Bombay Stock Exchange Limited

APPLICATION FOR TWS ID REGISTRATION/ DE-REGISTRATION ON BSE

NETWORKS
To be filled in by the Market Participant and submitted to DOT(Network), 2nd Floor, P J
Towers, Dalal Street, Fort, Mumbai 4001.
Tick One (√ )
REGISTRATION DE-REGISTRATION
TWS ID Nos. TWS ID Nos.

1. Market participant details:

Clearing No.
SEBI Registration No.
Participant Firm Name
Email ID of main contact

*Sharing with Clearing No.(if Sh. Member

applicable) Name

#Network Media Code (Tick one) CL LL L2 MW MT VB Other

Site Code/ Circuit No.

2. TWS location address.
Building
Lane
Town
State
Pin code
Phone No.1
Phone No.2
Fax No.
Name of contact person at site
Mobile No. of contact person. 0 0 9 1 -
3. Register Office Address of Market Participant:
Building
Lane
Town & State
Pin code
Phone Nos.
Fax No.
Name of Director / Compliance officer
Mobile nos. Director / Compliance office 0 0 9 1 -
E-mail address
Declaration: We hereby undertake to abide by the terms and conditions laid down and circulated
by BSE Ltd. / SEBI from time to time. We hereby declare that the information furnished above is
true and correct to the best of our knowledge and belief. We shall be responsible for any
information found incorrect / misleading at a later date and decision of BSE Ltd. in this regard shall
be final and binding on us

Rubber stamp & Sign of Market Participant Date:

*NOC of the Market Participant who owns the network connectivity is required for sharing
resources.
# Network Media Code ► CL: Campus LAN at BSE, LL: Direct leased line 256Kbps, L2: Direct
leased line 2Mbps, MW: Wireless MPLS 256Kbps, VB: VSAT, MT: Wired MPLS 256Kbps, Others:
Existing 64Kbps lines, 128Kbps lines, Regional Hub lines etc.