TMI BlogFORMSX X X X Extracts X X X X X X X X Extracts X X X X ..... .1 Name of the Applicant: 1.2 Address - Principal place of business/registered office: Pin code: _____________________ Telephone No: ______________ Telex No: _____________________ Fax No: ___________________ 1.3 Address for Correspondence: Pin code: ______________________ Telephone No: _____________ Telex No: ______________________ Fax No: __________________ Address of Branch Offices (in India Abroad): 1.4 Application to Board for any other intermediary activity: ___________ 2.0 ORGANISATION STRUCTURE (Organisation Chart separately showing functional responsibilities of portfolio management activities to be enclosed) 2.1 Objectives: In brief. (Memorandum and Articles of Association to be enclosed). 2.2 Date and Place of Incorporation/Establishment: Day Month Year Place 2.3 Status of the Applicant: (e.g. limited company-Private/Public, unlimited company, 2 [***] others. If listed, names of the stock exchanges and latest share price: to be given.) 2.4 Organisation Chart: General Organisation specific Activity. (i.e. Applied for registration) also state the fu ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... (c) Investments (Details should be given separately) (d) Others Major Sources of Income: (Rs. in lakhs) Year prior to the preceding year of current year Preceding year Current year * Fees charged as % of issue 5.4 Net Profit (Rs. in lakhs) Year prior to the preceding year of current year Preceding year Current year 5.5 Name and Address of the Principal Bankers 5.6 Name and Address of the Auditors 6.0 OTHER INFORMATION 6.1 Details of all settled and pending disputes: Nature of dispute Name of the party Pending/settle 6.2 Indictment of involvement in any economic offences in the last three years. 6.3 Indicate dealing/ trading with any Intermediary who has defaulted with or suspended by any stock exchange authorities or any other authorities. 6.4 Any other inf ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... 5. Average return to the client 6. 9 [* * *] (b) Only Portfolio Advisory Services (Indicate for both Resident/Non-resident clients) (c) List of Clients (Corporate clients only) Name Amount of portfolio Fund managed Services Rendered DECLARATION 10 [This declaration must be signed by two directors,] ___________________________________________________________ I/We hereby, apply for Registration. I/We warrant that I/We have truthfully and fully answered the questions above and provided all the information which might reasonably be considered relevant for the purposes of my/our registration. For and on behalf of __________________________________________________________ (Name of Applicant) _____________________________ __________________________ Director/ 11 [* * *] Director/ 12 [* * *] ____________________________ __________________________ Name in B ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... Signature of the Principal Officer Place: Name and address of the Principal Officer] ************ 1 Substituted for the words Application for grant of certificate/renewal of certificate by the Securities and Exchange Board of India (Change In Conditions Of Registration Of Certain Intermediaries) (Amendment) Regulations,2016 w.e.f. 08-12-2016. 2 Words and commas partnership, proprietary, omitted by SEBI (Portfolio Managers) (Amendment) Regulations, 2008, w.e.f. 11-08-2008. 3 Words and marks /partners/proprietor omitted by SEBI (Portfolio Managers) (Amendment) Regulations, 2008, w.e.f. 11-08-2008. 4 Notes omitted by SEBI (Portfolio Managers) (Amendment) Regulations, 2008, w.e.f. 11-08-2008. Prior to their omission, notes read as under: 1. In case of partnership or proprietary concerns, please indicate capital minus drawings. 2. In case of partnership or proprietary concerns, please indicate the financial position, means and 5 Omitted by SEBI (Portfolio Managers) (Amendment) Regulations, 2008, w.e.f. 11-08- ..... X X X X Extracts X X X X X X X X Extracts X X X X
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