Act, 1996,
1. Without prejudice to the provisions of any other law for the time being in force, any loss caused to the beneficial owner due to the negligence of the depository or the participant, the depository shall indemnify such beneficial owner.
2. Where the loss due to the negligence of the participant under Clause (1) above, is indemnified by the depository, the depository shall have the right to recover the same from such participant.
Freezing / Defreezing of accounts
22. The Beneficial Owner may exercise the right to freeze/defreeze his/her demat account maintained with the DP in accordance with the procedure and subject to the restrictions laid down under the Bye Laws and Business Rules / Operating Instructions.
23. The DP or the Depository shall have the right to freeze/defreeze the accounts of the Beneficial Owners on receipt of instructions received from any regulator or court or any statutory authority.
Redressal of Investor grievance
24. The DP shall redress all grievances of the Beneficial Owner against the DP within a period of thirty days from the date of receipt of the complaint.
Authorized representative
25. If the Beneficial Owner is a body corporate or a legal entity, it shall, along with the account opening form, furnish to the DP, a list of officials authorized by it, who shall represent and interact on its behalf with the Participant. Any change in such list including additions, deletions or alterations thereto shall be forthwith communicated to the Participant.
Law and Jurisdiction
26. In addition to the specific rights set out in this document, the DP and the Beneficial owner shall be entitled to exercise any other rights which the DP or the Beneficial Owner may have under the Rules, Bye Laws and Regulations of the respective Depository in which the demat account is opened and circulars/notices issued there under or Rules and Regulations of SEBI.
27. The provisions of this document shall always be subject to Government notification, any rules, regulations, guidelines and circulars/ notices issued by SEBI and Rules, Regulations and Bye-laws of the relevant Depository, where the Beneficial Owner maintains his/ her account, that may be in force from time to time.
28. The Beneficial Owner and the DP shall abide by the arbitration and conciliation procedure prescribed under the Bye-laws of the depository and that such procedure shall be applicable to any disputes between the DP and the Beneficial Owner.
29. Words and expressions which are used in this document but which are not defined herein shall unless the context otherwise requires, have the same meanings as assigned thereto in the Rules, Bye-laws and Regulations and circulars/notices issued there under by the depository and / or SEBI
30. Any changes in the rights and obligations which are specified by SEBI / Depositories shall also be brought to the notice of the clients at once.
31. If the rights and obligations of the parties hereto are altered by virtue of change in Rules and regulations of SEBI or Bye-laws, Rules and Regulations of the relevant Depository, where the Beneficial Owner maintains his/her account, such changes shall be deemed to have been incorporated herein in modification of the rights and obligations of the parties mentioned in this document.
F21 XX
S5 XX
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Client Name:
Client Code:
Date :________________
To
Sushil Financial Services Private Limited
Regd. Office: 12, Homji Street, Fort, Mumbai - 400 001.
Dear Sir/ Madam,
Sub : Authority Letter for Running Account
1. I/We hereby state that I/we are aware of the norms relating to Pay-in & Pay-out of Funds and Securities. In
order to facilitate operations and banking convenience, I /We hereby authorize you to maintain my/our
account, both Funds and Securities with you on a running account basis instead of daily settlement of Funds
and Securities due to me/us. Further, the Pay-out of Funds and Securities may be retained by you for the
purpose of margins/exposures/collateral/any other obligations due to you and you may charge the cost of
holding securities to my/our account with you. I/We also understand and agree that any credit amount lying
with you will not attract any interest.
2. On my/our specific request you may release the Funds and Securities due to me/us. If I/we have any
outstanding obligations on the settlement date, you may retain the requisite Funds and Securities towards
such obligations and may also retain the funds expected to meet margin obligations for next 5 trading days,
calculated in the manner specified by the exchanges.
3. I/We hereby agree that you will settle my/our account of Funds and Securities at least once in a calendar
quarter/month. While settling the account you will send, in physical or electronic form, the “Statement of
Funds and Securities” including the details of retained Funds and Securities and the pledge, if any. I/we
agree to bring to your notice any dispute arising from the Statement of Funds and Securities or settlement
within 7 working days from the date of receipt of Funds and Securities or Statement of Funds and Securities,
failing which it is agreed by me/us that the Statement of Funds and Securities as issued by you is proper and
correct.
My/Our preference for actual settlement of Funds and Securities is at least:
Once in a Calendar Quarter Once in a Calendar Month
4. I/we hereby agree that above stated periodic settlement of running account is not required in case I/we avail
margin trading facility or for funds given by me/us towards collaterals/margin in the form of Bank guarantee
(BG)/Fixed Deposit Receipts (FDR).
5. I/We understand that I/we may revoke this Authority at any point of time, however, by giving written prior
notice at your registered office.
6. I/We shall be liable for all losses, damages and actions which may arise as a consequences of your adhering
to and carrying out my/our directions given above and further agree that you shall not be liable for any claim
for loss or profit or for any consequential, incidental, special or exemplary damages, caused by retention of
such Funds and Securities in this regard.
Thanking you,
Yours faithfully,
(Client Signature)
Place :________________
F22 XX
Voluntary
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Undertaking cum Authority Letter
Client Name:
Client Code:
Date:
ToSushil Financial Services Private LimitedRegd. Office: 12, Homji Street, Fort, Mumbai – 400 001.
Dear Sir/Madam,
This is with reference to my/our trading account with you and in order to facilitate ease of operation, I/We undertake
and authorize you as under:
1. You are authorized to transfer money kept as Initial Margin to Mark to Market Margin or vice versa as and
when required by you. I / We am/are also liable to pay special margin or such other margin, as considered
necessary by you or the Exchange from time to time.
2. I/We authorize you to charge interest at the rate as 18% p.a. for any delay in the payment of obligation,
margin or any other sums due to you.
3. I/We authorize you to pledge/deposit my/our securities given as collateral with the exchanges/clearing
corporation/clearing house towards margin to facilitate my/our transactions in the normal course of
securities business.
4. I/We request you to consider my/our telephonic or Oral or SMS or any other electronic mode instructions for
order placing/order modification/order cancellation as a written instruction and give us all the confirmation on
telephone or Oral or SMS or any other electronic mode unless instructed otherwise in writing. I/We am/are
getting required details from contract issued by you.
5. I/We agree that the you shall not be liable or responsible for non execution of the orders placed through
trading terminals/website or through any other mode due to the failure of any system or link or any other
reason whatsoever and I/We understand that you reserve the right of refusing to execute any particular
transaction.
6. I/We acknowledge receipt of intimation with regards to your business volumes comprising of client as well as
proprietary trades.
7. I/We acknowledge receipt of the Cash, Future & Options and Currency Derivatives Risk Disclosure
Documents and have understood the same.
Thanking you,
Yours faithfully,
(Client Signature)
Place:
Voluntary
F23 XX
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Authority letter for Adjustment of funds and securities in Different Segment & Exchanges
Client Name:
Client Code:
Date: _____________________
To,Sushil Financial Services Private LimitedRegd. Office: 12, Homji Street, Fort, Mumbai – 400 001.
Dear Sir/Madam,
I/We shall be buying/selling/trading in securities, derivatives, currency instruments or mutual funds across various
segments of various Exchanges through your company and for the consideration thereof, shall have to make
payments and a situation may emerge when accounts may show a debit balance in my/our running account with a
segment of an Exchange and a credit balance in my/our running account with another segment of an Exchange.
With a view to efficiently utilize the funds, you are hereby authorized to transfer the surplus funds from one segment
to another segment of an Exchange/your company, whenever the need arises.
I/We further authorize you to adjust/appropriate any/all my/our delivery of securities on inter- settlement basis for
all the instances where any/all securities purchased by me/us are still lying with you on my/our account. I / We
agree that such inter settlement adjustment may be in the same Stock Exchange or across the Exchanges.
Your company shall have right of lien on the credit balance/securities on hold, if any, in my/our accounts maintained
with you. Any entries passed by you in accordance with this authorization shall be binding on me/us.
Thanking you,
Yours faithfully,
(Client Signature)
Place: ____________________
h ps ke t b n
T is s ace i p la k
F24 XX
Voluntary
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Client Name :
Client Code :
Date:
To,
Sushil Financial Services Private Limited
Regd. Office: 12, Homji Street, Fort, Mumbai - 400 001.
Dear Sir/Madam,
Sub: Authorisation for receipt of contract notes, bills, statement of funds / DP statement and securities
etc. in digitally signed electronic form.
1/We understand that, I/we have the option to receive the contract notes, bills, statement of funds and securities
etc. in any form (Physical or Electronic). I/We agree to receive contract notes, bills, statement of funds and
securities etc. in electronic form for all trades /transactions executed through you at the email id(s) registered with
you, as per the below mentioned terms and conditions:
E-mail ID_______________________________________
1. My/our non-verification or non-accessing of my/our email on regular basis shall not be a reason for dispute at
any time.
2. I/We confirm that contract notes, bills, statement of funds and securities etc. sent by you from time to time
to my/our email ids shall be deemed to have been delivered to me and it shall be presumed that the same is
in order.
3. Non-receipt of bounced mail notification by you shall amount to delivery at the e-mail Id(s) registered with
you.
4. In case of any failure in system at your end, contract notes, bills, statement of funds and securities etc. will be
issued in physical form and sent to my/our correspondence address, which shall be binding on me/us.
5. I/We hereby confirm that any change in e-mail id will be communicated through duly signed physical letter to
you. However, if I/we am/are an internet client then in that event the request for change in email id(s) can be
made by me/ us through a secured access using client specific user id and password.
I/We shall be liable for all losses, damages and actions which may arise as a consequence of your adhering to and
carrying out my/our directions as given above.
Thanking you, Yours faithfully,
(Client Signature)
Place :
Note: ECN should be signed by the client only and not by any authorised person on his behalf or any holder of the
power of attorney.
F25 XX
Voluntary
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Client Name:
Client Code:
Date :
To,
Sushil Financial Services Private Limited
Regd. Office: 12, Homji Street, Fort, Mumbai - 400 001.
Dear Sir/ Madam,
Sub : Registration for availing SMS Facility
I/We,_____________________ hereby confirm that my/our Mobile No. is and
hereby authorize you to send service messages / information / alerts / calls pertaining to my/our trading
Account maintained with you.
I/We further authorise you to send all research, recommendations and follow-ups through SMS on my/our
above mentioned mobile number.
I/We agree further that above facility offered to me/us is in addition to the existing usual facilities and in no way
I/we will hold the Company responsible for the late-receipt or non-receipt etc. of the above.
I/We also agree that I/we shall be solely responsible for all trading done by me/us, based upon the
recommendations, sent to me/us through above said service and I/we also understand that the information
contained therein does not constitute an offer to Buy or Sell any securities and such information shall be used
by me/us at my/our own risk therefore, & the Company or the Employees of the Company shall be in no way
responsible for any direct or indirect losses arising from the use thereof.
Thanking you,
Yours faithfully,
(Client Signature)
Place :
Th s spe is kept b ank
iac
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F26 XX
Voluntary
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CLIENT DEFAULTER DECLARATION
Date
I, having PAN No.
do hereby declare that I have not been involved in any terrorist activity and I have not been declared as defaulter or
my name is not appearing in defaulter database as per SEBI / Various Exchanges / Regulatory bodies / CIBIL /
(Credit Information Bureau of India Ltd.) / United Nation Securities Council etc.
I further declare that the above mentioned declaration / statement is true and correct.
F27
Client Signature
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Voluntary
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Date:
To,
Sushil Financial Services Pvt Limited
12 Homij Street, Fort Mumbai-400 001.
Sir,
Sub: Mutual Fund Service System (MFSS) facility
I/We___________________________________________________ am/are registered as your client with Client
Code No._____________________ and have executed the Trading Member and Client Agreement for the
purpose of trading
in the Capital Market segment of Bombay Stock Exchange Limited (BSE) and National Stock Exchange of India
Ltd. (NSE).
I/We am/are interested in availing the MFSS facility of the Exchange for the purpose of dealing in the units of
Mutual Funds Schemes permitted to be dealt with on the MFSS of the Exchange.
For the purpose of availing the MFSS facility, I/we state that Know Your Client details as submitted by me/us for the
stock broking may be considered for the purpose of MFSS and I/we further confirm that the details contained in
same remain unchanged as on date.
I/We are willing to abide by the terms and conditions as mentioned in the Circular dated 2nd December 2009 of
BSE and 24th November 2009 of NSE and as may be specified by the Exchange from time to time in this regard.
I/We shall ensure also compliance with the requirements as may be specified from time to time by Securities and
Exchange Board of India and Association of Mutual Funds of India (AMFI).
I/We shall read and understand the contents of the of the Scheme Information Document and Key Information
Memorandum, addenda issued regarding each Mutual Fund Schemes with respect to which I/we choose to
subscribe/redeem. I/We further agree to abide by the terms and conditions, rules and regulations of the Mutual
Fund Schemes.
I/We therefore request you to register me/us as your client for participating in the MFSS.
Thanking you,
Yours faithfully,
Client Name:
Client Signature
F28 XX
Voluntary
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F29 XX
Sushil Financial Services Pvt. Limited
Depository Tariff Plan (Please select the scheme)
SCHEME
Particulars
A ) Documentation charge
B ) Account maintenance**
Advance (Documentation + AMC) (A+B)
Custody charges
Dematerialisation
Transaction Charges
Within SFCL Off Mkt. Transaction
Within SFCL On Mkt Transaction
Outside SFCL (Buy)
OutsideSFCL (Sell)
Rematerialisation
Pledge Creation
Pledge Closure
Pledge Invocation
? Transaction and holding statement will be mailed once in a month FREE of cost
? Statutory charges as applicable
? Rates are subject to revision from CDSL
? For CORPORATE Accounts additional Rs.500/- P.A. will be charged for AMC"
Additional Statement will be charge @Rs10 per request
INVESTOR
Rs. 50/-
Rs. 400/- (only First Year)
Rs. 450/-
Nil
Rs. 25/- per request +Rs. 3/- per certificate
Min Rs.15 or .04%
Rs.25/- or .05%
NIL
Min Rs.25/or .04%
35/-
35/
35/-
Nll
ECONOMY
Rs. 50/-
Rs. 300/-
Rs. 350/-
Nil
Rs. 25/- per request +Rs.3/-per certificate
Min Rs.15 or .04%
Min RS.10 or.04%
Nil
Min Rs.25/or .04%
35/-
35/-
35/-
Nil
CLASSIC(Only with Auto Pay In POA)
Rs. 50/-
Rs. 1049/-
Rs. 1099/-
Nil
Rs.25/- per request +Rs. 3/- per certificate
Min Rs.15 or .04%
NIL
Nil
Min Rs.25/or .04%
35/-
35/-
35/-
PREMIUM
Rs. 50/-
NIL
Rs. 3700/- (Rs.3300/-,be refunded on closing of the account)
Nil
Rs.25/- per request +Rs. 3/- per certificate
Min Rs.15 or .04%
Rs. 15/-
NIL
Min Rs.25/- or .04%
35/-
35/-
35/-
Nll
Mandatory for DP
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LETTER FROM THE BANK (Certifying Account Number, Photo, Signature and the period from which the account is in operations)
"This is to certify that Savings / Current Account No.
belongs to
and the account had been in operation since
We confirm that the signature of the client agree with the specimen signature held in our records. We alsoconfirm the address of the client appended below is as per our records.
Office / Gala / Flat
Name of thePremises
Name of theRoad / Street
Town/Village City
Pin Code
Country
Banker's Verification
Please affix your Latest Photograph
here.
DO NOT
STAPLE
State
MD YY Y Y/ /MD
MD YY Y Y/ /MD
Client Signature
F30 XX
Th s spa e is kept blank
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