Single Registration Application

(On the letterhead of the member)

Date: _______________

To,
The Membership Compliance Dept.
National Stock Exchange/National Securities Clearing Corporation
Exchange Plaza
Bandra-Kurla Complex
Bandra (E)
Mumbai – 400 051.

Subject: Application for Single Registration

Dear Sir/Madam,

Further to Exchange Circular Ref No ____ dated _____we are desirous to obtain SEBI single registration
number. Currently we are registered in CM/FO/CD/Debt segment(s) and having registration no. <Mention
Old Registration no.>

We hereby apply for the single registration as per the documents required by you, and undertake to
conform to and to abide by the Memorandum & Articles of Association and the Rules, Bye-Laws,
Regulations, Business-Rules, Circular, Notifications and office orders, issued by the Exchange/Clearing
Corporation from time to time. We shall be liable for all contracts and transactions in the exchange
entered by us or by our authorized representatives and we shall comply with all requirements of the
Exchange relating to settlement thereof. We also confirm to abide by all decisions of the
Exchange/Clearing Corporation with respect to the operation of the Exchange/Clearing Corporation and
would perform accordingly in meeting my financial, regulatory and operational responsibility as decided
of the Exchange/Clearing Corporation from time to time.

Thanking You.

Yours sincerely,

Signature with Stamp

(To be signed by atleast two Designated Directors)

Place:
 FORM A

SECURITIES AND EXCHANGE BOARD OF INDIA

(Stock Brokers and Sub-Brokers) Regulations 1992
(Regulation 3)

APPLICATION FORM FOR REGISTRATION AS STOCK BROKER WITH SECURITIES AND

EXCHANGE BOARD OF INDIA

Table 1:

Sl. No. Particulars Details

1 Name of Member with Code No.

2 Trade name of Member

Name of the Stock Exchange/ segment of which the applicant

3
is the member

4 Date of admission to exchange/ segment

5 Address of Member

Fax Number(s), Phone Number(s) of office and residence and

6
email address

Form of Organization - Sole proprietorship, partnership,

7
corporate body, financial institution, others (please specify)

8 Net worth along with supporting document

9 PAN of the applicant

Table 2: Details of proprietor/ partners/ directors
Experience in derivatives
Educational trading or securities market, as
Sl. No. Names Age PAN Qualifications applicable

Table 3: Details of sales personnel or approved user who has passed any certification programme

Certificate No. (Please

Sl. provide the copy of
No. Name PAN no Date of test Percentage certificate)

Other details:

1. Please furnish a copy of the memorandum and articles of association or the partnership deed, as the
case may be.

2. If the applicant intends to clear and settle his trades through a clearing member, the applicant is
required to furnish the name and details of the clearing member along with a copy of MoU/ agreement/
contract with them for the same.

Undertaking:

4. Whether the applicant or its director or partners, any time convicted of any economic offence? If so,
furnish the details.

5. Whether the applicant or its directors or partners, declared insolvent or declared defaulter by any
exchange? If so, furnish details.

6. Whether the applicant or its directors or partners at any time subjected to any proceedings or penalty by
the Board under SEBI Act or any of the regulations framed under the SEBI Act? If so, furnish the details.

7. Whether any disciplinary action has been initiated/ taken or penalty has been imposed by SEBI/ stock
exchange(s)/ clearing corporation(s) or any other regulatory authority? If yes, furnish details. Also
provide the details of corrective steps taken thereon.
Declaration:

I declare that the information given in this form is true and in the event of any information furnished is
false, misleading or suppression of facts, my certificate of registration is liable to be cancelled by SEBI
without assigning any reasons whatsoever.

Dated ____________ Signature

______________________________________________________________________________

RECOMMENDATION OF THE STOCK EXCHANGE

This is to certify that ______________________________ is a member of this Stock Exchange and is

recommended for registration with the Securities and Exchange Board of India.

Signature:

Name:

Designation:
 FORM AD

SECURITIES AND EXCHANGE BOARD OF INDIA

(Stock Brokers and Sub-Brokers) Regulations 1992
(Regulation 10A)

APPLICATION FORM FOR REGISTRATION AS CLEARING MEMBER WITH SECURITIES

AND EXCHANGE BOARD OF INDIA
Table 1:
Sl. No. Particulars Details
1 Name of Member with Code No.

2 Trade name of Member

Name of the Clearing Corporation of which the applicant is the
3
member
4 Date of admission to Clearing Corporation

5 Address of Member

Fax Number(s), Phone Number(s) of office and residence and

6
email address

Form of Organization - Sole proprietorship, partnership,

7
corporate body, financial institution, others (please specify)

8 Net worth along with supporting document

9 PAN of the applicant

Table 2: Details of proprietor/ partners/ directors

Experience in derivatives
Educational trading or securities market, as
Sl. No. Names Age PAN Qualifications applicable

Other details:

1. Please furnish a copy of the memorandum and articles of association or the partnership deed, as the
case may be.
Undertakings:

3. Whether the applicant or its director or partners, any time convicted of any economic offence? If so,
furnish the details.

4. Whether the applicant or its directors or partners, declared insolvent or declared defaulter by any
exchange? If so, furnish details.

5. Whether the applicant or its directors or partners at any time subjected to any proceedings or penalty by
the Board under SEBI Act or any of the regulations framed under the SEBI Act? If so, furnish the details.

6. Whether any disciplinary action has been initiated/ taken or penalty has been imposed by SEBI/ stock
exchange(s)/ clearing corporation(s) or any other regulatory authority? If yes, furnish details. Also
provide the details of corrective steps taken thereon.

Declaration:

I declare that the information given in this form is true and in the event of any information furnished is
false, misleading or suppression of facts, my certificate of registration is liable to be cancelled by SEBI
without assigning any reasons whatsoever.

Dated ___________ Signature

______________________________________________________________________________

RECOMMENDATION OF THE CLEARING CORPORATION

This is to certify that ___________________________is a member of this Clearing Corporation and is

recommended for registration with the Securities and Exchange Board of India.

Signature:

Name:

Designation:
 Annexure: C-1 (If not Submitted to the Exchange)

NETWORTH CERTIFICATE

This is to certify that the Net worth of M/s. ______________________as on _____________as per the
statement of computation of even date annexed to this report is Rupees______________ only).

We further certify that:

 M/s._________________ is not engaged in any fund-based activities or business other than that of
securities. Existing fund based assets, if any have been divested from the books of account and have
not been included for the purpose of calculation of networth.

 the computation of networth based on my / our scrutiny of the books of accounts, records and
documents is true and correct to the best of my / our knowledge and as per information provided to
my / our satisfaction.

 the computation of networth is in accordance with NSE Circular No. 93 (Ref.No.: NSE/MEM/475)
dated March 4, 1998/the method of computation prescribed by SEBI as per Schedule VI of Securities
and Exchange Board of India (Stock Brokers and Sub-brokers) (Second Amendment) Regulations,
2013 (strike off whichever is not applicable).

Place:
For (Name of Accounting Firm)
Date:

Name of Partner/Proprietor
Chartered Accountant
Membership Number
 Annexure C- 1A

Computation of Networth of Clearing Members of Futures Segment as part of Membership

Requirements

The method of computation of Networth as prescribed by Dr. L.C. Gupta Committee on Derivatives for
clearing members is as follows

Capital + Frees Reserves

Less Non-allowable assets viz.,
(a) Fixed Assets
(b) Pledged Securities
(c) Member’s card
(d) Non-allowable securities (unlisted securities),
(e) Bad deliveries
(f) Doubtful Debts and Advances*
(g) Prepaid expenses, losses
(h) Intangible Assets
(i) 30% of Marketable securities

*Explanation:

Includes debts/advances overdue for more than three months or given to associates

For (Name of Accounting Firm)

Name of Partner/Proprietor
Chartered Accountant
Membership Number
 UNDERTAKING
(To be given on the letterhead of the applicant)

I/We, M/s______________, hereby undertake / declare / confirm that:

1. Indictment or involvement in any economic offences by the applicant or any of the Directors, or partners
2. If applicant or any of the Directors, or partners/shareholders declared insolvent / bankrupt or declared defaulter
by any Exchange/Clearing Corporation/Clearing House?
3. If applicant or any of the Directors, or partners subjected to any proceedings or penalty by SEBI?
4. Whether the applicant has necessary infrastructure like adequate office space, equipment’s and manpower to
effectively discharge his activities?
5. Whether the applicant has been subjected to disciplinary proceedings under the rules, and bye-laws of a stock
exchange, or enforcement action under securities laws, with respect to his business as a stock-broker involving
either himself or any of his partners, directors or employees?
6. Whether any Enquiry/investigation/disciplinary action/adjudication/prosecution/ any other action has been
initiated/taken or penalty has been imposed pending against the applicant, its associate/s or any of its
directors/shareholders/partners by SEBI/exchange(s)/clearing corporation(s)/clearing house or any other
regulatory authority?*
7. Whether the applicant has any financial liability which is due and payable in terms of the Act, the Securities
Contracts (Regulation) Act, 1956 or rules and regulations there under?
8. Whether order for winding up has been passed in the case of a broker being a company registered under the
Companies Act, 1956?*
9. Whether any of the partners or proprietor or karta or any whole-time directors in case a broker is a company
registered under the Companies Act, 1956 has been convicted by a court of competent jurisdiction for an
offence involving moral turpitude?
10. Whether the applicant or any of the partners or proprietor or karta or any whole-time directors in case of broker
is a company registered under the Companies Act, 1956 is/are fit and proper person/s as defined under SEBI
(Intermediaries) Regulation, 2008?
11. No dues are payable to SEBI by the applicant towards Stock Broker Fee or Sub Broker Fee
12. Whether the applicant satisfies the minimum net worth and deposit requirements as specified in Schedule VI,
for the segment for which membership or approval is sought?
13. Whether the incoming whole time / designated / qualified directors of the applicant are eligible to be appointed
as designated director under the Securities Contract (Regulation) Act, 1956?
14. Whether any adverse comments against the applicant or its directors / partners / proprietor or associates as per
the Vanishing Companies database of Ministry of Corporate Affairs (MCA)?
15. Whether any adverse comments against the applicant or its directors / partners / proprietor or associates as per
the RBI data on suit/non suit filed accounts?
16. As long as the applicant is engaged in stock broking/Clearing as a member of any recognized Stock
Exchange/Clearing Corporation/Clearing House in India, it will engage itself in only such business as a
member of recognized stock exchange/Clearing Corporation/Clearing House permitted to engage in under the
Securities and Contracts (Regulation) Rules 1957 and the Rules, Bye-Laws & Regulations of the Stock
Exchange/Clearing Corporation/Clearing House. The applicant is aware and acknowledge that if it engages in
other Business, the Stock Exchange will be entitled to take disciplinary action (including fine, suspension &/or
expulsion) against it.
17. The applicant agrees to abide by the Rules, Bye-Laws & Regulations as made or amended from time to time
and all notice/circulars issued by relevant authority from time to time
18. The applicant had not introduced through any member broker / sub-broker of the Exchange any fake / forged /
stolen shares in the Exchange / market
19. Whether there are any instances of violation or non-adherence to any securities market related regulations by
the applicant or its associate(s) / group companies in India or abroad and any action has been taken by a
regulatory agency in this regard.

(Stamp and signature of authorised signatories)

Date:
Place:

Note:
1. Undertaking to be filled with responses (Yes/No) and details to be provided wherever applicable, stamped &
signed by two designated directors or authorised signatory(ies) as per Board Resolution mentioning names and
designations.
2. In case the applicant has to furnish any details pertaining to the above mentioned confirmations, the same can be
provided as annexure (duly stamped and signed by the authorised signatories) to the undertaking .
 Declaration by Stock Broker
(To be certified by a practicing chartered accountant/ practicing company secretary)

1. I/We declare that the information given in this application form is true and in event of any
information furnished is false, misleading or suppression of facts; my certificate of registration is
liable to be cancelled by SEBI without assigning any reasons whatsoever.
2. I/We hereby declare that the director/designated directors of the company were/are not debarred
and/or no action were/are initiated against them by the Securities and Exchange Board of India
from associating from the capital market and the company undertakes that it will not appoint any
such person/s, in future as director(s)/designated director(s) of the company.
3. I/We hereby declare that neither our company not any of the directors of our company are in any
way associated/connected with any of the defaulting or defaulting trading members of any Stock
Exchange.
4. I/We further declare that no investigation/enquiry by any Stock Exchange is pending against our
company or any of the directors of our company.
5. I/We hereby undertake that as long as the company is engaged in stock broking as a member of
any recognized Stock Exchange in India, it will engage itself in only such business as a member
of a recognized Stock Exchange is permitted to engage in under the securities and contracts
(Regulation) Rules, 1957, and the Rules, Bye-laws & regulations of the Stock Exchange
6. I/We are aware and acknowledge that if we engage in any other business the Exchange will be
entitled to take disciplinary action (including fine, suspension &/or expulsion) against us.
.

Stamp and Signature of two Directors/Proprietor/Partners

Membership No.

Place :
Date :
 Annexure: C-3 (If Applicable)

DETAILS OF DIRECTORS/PARTNERS AS ON _______________

Sr Name$ Fathers Designation Date of Education PAN Director Residential Designated Share holding * Directorships/ /
No Name @ Birth Identification Address & directors controlling
Number Telephone (Yes/No) shareholding
(DIN) Nos. # in other cos.
No. Amt. % of
total
1
2
3
4
5
NOTES :

@ Please clearly state whether the Director is a Managing Director or Whole-time Director or Executive
Director or Non-Executive Director or Executive Chairman or Non-Executive Chairman

# Identify atleast two designated directors/partners (A designated director is one who is a HSC by
qualification (or CA, ICWA or CS or equivalent) and possesses atleast 2 years of experience
pertaining to securities market. They, essentially, look after the stock market operations of a trading
member entity. Every trading member corporate should have atleast 2 such directors who meet the
aforesaid norms.)

$ All initials to be expanded

Date:
Place:
Authorised Signatory / Director(s) / Partner(s)

CERTIFICATE
This is to certify that the details of directors of M/s. ______________ as given above, based on my/ our
scrutiny of the books of accounts, records and documents is true and correct to the best of my/our
knowledge and as per information provided to my/our satisfaction.

Place:
For (Name of Accounting Firm)
Date:

Name of Partner/Proprietor

Chartered Accountant

Membership Number
 Annexure: C-6 (If Applicable)

SHARE HOLDING PATTERN of _____________________ as on ______

EQUITY / PREFERENCE (Please indicate and use separate sheets for equity/preference shares)
Sr No. Name $ Number of Face value Amt Paid up % of total
shares held per share (Rs. In lakh)
1
2
3
4
5
6
7
8
Others
TOTAL 100%
$ All initials to be expanded

NOTES:
1. In case of bodies corporate holding not less than 51% of the paid up capital in the trading member
entity, the details of their shareholding shall also be furnished in the same format as given above
2. In case of HUF holding not less than 51% of paid up capital of trading member entity, the details
of Karta and co-parceners to be provided
3. Persons holding 2% or more of the paid up capital should be shown separately and not clubbed in
Others.

Date:
Place: Authorised Signatory/Director (s)

CERTIFICATE

This is to certify that the shareholding in M/s. ______________ as given above, based on my/ our
scrutiny of the books of accounts, records and documents is true and correct to the best of my/our
knowledge and as per information provided to my/our satisfaction.

Place:
For (Name of Accounting Firm)
Date:
Name of Partner/Proprietor
Chartered Accountant
Membership Number
 Annexure: C-7 (If Applicable)

Sr Name of Person (s) Relation Residential addressNo. of Total % of Total % of PAN CIN (incase
No dominant supporting $ (with PIN code) andshares Amt @ Total of corporate
shareholder dominant contact no. held paid
shareholder up @
Self Relatives
1 A
A1
A2
2 B
B1
B2
3 C

TOTAL
DETAILS OF DOMINANT GROUP as on _____

$ Please specify relation of person supporting dominant shareholder

@ : For arriving at the shareholding of persons constituting the dominant group, the shareholding of
close relatives, namely parents, spouse, children and their descendants, brothers and sisters only may also
be counted.

Date:
Place:
Authorised Signatory/Director(s)

CERTIFICATE

This is to certify that the shareholding in M/s. ______________ as given above, based on my/ our
scrutiny of the books of accounts, records and documents is true and correct to the best of my/our
knowledge and as per information provided to my/our satisfaction..

Place:
For (Name of Accounting Firm)
Date:

Name of Partner/Proprietor
Chartered Accountant
Membership Number
 Associate Details of all the associate (If Applicable)
(On the letter head of the applicant)

Sr. PAN Nature of Correspondence

No. along Interest of Address
CIN Nature of with Applicant
Name of Business scanned Company
the Form of copy of
Company Organization PAN

1.

2.
3.
4.
Note: Kindly attach certified copy of PAN card for each of the PANs disclosed above.

Stamp and Signature of Applicant/Authorised Signatory

Place :
Date :
 Details of Other SEBI Registration

S.No. Particulars Details

1 Whether the Applicant is registered with SEBI in any capacity? Yes/No
2 Whether the Applicant has applied for any other registrations with SEBI? Yes/No
3 Whether Details of Registration with any other Govt. Regulatory Body? Yes/No

Details of Change in Control (If Applicable)

Is the Application made to the Board after seeking NOC for Change in Control? – Yes/No

Link Entities

Details of Registrations against which a Single Registration No. is to be issued

(Please mention all the SEBI registration details including NSE membership)

Compliance Officer Details

SNo Particulars
1 First Name
2 Middle Name
3 Last Name
4 Qualification
5 Date Of Appointment
6 PAN No along with Attachment
Correspondence address details of Compliance
7 Officer

Attachments

S.No. Particulars
1 Status Report from other Exchanges (If Applicable)
2 Experience Certificate of Designated Directors/Proprietors/Partners (as the case maybe)
3 Scanned copy of physical application form for Registration – Each document to be scanned separately
4 Copy of certificate issued by recognized University / Educational Institution
5 Copy of NISM certificates as per the details provided
6 Board Resolution / Declaration in respect of Authorized Signatories
7 Board Resolution w.r.t designated directors (Designated Partner for LLP)
8 Copy of MOA and AOA
9 PAN Card copy of the member
10 PAN Card copy of all directors/Compliance officer/partners/LLP/Top 5 shareholders/Associates
11 Original SEBI certificates of all segments of all Exchanges the member is registered with.
*Alongwith hard copy submission, all the documents are also to be scanned in pdf format
(max upto 2 mb for each document) and sent to compliance_mem@nse.co.in
Checklist:

Sr. Particulars
No. Y/N
1 Application form for SEBI registration
All the segments to be mentioned
SEBI reg. No. for all segment to be mentioned

2 Form A (For Trading Membership)

To be given on plain paper/letter head
Each page should be stamped and signed by authorised signatories as per Board
Resolution.
Table 1:
All the columns to be filled, wherever Not applicable, 'NA' to be filled in
Point no. 8 - Netwoth amount and date to be mentioend cross checked from the networth
certificate attached

Table 2:
All the columns to be filled, wherever Not applicable, 'NA' to be filled in

Table 3:
Details of dealers as per the required columns who have cleared NCFM / equivalent
Derivatives Examination/ NISM (atleast 2) to be given
Certified copies of their certificates to be enclosed

Undertaking:
To fill in Yes/ No, as applicable
If Yes, required details to be provided
Declaration of the trading member and the Recommendation of the Exchange should be
on the same page.
Declaration of member to be dated, stamped and signed

2 Form AD (For Clearing Membership)

To be given on plain paper/letter head
Each page should be stamped and signed by authorised signatories as per Board
Resolution.
Table 1:
Point no. 3. Mention name of the Clearing Corporation of which the applicant is a
member (NSCCL)
Point no. 8 - Networth amount and date to be mentioned cross checked from the networth
certificate attached

Table 2:
All the columns to be filled, wherever Not applicable, 'NA' to be filled in

Undertaking:
To fill in Yes/ No, as applicable
If Yes, required details to be provided
Declaration of the trading member and the Recommendation of the Exchange should be
on the same page.
 Declaration of member to be dated, stamped and signed

3 C-1 : Certificate of Net worth

To be in prescribed format
Amount of net worth to be adequate (as per segment applied for)
To be dated and certified by CA
If the applicant has applied for debt segment and also regulated by sectoral regulator other
than SEBI, the networth shall be computed in the manner as specified by such sectoral
regulator.
Date of certification not to be more than 6 months from date of receipt of application form

4 Clearing Member confirmation

Separate letters should be issued for Futures & Options, Currency derivatives
To be original / Photocopy attested by authorised signatories with stamp
Name of the Trading member should be mentioned
Segment in which to act as clearing member to be clearly mentioned
If the applicant has applied for debt segment and also regulated by sectoral regulator other
than SEBI, the networth shall be computed in the manner as specified by such sectoral
regulator.
Date of certification not to be more than 6 months from date of receipt of application form

5 Board Resolution
Board resolution to be in original
To be on the letterhead of the applicant.
To mention the names and designation of authorised signatory(ies) and whether
jointly/severally, etc.
Specimen signatures of authorised signatories to be present on board resolution
Board resolution to be signed by Designated Director(s)

6 Undertaking
To be on letter head
To be in prescribed format
To be filled with responses (Yes/No) and details provided wherever applicable
To be signed by two designated directors or authorised signatory(ies) as per the Board
Resolution
To be stamped and dated

7 Declaration by Stock Broker

To be on letter head
To be in prescribed format
To be signed by two designated directors or authorised signatory(ies) as per the Board
Resolution
To be stamped and dated
To be certified by PCA/PCS

8 C-3 : Details of Directors / Partners

To be in prescribed format (all columns to be present)
Details in all columns to be filled. If any column is not applicable "Not applicable" to be
mentioned.
 Name of the directors should be uniform across all forms submitted and should also match
with the PAN card(s) provided.
To be dated, stamped and signed by the authorised signatories as per Board Resolution.
Annexure to be duly certified by CA in prescribed format
Date of certification not to be more than 6 months from date of receipt of application form

9 C-6 : Share holding pattern of company

To be in prescribed format (all columns to be present)
To be dated, stamped and signed by the authorised signatories as per Board Resolution.
Annexure to be duly certified by CA in prescribed format
Date of certification not to be more than 6 months from date of receipt of application form

10 C-7 -Details Of Dominant Group

To be in prescribed format (all columns to be present)
To be dated, stamped and signed by the authorised signatories as per Board Resolution.
Annexure to be duly certified by CA in prescribed format
Date of certification not to be more than 6 months from date of receipt of application form

11 Associate Details of all the associate

To be in prescribed format (all columns to be present)
To be dated, stamped and signed by the authorised signatories as per Board Resolution.
PAN Card of all the associates
Top 5 Shareholders details of all associates
PAN Card of top 5 shareholders of all associates
Shareholding details with No. of Shares & Percentage (with as on date mentioned)
SEBI registration no. of Associates, if registered with SEBI
Details of Disciplinary Actions:
Any Disciplinary Actions Taken/Initiated (Y/N)
If Yes, Action Taken / Initiated By
Name of Case
Status of the case
Details of Violations / Observations
Corrective steps taken

Whether Details of Registration with SEBI or any other Govt. Regulatory Body? (Y/N)
If Yes, Name of Regulator
Registration No.
Registration Start Date
Registration End Date - not mandatory
Activity Details
Details of Action taken in the past (if any)

12 Details of Other SEBI Registration

To be in prescribed format (all columns to be present)
To be dated, stamped and signed by the authorised signatories as per Board Resolution.

13 Link Entities
To be in prescribed format (all columns to be present)
To be dated, stamped and signed by the authorised signatories as per Board Resolution.

14 Compliance Officer Details

 All details are mentioned
Self-attested PAN Card copy attached with application

15 Attachments
Status Report from other Exchanges (If Applicable)
Experience Certificate of Designated Directors/Proprietors/Partners (as the case maybe)
Educational Proof of designated director
Scanned copy of physical application form for Registration
NISM certificates as per the details provided
MOA and AOA
PAN Card copy of the member
PAN of top 5 shareholders
PAN of directors
PAN of Associate co.
Original SEBI certificates of all segments of all Exchanges where the member is
registered.