TMI BlogApplication for grant of certificate of registrationX X X X Extracts X X X X X X X X Extracts X X X X ..... ts. 4. Answers shall be typewritten. 5. Information that is required to be provided in more detail may be given on separate sheets which should be attached to the application form. 6. All signatures shall be original. PART: I GENERAL INFORMATION 1.0 PARTICULARS OF THE APPLICANT 1.1 Name of the Applicant (Name of Manager of Alternative Investment Fund in case applicant is offering Co-investment services only): 1.2 PAN No. (Attach Copy of PAN Card) 1.3 Address of Registered office: (Attach proof of address) Pin Code:_____________ Mobile No: _______________Telephone No:____________________ Fax No:__________________ Email:_____________________ 1.4 Address for Correspondence: Pin Code:__________________ Mobile No: __________________Telephone No:_________________ Fax No: ___________________Email: _______________________ 1.5 Address - Principal place of business: (Where PMS activity shall be carried out) Pin Code:______________________ Mobile No: _______________________ Telephone No: ______________________ Fax No: __________________Email ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... Percentage of Shareholding Following documents to be provided: 1. Declaration that the personnel mentioned above is currently employed with the organization. 2. Undertaking by the personnel concerned that the details provided regarding them are true to the best of their knowledge and belief. 3. Supporting documents for work experience 2.7 Particulars of Promoters: [Type (Individual/ Corporate); Name; PAN (Copy of PAN Card); Address; Telephone No.; Mobile; Email] 2.8 Particulars of Compliance Officer [Name; PAN (Copy of PAN Card); Qualification, Date of Appointment; Address;] Experience: Company Name Designation Area of Work Nature of Work Experience (In yrs) (Separate sheet may be attached for information on work experience) 2.9 Particulars of Principal Officer [Name; PAN (Copy of PAN Card); Qualification, Date of Appointmen ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... Nature / Quantum of financial dealing Nature of interest of promoter /director Nature of interest of applicant company/ entity Ownership details: Name of the Shareholder No. of Shares Percentage of Shareholding Details of Registration with SEBI or any other Govt. Regulatory Body: Name of Regulator Registration No. Registration Start Date Registration End Date Registration Status Details of Action Taken in past (if any) 2.13 List of major shareholders/ partners of the Applicant (holding 5% or more voting rights): [Name; Type; Address; Telephone No.; Mobile; Em ..... 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 Details of investments, Loans and Advances made to Associate Companies/ Firms where Promoters/Directors have an interest 5.4 Major Sources of Income: (Rs. in Crore) Year prior to the preceding year of current year Preceding year Current Year 5.5 Net Profit (Rs. in Crore) Year prior to the preceding year of current year Preceding year Current Year 5.6 Particulars of Principal Banks: Name, Contact Person; Address; Telephone No.; Mobile; Email 5.7 Particulars of Auditors: Name; Type (Internal/ External); Contact Person; Address; Tele ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... ument to be provided 9.3. Details of Custodian: (Name, Address, SEBI Registration No., Date of Appointment) (Not applicable in case of applicant offering Co-investment services only) 9.4. Details of Registration with other Regulatory bodies. 10.0 DECLARATIONS 10.1. Declaration of compliance with Regulation 7(2) signed by at least Two Directors or designated partners (compliance with Regulation 7(2)(e) shall not be applicable in case of applicant offering Co-investment services only) 10.2. Declaration for Fit and Proper Person as specified in the Securities and Exchange Board of India (Intermediaries) Regulations, 2008 10.3. Declaration of Compliance with clause 12 (b) of Schedule III of these Regulations. 10.4. Declaration of Compliance with SEBI circular on fees and charges. 10.5. Declaration of type and frequency of reports sent/ proposed to be sent to clients. 10.6. Declaration of time taken for transfer of securities into client accounts. 10.7. Declaration of submission of periodic reports and Disclosure Document to SEBI. 10.8. Declaration of compliance with clause (e) of sub-regula ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... FORM C Securities and Exchange Board of India (Portfolio Managers) Regulations, 2020 [Regulation 22] ____________________________________________________________ (Name of the Portfolio Manager) ____________________________________________________________ (Address of the Portfolio Manager (along with phone numbers, fax, email etc.) We confirm that: (i) the Disclosure Document forwarded to the Board is in accordance with the SEBI (Portfolio Managers) Regulations, 2020 and the guidelines and directives issued by the Board from time to time; (ii) the disclosures made in the document are true, fair and adequate to enable the investors to make a well informed decision regarding entrusting the management of the portfolio to us / investment through the Portfolio Manager. (iii) the Disclosure Document has been duly certified by an independent chartered accountant (Indicate name, address, phone number and registration number of the chartered accountant) on (date). (Enclose a copy of the chartered accountant s certificate to the effect that the disclosures made in the document are true, fair and adequate to enable the investors to make a well informe ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... ls of such Branch Offices, including address, name of contact person, mobile number of contact person, email of contact person etc: 2.0 ORGANISATION STRUCTURE 2.1 Objectives: In brief. (Memorandum and Articles of Association/ Partnership Deed to be enclosed). (Copy of Board Resolution to be enclosed) 2.2 Date and Place of Incorporation: Day Month Year Place ROC Registration No. 2.3 Status of the Applicant: (e.g. Limited Company-Private/Public, LLP etc. If listed, names of the recognized stock exchanges to be given.) 2.4 Organization Chart: [separately showing functional responsibilities (names and designations) of portfolio management activities to be enclosed] 2.5 Particulars of all Directors/ Partners: [Name; Address; Qualification; Date of Appointment; DIN; PAN (Copy of PAN Card); Telephone No.; Mobile; Email] Experience: Entity Name Designation Area of Work Nature of Work Experience (In yrs) (Separate sheet may be attached for information on work experie ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... Following documents to be provided: 1. Bio-Data detailing the relevant experience as per Reg 7(2)(d) of SEBI Portfolio Managers Regulations, 2020. 2. Copy of Certifications. 3. Certificate stating that the Principal Officer has been appointed and is compliant with the requirements and is not otherwise disqualified under the Regulations. 2.10 Other SEBI Registration Details Registered : Registration No. Role Company Name Stock Exchange Registration Start Registration End Registration Status Applied : Application No. Role Company Name Stock Exchange Application Date Application Status 2.11 Number of employees (Total number of employees and number of employees for Portfolio Management services) 2.12 Name and activities of associate companies/ ent ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... Year prior to the preceding year of current year Preceding year Current year (a) Paid-up capital (b) Free reserves (excluding revaluation reserves) (c) Total (a) + (b) 5.2 Net worth of Applicant (Net worth certificate not older than 3 months from the date of application to be enclosed) 5.3 Deployment of Resources (Rs. in Crore) Year prior to the preceding year of current year Preceding year Current year (a) Fixed Assets (b) Plant and Machinery and office equipment (c) Investments (Details should be given separately) (d) Others ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... ther any of them were suspended/had defaulted with any Stock Exchange authority. 7.6 Describe Accounting system followed/to be followed for Portfolio Management Services. 7.7 Indicate various research and database facilities provided. 7.8 Details of activities proposed to be outsourced. 8.0 EXPERIENCE 8.1 Experience in financial services rendered: Details of Activity Area Period 9.0 ADDITIONAL INFORMATION 9.1. Copy of Draft Agreement with Client to be provided 9.2 Copy of Draft Disclosure Document to be provided 9.3. Details of Custodian: (Name, Address, SEBI Registration No., Date of Appointment) 9.4. Details of Registration with other Regulatory bodies. (10) DECLARATIONS 10.1 Declaration of compliance with Regulation 7 (2) signed by at least Two Directors or designated partners 10.2 Declaration for Fit and Proper Person as specified in SEBI (Intermediaries) Regulations, 2008 10.3 Declaration of Compliance with clause 12 (b) of Schedule III of these Regulations. 10.4 Declaration ..... X X X X Extracts X X X X X X X X Extracts X X X X
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