demat account opening form individual (only...

DEMAT ACCOUNT OPENING FORM

INDIVIDUAL (ONLY DEMAT)

PROFITMART SECURITIES PVT. LTD.(formerly known as M3 Multiple Securities Brokers Pvt. Ltd)

Branch Name

Branch Code

AP Name:

AP Code:

Version

Form No

Client Code

Client Name

1.0 October 2016

JURISDICTION:

DISCLOSURE IN TERMS OF SEBI CIRCULAR NO.SEBI/MRD/SE/CIR-42/2003 DATED NOVEMBER 19, 2003

All disputes arising from this contract / sale / agreement would be subject to the exclusive jurisdiction of courts in Mumbai, India.

caters to Institutional, Corporate, High networth and other retail clients through membership ofvarious exchanges.PROFITMART SECURITIES PVT. LTD.

PROFITMART SECURITIES PVT. LTD.PROFITMART SECURITIES PVT. LTD.

besides doing client based business also does its own investment and/or trading.

“Proprietary Trading Disclosure noted”

Client Name :

Client Code :

Signature of Client :

Director/Authorised Signatory

(1/13)

1

INDEX

S. No. Document SIGNIFICANCE PAGE(s)

1 Account Opening Form 2-4KYC form - Document captures the basic information about theconstituent and an instruction/check list for filling KYC form.

2 Rights and Obligations BO Providedto the client

3 DIS Issue Option form for issue of Delivery Instruction Slip

MANDATORY DOCUMENTS AS PRESCRIBED BY SEBI & EXCHANGE

5

4 Declaration Declaration related to Mobile/Email registration. 7

8 Power of Attorney Power of Attorney provided to broker to facilitate payin ofsecurities and other authorizations 10 -12

5 Authorization 7Authorization to debit Trading account for Demat account charges

Rights and Obligations BO

7 Fatca FATCA/CRS DECLARATION 9

6 Tarif SheetDocument detailing the rate/amount of brokerage and othercharges levied on the client for trading on the stock exchange(s)and charges related to demat account

8

1. FULL NAME (As appearing in supporting identification document):

3. a. Gender Male Female b. Marital Status Single Married

A. Identity Details (Please see guidelines)

6. Proof of Identity submitted for PAN exempt cases Please Tick 3 (Please see guideline ‘D’ overleaf)

5. a. Pan No.: (Please enclose a duly attested copy )

b. Status (please Tick ): Resident Individual Non Resident Foreign National3 (Passport CopyMandatory for NRIs & Foreign Nationals)

b. Aadhaar Number (if any)

UID (Aadhaar) Passport Voter ID Driving Licence Others

Name

4. a. Nationality Indian Other ___________c. Date of Birth D D M M Y Y Y Y

2. Father’s/Spouse NameMother’s Name

B. Address Details1 Address for Residence/Correspondence.

Photograph

Please affixthe recent passportsize photograph and

sign across it

sign across

(2/13)

(Please see guidelines)

City/Town/Village _____________________ PIN Code State:______________Country:_____________

Tel (Off): Tel (Res):Mobile: Fax:Email Address:

Proof Of Address To Be Provided By Applicant. Please Submit Any One Of The Following Valid Documents & Tick Against The Document AttachedPassport Ration Cars Registered Lease/Sale Agreement of Residence Driving Licence Voter Identity Card*Latest Bank A/c Statement/Passbook Latest Telephone Bill Latest Electricity Bill Latest Gas BillOTHERS

(only Landline)

(Please Specify)*Not more than 3 months old. Validity/Expiry date of proof of address submitted (dd/mm/yyyy)

2. Permanent Address of Resident Applicant if Different From Above B1 OR Overseas Address (Mandatory) For Non Resident Applicant:

Know Your Client (KYC)Application Form (For Individuals Only)Please fill/type the form in English and BLOCK letters.Once completed, please mail the completed form along with the necessary proofs to our corporate office in Mumbai.

Application No.:_____________________

(Please see guideline ‘D’)

2

PROFITMART SECURITIES PVT. LTD.

Seal / Stamp intermediaryName & Signature of the Authorized Signatory

Proof Of Address To Be Provided By Applicant. Please Submit Any One Of The Following Valid Documents & Tick Against The Document AttachedPassport Ration Cars Registered Lease/Sale Agreement of Residence Driving Licence Voter Identity Card*Latest Bank A/c Statement/Passbook Latest Telephone Bill Latest Electricity Bill Latest Gas BillOTHERS

(only Landline)

(Please Specify)*Not more than 3 months old. Validity/Expiry date of proof of address submitted (dd/mm/yyyy)

Any Other Information:

(3/13)

City/Town/Village _____________________ PIN Code State:______________Country:_____________

PROFITMART Securities Pvt. Ltd.328, 3RD Floor, Champak Lal Industrial Estate, Near MTNL Office,

Near Sion Circle, Sion, Mumbai – 400 022.• Phone: +91-22-6792 0000 • Fax: +91-22-6792 0099. • URL: www.profitmart.in • Email: [email protected]

Correspondence Office:

ADDITIONAL KYC FORM FOR OPENING A DEMAT ACCOUNT

APPLICATION NUMBER: DATEDP INTERNAL REFERENCE NUMBER:DP ID BO ID

(DD/MM/YYYY)

1 2 0 8 3 6 0 0

STATUS SUB - STATUS

INDIVIDUAL INDIVIDUAL RESIDENT INDIVIDUAL DIRECTOR

INDIVIDUAL DIRECTOR’S RELATIVE INDIVIDUAL HUF / AOP

INDIVIDUAL PROMOTER MINOR

INDIVIDUAL MARGIN TRADING A/C (MANTRA) OTHERS (SPECIFY)____________________

NRI NRI REPATRIABLE NRI NON - REPATRIABLE

NRI REPATRIABLE PROMOTER NRI NON - REPATRIABLE PROMOTER

NRI DEPOSITORY RECEIPTS OTHERS (SPECIFY)_____________________

FOREIGN FOREIGN NATIONAL OTHERS (SPECIFY)_____________________

NATIONAL FOREIGN NATIONAL DEPOSITORY RECEIPTS

I/We Request You To Open A Demat Account In my/ our Name as per following details:SOLE/FIRST HOLDER’S NAME

*In case of Firms, Association of Persons (AOP), Partnership Firm, Unregistered Trust, etc. although the account is opened in the name of thenatural persons, the name of the Firm, Association of Persons (AOP), Partnership Firm, Unregistered Trust, etc., should be mentioned above.

TYPE OF ACCOUNT (PLEASE TICK WHICHEVER IS APPLICABLE)

HOLDER DETAILS

TO BE FILLED BY THE BY DEPOSITORY PARTICIPANT

DETAILS OF GUARDIAN (IN CASE THE ACCOUNT HOLDER IS MINOR)

GUARDIAN’S NAME:

RELATIONSHIP WITH THE APPLICANT: PAN NO. (Compulsory)

I / We instruct the DP to receive each and every credit in my/our account. (If not marked, the default option would be ‘Yes’)Yes No

I / We would like to instruct the DP to accept all the pledge instructions in my/our account without any other furtherinstruction from my/our end (If not marked, the default option would be ‘No’) Yes No

Account Statement Requirement AS PER SEBI REGULATION DAILY WEEKLY FORTNIGHTLY MONTHLY

I / We request you to send Electronic Transaction-cum-Holding Statement at the email ID

Yes No

CDSL

3

Second Holder’s Name

PAN

Third Holder’s NamePAN

Sole / First Holder’s Name

PAN

UID

UID

UID

SMS ALERT FACILITY. Annexure - 2.4Refer to Terms & Conditions given as

TRANSACTIONS USING SECURED TEXTING FACILITY (TRUST). Annexure - 2.6Refer to terms and Conditions

MOBILE NO. +91

[Mandatory, if you are giving Power of Attorney (POA)](If POA is not granted & you do not wish to avail of this facility, cancel this option).

I/We wish to avail the TRUST facility using the Mobile number registered for SMS Alert Facility. I have read and understoodthe Terms and Conditions prescribed by CDSL for the same.

I/We wish to register the following clearing member Ids under my / our below mentioned BO ID registered for TRUST

Stock Exchange Name / ID Clearing Member Name Clearing Member ID (Optional)

YES NO

I / We would like to receive the Annual Report (Tick the applicable box. If not marked, the default option would be in Physical)

I / We wish to receive dividend / interest directly in to my bank account as given below through ECS (If not marked, the defaultoption would be ‘Yes’) [ECS is mandatory for locations notifed by SEBI from time to time) YES

PHYSICAL

NO

ELECTRONIC BOTH PHYSICAL AND ELECTRONIC

I / We would like to share the email ID with the RTA YES NO

Bank Details [Dividend Bank Details]

1. Photocopy of the cancelled cheque having the name of the account holder where the cheque book is issued, (or)2. Photocopy of the Bank Statement having name and address of the BO3. Photocopy of the Passbook having name and address of the BO, (or)4. Letter from the Bank.

_ In case of options 2, 3 and 4 above, MICR code of the branch should be present / mentioned on the document.

To register for Easi please visit our website www.cdslindia.comEasi allows a BO to view his ISIN balances, transactions and value of the portfolio online.

I / We wish to avail the following facility:

Basic Services Demat A/C facility:

Rajiv Gandhi Equity Savings Scheme (RGESS)

EASI

YES (Please sign the BSDA declaration) NO

OTHER DETAILSGROSS ANNUAL INCOME DETAILS (Income Range per annum)

DATE (DD/MM/YYYY)

UP TO RS. 1 LAC RS. 1 LAC - RS. 5 LAC RS. 5 LAC - RS. 10 LACRS. 10 LAC - RS. 25 LAC MORE THAN RS. 25 LAC

OCCUPATION:

NET WORTH AS ON DATE (NOT OLDER THAN 1 YEAR)VALUE IN Rs.

PRIVATE / PUBLIC SECTORRETIRED HOUSEWIFE STUDENT OTHER (SPECIFY)

GOVT. SERVICE BUSINESS PROFESSIONAL AGRICULTURE

ANY OTHER INFORMATION:

AFFILIATIONS: POLITICALLY EXPOSED PERSON (PEP) RELATED TO POLITICALLY EXPOSED PERSON (RPEP)

4

Bank Code (9 digit MICR code)IFS Code (11 character)Account number

Account type Saving Current Others (specify)

Bank Name

Branch NameBank Branch Address

CityCountry PIN code

State

5

DP ID BO ID

I/We require you to issue Delivery Instruction Slip (DIS) booklet to me/us immediately on opening my/our CDSL account though I/We haveissued a Power of Attorney (POA) in favor of Profitmart Securities Pvt. Ltd. for executing delivery instructions for settling stock exchangetrades (Settlement related transactions) efected through such Clearing Member.

OR

I/We do not require Delivery Instruction Slip (DIS) for time being. Since I/We have issued a POA in favor of Profitmart Securities Pvt. Ltd. forexecuting delivery instructions for settling stock exchange trades (Settlement related transactions) efected through such Clearing Member.However, the Delivery Instruction Slip (DIS) booklet should be issued to me/us immediately on my/our request at any later date.

I/We hereby select:

Dear Sir,I/We hereby state that: (select one of the option given below)

OPTION 2

1 2 0 8 3 6 0 0

OPTION FORM FOR ISSUE OF DIS BOOKLET (OPTIONAL)

TO: PROFITMART SECURITIES PVT. LTD.328, 3RD Floor,Champak Lal Industrial Estate,Near MTNL Office, Near Sion Circle,Sion, Mumbai – 400 022.

DATE (DD/MM/YYYY)

First/Sole Holder Signature Second Holder Signature Third Holder Signature

OPTION 1

OPTION 1

OPTION 2

(4/13)

DP ID BO ID1 2 0 8 3 6 0 0

NOMINATION REGISTRATION NO.:

FULL NAME OF THE NOMINEE:

FULL NAME OF GUARDIAN OF NOMINEE:

ADDRESS:

ADDRESS:

DATE (DD/MM/YYYY)

I/We the sole holder/Joint holders/Guardian (in case of minor) hereby declare that:I/We do not wish to nominate any one for this demat account.

I/We nominate the following person who is entitled to receive security balances lying in my/our account, Particularswhereof are given below, in the event of my/our death.

CITY:

CITY:

TELEPHONE NUMBER:

TELEPHONE NO.:

FAX NUMBER:

FAX NO.:

STATE:

STATE:

COUNTRY:

COUNTRY:

PIN CODE

PIN CODE

PAN NO.

EMAIL ADDRESS:

EMAIL:

AGE:

DATE OF BIRTH (MANDATORY IF NOMINEE IS A MINOR):

RELATIONSHIP WITH BO (IF ANY):

RELATIONSHIP OF GUARDIAN WITH NOMINEE:

UID NO.

Name of the Witness

Details of the Witness

Address of the Witness

(Signatures should be preferably in black ink)

First Witness Second Witness

Name of the Second Holder

(Please Tear Here)

(Please Tear Here)

We hereby acknowledge the receipt of the Account Opening Application Form / Nominee Details / DIS:

Acknowledgement ReceiptApplication No.: Date:


PAN NO. (Compulsary)

NOMINATION DETAILS

Name of the Sole/First Holder

As the nominee is a minor as on date, to receive the securities in this account on behalf of the nominee in the event of the death of the Soleholder/all Joint holders, I/We appoint the following person to act as :Guardian

This nomination shall superseds any prior nomination made by me/us and also any testamentary document executed by me/us.Note : Two witnesses shall attest signature(s) / thumb impression(s)

Signature of the Witness

Name of the Third Holder

(TRADING & DEMAT)

I/We have received and read the Rights and Obligations document and terms & conditions and agree to abide by and be bound by the same and by the Bye Lawsas are in force from time to time. I/We declare that the particulars given by me/us above are true and to the best of my/our knowledge as on the date of makingthis application. I/We agree and undertake to intimate the DP any change(s) in the details/Particulars mentioned by me/us in this form. I/We further agree thatany false/misleading information given by me/us or suppression of any material information will render my account liable for termination and suitable action.

FOR PROFITMART SECURITIES PVT. LTD.

6

(5/13)

Declaration Please strike of whichever is not applicable

I hereby declare that the mobile no./email id mentioned in the Accountopening form/ request for change in mobile no./email id is my own

Yes / no

* [Only the mobile no./email of your spouse, dependent children and dependent parents can be registered in your demat account]

[In case the option ‘No’ has been selected above, the request letter appended below is required to be submitted]

REQUEST LETTER FOR REGISTRATION OF MOBILE NO./EMAIL OF PERSON BELONGING TO THE CLIENT’S FAMILYPlease note that the mobile no./Email Address /both mentioned in the Account opening form/ request for change in mobileno./Email belongs to Mr/Mrs./Ms. __________________________________ who is my __________________________(relationship with the client)

[*Refer to the instructions mentioned below]



7

I/We have opened/have a beneficiary account with your CDSL depository along with a trading account for investment and tradingpurposes. It would be difficult for me/us to keep issuing separate cheques against your depository bills.I/We, therefore authorize you to debit the charges payable towards operation of the above account. I/We are aware of the charges foroperating the said account. Any such sum debited to my trading account shall be binding on me/us.

Dear Sir,

Sub: Authorisation to debit trading account for the demat account charges

Thanking you,Yours truly,

Ref: DP ID: 1 2 0 8 3 6 0 0

VOLUNTARY

To,328, 3RD Floor, Champak Lal Industrial Estate,Near MTNL Office, Near Sion Circle,Sion, Mumbai – 400 022.


BO ID

First/Sole Holder Signature Second Joint Holder Signature Third Joint Holder Signature

(7/13)

(6/13)

(8/13)

Charges

NOTE: For all purposes the bill date shall be construed as the date of demand and the bills will be considered as the bill cum notice for payment andProfitmart Securities Pvt. Ltd. reserves the right to Freeze Depository account for debit transaction in case of non payment of charges after twodays from the bill date.Interest @ 18% p.a will be charged on the outstanding bill amount if not paid within the due date. The above tariff is subject to change. Changes ifany be intimated 30 days in advance. Annual Maintenance Charge (AMC) is non refundable. Service Tax, Education Cess and HigherEducation Cess applicable on all above charges except stamp charges

SCHEDULE A - TARIFF STRUCTURE (DP ID 12083600)

I/We agree to pay the charges as per following charge structure for our Demat account with Profitmart Securities Pvt. Ltd.

BO ID DATE (DD/MM/YYYY)

DP ID 1 2 0 8 3 6 0 0

PROFITMART SECURITIES PVT. LTD.328, 3RD Floor, Champak Lal Industrial Estate, Near MTNL Office, Near Sion Circle, Sion, Mumbai – 400 022.

Phone: +91-22-6792 0000 • Fax: +91-22-6792 0099.• URL: www.profitmart.in • Email: [email protected] • CIN No: U65990MH2011PTC217211

CHARGE HEAD

Pledge ChargesCreation / Closure andConfrmation of both

Pledge Charges forInvocation

DematerializationCharges

Cheque Bounce charges

RematerializationCharges

SLB Charges

Repurchase /Redemption Charges

Failed / RejectedTransactions

Demat Rejection

Statement Requests

E-Mail Statement

Transaction chargesMarket / Of Market /InterdepositoryTransactions

– Rs. 20/- per scrip

– 0.02% of the transaction charges subject to a minimum of Rs. 50/- plus NSDL / CDSLcharges at actual.

– 0.05% of the transaction charges subject to a minimum of Rs. 50/-

– Rs 10.00 per certifcate plus courier charges of Rs. 35/- per demat request for every 500 gms.

– Charges will be applied based on charges as determined by our bankers.

– Rs. 25/- per certifcate or 0.05% of the value whichever is higher.

– For Securities Borrowings: Rs. 25/- plus NSDL / CDSL charges at actuals.– For Securities Lending: Rs. 25/- plus NSDl / CDSL charges at actuals.

– Flat Rs. 25/- per transaction plus Depository charges at actuals.

– Rs. 50/- per transaction.

– Rs. 35/- per rejection for every 500 gms.

– Adhoc statement requests: - Rs. 25/-

– Periodic Bills and Transactions statements and other communications will be sent by emailonly. Terms and Conditions for the same to be mandatorily executed. Requests for physicalstatements will be charged as mentioned above.

CHARGES


ChargesAnnual Maintenance

8

POA Charges – Rs. 100/-

(9/13)

– Rs. 999 Life Time

9


(10/13)

POWER OF ATTORNEY

TO ALL TO WHOM THESE PRESENTS SHALL COME I/WEMr./M/s. (First holder)___________________________________

(Second holder)_______________________________________

(Third holder)________________________________________an individual/a sole proprietary concern/a partnership firm/a bodycorporate/trust, registered/incorporated, under the provisions ofthe Indian Partnership Act, 1932/the Companies Act 1956, or anyrelevant Act, having his/her/its residence/ registered office/place ofbusiness at

(hereinafter referred to as “Beneficial Owner”) wish to avail/haveavailed the broking/e-broking facilities and services offered(hereinafter referred to as "Services") by Profitmart Securities Pvt.Ltd (hereinafter referred to as “PSPL''), a Partnership Firmincorporated under the Indian Partnership Act of 1932, having itsregistered office at 328, Champak lal industrial Estate, near MTNLoffice, Sion ,Mumbai - 400022 and is a Member (Trading Member)of the National Stock Exchange of India Limited (NSE), respectively(hereinafter referred to as “the Exchange”). Whereas in the courseof availing the services and for meeting the settlement obligationthereof on the Exchanges, I/We do hereby nominate, constitute andappoint M/s. Profitmart Securities Pvt. Ltd (Member Broker),hereinafter referred to as “Profitmart Securities Pvt. Ltd.” actingthrough their Partners and/or duly authorised staff for the purpose,as my/ our true and lawful attorneys for my depository account withProfitmart Securities Pvt. Ltd Securities Pvt. Ltd. (DepositoryParticipant) DP ID 12083600, Client ID ____________________ toexecute and perform severally the following acts, deeds, mattersand things, provided the attorney complies with all applicableconditions of all or any of their services offered by them in theircapacity as stock Brokers.

(A) I/We, as the Client of (Profitmart Securities Pvt. Ltd. ) being atrading member of (National Stock Exchange of India Ltd.)desire to invest and/or trade in commodities, shares, bonds,debentures and other securities, whether listed or unlisted,including units of mutual funds, government securities,certificate of deposits, warrants, options, futures, derivatives,securitized debt instruments, fixed return investment, equitylinked instruments, Exchange Traded Funds (ETF) or othermarketable Securities of a like nature in or of any incorporated

__________________________________________

___________________________________________________

WHEREAS:

company, deposits or other money market instruments, unitsissued by Unit Trust of India, cumulative convertiblepreference shares issued by any incorporated company andSecurities issued by the Central Government or a StateGovernment for the purpose of raising public loan (herein afterreferred to as the “Securities”) offered by the (ProfitmartSecurities Pvt. Ltd. ) as trading member of a Registered StockExchange. Accordingly as the Client, I/We have enteredinto/propose to enter into Member – Client Agreement (hereinafter referred to as the said “Member-Client Agreement” asamended and in force from time to time) with Member/(Profitmart Securities Pvt. Ltd. ) in this regard:

(C) Pursuant to the terms of the said Member-Client- Agreement,I/We have designated/are designating the said DematAccount for the purpose of the said Member- Client-Agreement;

(D) As consideration for the above mentioned facilities as well as aprerequisite for fulfilling all the various preconditions,requirements and obligations as the Client of (ProfitmartSecurities Pvt. Ltd.) as well as for facilitating (ProfitmartSecurities Pvt. Ltd.) to exercise its powers available in law andto facilitate proper execution and completion of all tradetransactions in Securities/commodities by (ProfitmartSecurities Pvt. Ltd.) in my/our behalf, I/We individual/jointaccount holder, am/are desirous of appointing (ProfitmartSecurities Pvt. Ltd.) as my/our attorney and confer upon(Profitmart Securities Pvt. Ltd.) the powers hereinafter stated.

1. To operate the Designated Demat Account, hold, pledge,debit all or any of the Securities / commodities from time totime held by me/us in the Designated Demat Account and togive such instructions as and when the said Attorney maydeem fit, to transfer all or any of the said Securities /commodities to any account(s) of (Profitmart Securities Pvt.Ltd.) or in accordance with the instructions of (ProfitmartSecurities Pvt. Ltd.) towards the fulfilling of all or any of my/ourdelivery obligations for and transactions completed on my/ourbehalf through the on-line or offline trading facilities of(Profitmart Securities Pvt. Ltd.). The (Profitmart SecuritiesPvt. Ltd.)'s beneficiary account details for the above purposeare mentioned more particularly in 'Schedule II' forming part ofthe present POA and I understand that any change to thesame shall be communicated to me/ us by way of a writtencommunication by (Profitmart Securities Pvt. Ltd.).

10


(11/13)

11

2. To sign, deliver, endorse, and/or acknowledge all instructions,forms, transfer deeds, depository forms and instruments,delivery instruction slips and other instruments and writingswhich are required or considered necessary or advisable forperforming all or any of the powers or authorities herebyconferred by me/us on the said Attorney.

3 To debit securities/commodities to the said Designated DematAccount and/or transfer securities/commodities from the saidDesignated Demat Account to any other account of(Profitmart Securities Pvt. Ltd.) (towards settlement as listedin Schedule II, to the extent of shares sold through (ProfitmartSecurities Pvt. Ltd.) for pay in obligation

4. To credit my/our Designated Demat Account(s) with anysecurities/commodities that are erroneously received or suchsecurities / commodities which (Profitmart Securities Pvt. Ltd.)is not entitled to receive

6. To do all such acts, deeds and things as may be necessary foror incidental to my / our, individual / joint account holders beingthe Client of (Profitmart Securities Pvt. Ltd. ) for the purposesas aforesaid.

7. To send consolidated summary of scrip-wise buy and sellpositions by way of SMS / email on a daily basis

8. AND I /We, individual / joint account holders do hereby formyself/ ourselves, agree to ratify and confirm all andwhatsoever my / our said Attorney shall do or purport to do orCause to be done by virtue of these presents.

9. AND I /We, individual / joint account holders do hereby formyself / ourselves agree and confirm that the aforesaidowners shall be exercised by the Attorney acting through anyof its officers or employees.

10. To issue instructions relating, executing delivery/receiptinstructions, pledge creation instructions, pledge closureinstructions, lending and borrowing instructions, to operatethe depository account by issue and receipt of instructions forthe above mentioned purpose and such other authorizationgiven by me/us severally on behalf of all of us, or all/any of usjointly, in any electronic form, in any format and at any timeeither through the portal of Profitmart Securities Pvt. Ltd orthrough the internet will be validly constituted attorney tointimate the same to the Depository Participant for thepurpose of debiting or crediting my account opened with theDepository Participant.

.12. I/We also undertake to pay such demat charges/fees andsuch other charges incurred by Profitmart Securities Pvt. Ltdunder this power of attorney and that I/We further authoriseProfitmart Securities Pvt. Ltd to debit my/our account withProfitmart Securities Pvt. Ltd with the said charges as andwhen the same becomes due for payment and I/we herebyundertake to pay the same immediately on demand made byProfitmart Securities Pvt. Ltd. All charges have beenmentioned in the Tariff sheet in the application form.

13. We specifically agree that in case of death, disability,insolvency, winding up or liquidation of any one or more of usor of the joint account holder/s, the surviving joint holders andheirs, nominees, executors, administrators, successors andlegal representatives of the account holder who has died,disabled, dissolved, been adjudged insolvent, wound up orliquidated shall forthwith inform the Attorney of the same inwriting. In such an event, the Power of Attorney and theinstructions contained herein shall be revoked forthwith andremaining joint holders along with heirs, nominees, executors,administrators, successors and legal representatives of suchjoint account holder/s shall forthwith execute a fresh power ofattorney and other relevant documents. Incase of change inconstitution of the Designated Demat Account, this POA shallterminate and new POA shall have to be executed by newaccount holders.

14. I/We hereby ratify and confirm and agree to ratify and confirmall that the said Attorney or any of its officers, employees, shalldo or cause to be done in or concerning the premises by virtueof these presents and I /We hereby agree that all such actsdone by my/our above mentioned Attorney shall be deemed tobe acts done by me/us and if necessary shall be ratified byme/us on the instructions of the said Attorney.

15. This POA has been given to (Profitmart Securities Pvt. Ltd.) toinvest and/or trade in the securities / commodities with orthrough the online and/or off-line trading facilities offered by(Profitmart Securities Pvt. Ltd.) as trading members of(National Stock Exchange of India Ltd) in terms of the saidMember-Client Agreement and for (Profitmart Securities Pvt.Ltd.) agreeing at my/our request to act as my/our Attorney andaccordingly this POA shall in all events be treated as valid,effective and operative till the said Member-Client Agreementis in force and/or till all the relevant Securities / commoditiesand/or all amounts together with principal, charges and


(12/13)

expenses and all other monies due and payable in respect ofthe Member-Client Agreement and/or the transactionscompleted by (Profitmart Securities Pvt. Ltd.) on my/ourbehalf have been duly received, paid in full and settledsatisfactorily by me/us as the Client and the cessation of thisauthority shall not affect or impair any act thereto done inexercise of these presents.

16. To comply and /or cause to be complied with all statutory andother requirements attached to or arising out of these presentsand for this purpose take such steps and actions necessary orproper, including signing of affidavits, indemnity, declarations,legal documents, deeds and writings required.

17. To do or omit to do all such acts and things as (ProfitmartSecurities Pvt. Ltd.) may in its discretion consider to benecessary or desirable in order to exercise its powershereunder or to comply with any laws, orders, rules,regulations or directions of any government or regulatory orother authorities.

18. My/Our Attorney (Profitmart Securities Pvt. Ltd.) shall not beliable for any loss that may result from failure/inability ofelectronic connectivity of rejection of my/our any instruction /application for any reason whatsoever.

19. Either party may revoke or cancel the said POA at any givenpoint of time.

IN WITNESS THEREOF I/WE, individual / joint account holders hereunto have set and subscribe my/our respective hand(s) hereto

at _______________________________________ on this ______________________day of_____________20_______

12

Witness 1 Witness 2

NAME:

ADDRESS:

SIGNATURE:

NAME:

ADDRESS:

SIGNATURE:


(13/13)

SCHEDULE – II

PARTICULARS CLIENT ID

12083600

12083600

CDSL POOL A/C

CDSL CLIENT MARGIN A/C

CDSL BENE A/C

DP ID

00000020

12083600 00000016

This pa

ge ha

s bee

n inte

ntion

ally l

eft bl

ank

Mebership No. : NSE - 14556

SEBI Regn. No. :SEBI Regn. No. : NSE CDS -Mebership No. : CDSL DP - 12083600SEBI Regn. No. : CDSL - IN-DP-295-2016

SEBI Regn. No. : NSE CASH -NSE F&O -

INZ000093633INZ000093633INZ000093633

PROFITMART SECURITIES PVT. LTD.(formerly known as M3 Multiple Securities Brokers Pvt. Ltd)

Corporate office

PROFITMART SECURITIES PVT. LTD.Name of stock broker/trading member /clearing member

SEBI Registration No.and date

For any grievance/dispute please contact at the above address or Email:[email protected] Phone No. : +91 - 022 - 6792 0000. In case not satisfied with the response, please contact the concerned exchange(s) at on NSETel. : +91 - 022 - 2659 8190 • Email ID : [email protected], CDSL Tel. : +91 - 022 - 22728642 • Email ID : [email protected]


DP Compliance officer Name:Phone No: & E-mail Id:

Director’s NamePhone No: & E-mail Id:

For NSE CASH & Dated : 21.10.2016INZ000093633INZ000093633INZ000093633IN-DP-295-2016

For NSE F&O & Dated : 21.10.2016For NSE CDS & Dated : 21.10.2016For CDSL DP & Dated : 17.10.2016

328, 3RD Floor, Champak Lal Industrial Estate, Near MTNL Office,Near Sion Circle, Sion, Mumbai – 400 022.• Phone: +91-22-6792 0000 • Fax: +91-22-6792 0099.• URL: www.profitmart.in • Email: [email protected]• CIN No: U65990MH2011PTC217211

022 - 6792 0000 • [email protected] Kothari

Niranjan Mahanjan022 - 6792 0000 • [email protected]

Clearing MemberNSE CurrencyIL&FS SECURITIES SERVICES LTD.INE231308334

NSE F&OAXIS BANK LTD.INF231133937