TMI BlogFORMSX X X X Extracts X X X X X X X X Extracts X X X X ..... tions: 1. Applicants must submit a completed application form together with supporting documents to the Securities and Exchange Board of India. 2. All columns of the application should be filled in. In case a column is not relevant then Not applicable should be specified. 3. Information which needs to be supplied in more details may be written on separate sheets which should be attached to the application form. 4. Original copy of form duly signed should be submitted for registration. PART I GENERAL INFORMATION 1. Applicant s details : 1.1 Name of the Applicant : ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... ment of the organization of the applicant Day Month Year Place 2.3 Status of the applicant (specify whether proprietary, partnership, association of persons, body of individuals, limited company - public/private, others. If listed, name the stock exchange and latest share price : high and low) : : 2.4 Organisation Chart stating the functional responsibility at various levels : 2.5 Particul ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... 5. Financial information : 5.1 Capital structure (Rs. in lakh) : Current year Last year Previous year Second year Third year (a) Paid-up capital (b) Free reserves (excluding revaluation reserves) ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... (Rs. in lakh) : Current year Last year Previous year Second year Third year 5.4 Please enclose three years of audited annual accounts and where unaudited reports are submitted, give reasons : 5.5 Name and address of the principal bankers 5.6 Name and address of the auditors (internal, external and tax auditor, if any, as applicable) : 6. ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... ature of Name Pending/ development/disputes regarding underwriting of the settled dispute party 8.4 Indicate underwriting defaulted with any company and reasons for the same Declaration THIS DECLARATION MUST BE SIGNED BY THE PRINCIPAL OFFICER/S: I/We hereby apply for grant of certificate of registration by the Board. I/We warrant that I/we will carry out my/our duties in accordance with the Act, Rules and Regulations. 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 grant of certificate ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... underwriter subject to the conditions in the rules and in accordance with the regulations. II. Registration Code for the underwriter is................... 6 [III. This certificate of registration shall be valid unless it is suspended or cancelled by the Board.] Place : Date : By Order For and on behalf of the Securities and Exchange Board of India Authorised signatory ********** 1 Substituted for Regulation 3A/Regulation 8A 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. Prior to this the words Regulation 3A/Regulation 8A were substituted for the words Regulation 3 by the SEBI (Underwr ..... X X X X Extracts X X X X X X X X Extracts X X X X
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