TMI BlogForm for Informant’s Voluntary Information Disclosure to be submitted to the BoardX X X X Extracts X X X X X X X X Extracts X X X X ..... is non-mandatorily, remaining fields are mandatory I. PERSONAL INFORMATION OF THE INFORMANT A.INDIVIDUAL 1: Last Name: First Name: Title: Address: City / State: PIN: Telephone (with State Code): Mobile: E-Mail address: Employment Details*: Permanent Account Number, if available: II. LEGAL REPRESENTATIVE (where applicable) Last Name: First Name: Title: Firm Name (i ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... stion (7), then please provide, Date of submission of original information: dd/mm/yy 4 [ 9. Please describe in detail how the information submitted by you constitutes a violation of insider trading laws. The details must include specific information with respect to: (i) details of the securities in which insider trading is alleged; (ii) the unpublished price sensitive information based on which insider trading is alleged; (iii) date on which the unpublished price sensitive information was made public; (iv) details of circumstances/evidence leading to possession of unpublished price sensitive information by the alleged violator(s); (v) details of insiders/suspects and their trades ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... I/we accept that the reward would be an ex-gratia payment which, subject to the Securities and Exchange Board of India (Prohibition of Insider Trading) Regulations, 2015, shall be granted at the absolute discretion of the competent authority. The decision of the authority shall be acceptable to me/us and I/we shall not challenge it in any litigation, appeal, adjudication, etc. In the event of my/our death before the reward us paid to me/us, it may be paid to . (Details of nominee) I/we declare that the information contained herein is true, correct and complete to the best of my/our knowledge and belief and not obtained from the categories of persons indicated in sub-regulation (2) and su ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... r where the Securities and Exchange Board of India requires the said information for the purpose of verification for declaring any gratuitous reward to the Informant or where the Securities and Exchange Board of India determines that it is necessary to seek such information to accomplish the purpose of the Securities and Exchange Board of India Act including for the protection of investors, sharing with foreign securities regulators and foreign and Indian law enforcement agencies, etc.; (c) I am and shall continue to be legally obligated to provide the original Voluntary Information Disclosure Form without demur within seven (7) calendar days of receiving such request from the Securities and Exchange Board of India. Signature: ..... X X X X Extracts X X X X X X X X Extracts X X X X
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