Know Your Client (KYC)

Application Form (For Individuals Only)

 Please fill the form in ENGLISH and in BLOCK letters
Moneylicious Securities Private Limited
 Fields marked * are mandatory. Application Number :
 Fields marked * are pertaining to CKYC and mandatory only
if processing CKYC also
Application Type : ✔ New KYC Modification KYC
KYC Mode: (Please tick)
Normal EKYC OTP EKYC Biometric Online KYC Offline KYC ✔ Digilocker
1. Identity Details (Please Refer Guidelines Overleaf)
PAN Number ERKPP6342F
Client Name KEANE AGNELO PINTO
Maiden Name
Father/Spouse Name BERNARD KEVIN PINTO
Date Of Birth 03/08/2000
Gender ✔ Male Female Transgender
Marital Status ✔ Single Married
Nationality ✔ Indian Others ___________________
✔ Resident Individual Non-Resident Indian

Residential Status Foreign National Person of Indian Origin

(Passport mandatory for NRIs and Foreign Nationals. PIO selection is only for CKYC
and not for KRA KYC, Select NRI or Foreign National based on Nationality of the
individual)

Proof of Identity (POI) submitted for PAN exempted cases (Please tick)
✔ A - Aadhaar Card XXXX - XXXX - __ __ __ __
9598
B - Passport No.
C - Voter ID
D – DL
E - NREGA Card
F - NPR
Z - Others
2. Address Details (Please Refer Guidelines Overleaf)
A. Correspondence Address / Local Address
Address Line 1 S/O: Bernard Kevin Pinto B/ 108, Palash-Upvan
Address Line 2 CHS Gawand Baug Kokanipada Thane Thane Pokhran
Address Line 3 Road No 2
City / Town / Village Thane District Thane PIN 400610
State Maharashtra Country INDIA
Address Type Residential/Business ✔ Residential Business Registered Office Unspecified
NAME OF THE ACCOUNT HOLDER SIGNATURE OF THE ACCOUNT HOLDER
KEANE AGNELO PINTO

Place MUMBAI

Date 08/05/2024

1
B. Permanent Residence Address of applicant, if different from above A
Address Line 1 S/O: Bernard Kevin Pinto B/ 108, Palash-Upvan
Address Line 2 CHS Gawand Baug Kokanipada Thane Thane Pokhran
Address Line 3 Road No 2
City / Town / Village Thane District Thane PIN 400610
State Maharashtra Country INDIA
Address Type Residential/Business ✔ Residential Business Registered Office Unspecified
Proof of Address (attested copy of any 1 POA for correspondence and permanent address each to be submitted)
✔ A - Aadhaar Card 9598
XXXX - XXXX - __ __ __ __
B - Passport No.
C - Voter ID
D – DL
E - NREGA Card
F - NPR
Z - Others
3. Contact Details (in CAPITAL)
Email ID [email protected]
Mobile Number +91 - 9167073158
Tel No (Off) Tel No. (Res)
4. Applicant Declaration
I/We hereby declare that the KYC details furnished by me are true and correct to the best of my/our knowledge and belief
and I/we under-take to inform you of any changes therein, immediately. In case any of the above information is found to
be false or untrue or misleading or misrepresenting, I am/We are aware that I/We may be held liable for it.
I/We hereby consent to receiving information from CVL KRA through SMS/Email on the above registered number/Email
address.
I am/We are also aware that for Aadhaar OVD based KYC, my KYC request shall be validated against Aadhaar details.
I/We hereby consent to sharing my/our masked Aadhaar card with readable QR code or my Aadhaar XML/Digilocker XML
file, along with passcode and as applicable, with KRA and other Intermediaries with whom I have a business relationship
for KYC purposes only.

NAME OF THE ACCOUNT HOLDER SIGNATURE OF THE ACCOUNT HOLDER

KEANE AGNELO PINTO

Place MUMBAI

Date 08/05/2024

FOR OFFICE USE ONLY

In-Person Verification (IPV) carried out by
Intermediary Name Moneylicious Securities Pvt Ltd
AMC / Intermediary Code 1200006593
Employee Name Satish Jangaiah Battu
Employee Code 100369
Employee Designation KYC OFFICER
IPV Date 08-05-2024
✔ Self Certified document copies received (OVD)
Employee
True copies of documents received (Attested) Signature
2
Proof of Identity

Client Name KEANE AGNELO PINTO

Pan Number ERKPP6342F

3
 DIGILOCKER VERIFIED E-AADHAAR
This document is generated from verified Aadhaar XML obtained
from DigiLocker with due user consent and authentication

Document Type e-Aadhaar generated from DigiLocker verified Aadhaar XML

Generation Date 2024-05-08T01:41:11.617Z Download Date 2024-05-08T01:41:11.617Z

Masked Aadhaar
xxxxxxxx9598
Number
Name Keane Agnelo Pinto
Date of Birth 03/08/2000
Gender Male
c/o, s/o S/O: Bernard Kevin Pinto
Address S/O: Bernard Kevin Pinto B/ 108, Palash-
Upvan CHS Pokhran Road No. 2 Kokanipada
Gawand Baug Thane Thane Maharashtra
400610 India

Landmark Gawand Baug District Thane

City Thane
Pincode 400610 State Maharashtra
Signature

Client Name KEANE AGNELO PINTO

5
 INSTRUCTIONS & CHECKLIST FOR FILLING ACCOUNT OPENING FORM & KYC
A. IMPORTANT POINTS:
1. Self-attested copy of the PAN card is mandatory for all clients.
2. Copies of all the documents submitted by the applicant should be self-attested and accompanied by originals for
verification. In case the original of any document is not produced for verification, then the copies should be properly
attested by entities authorized for attesting the documents, as per the below mentioned list.
3. If any proof of identity or address is in a foreign language, then translation into English is required.
4. Name & address of the applicant mentioned on the KYC form, should match with the documentary proof submitted.
5. If correspondence & permanent address are different, then proofs for both have to be submitted.
6. Sole proprietor must make the application in his individual name & capacity.
7. For non-residents and foreign nationals, (allowed to trade subject to RBI and FEMA guidelines), copy of
passport/PIOCard/OCICard and overseas address proof is mandatory.
8. For foreign entities, CIN is optional; and in the absence of DIN no. for the directors, their passport copy should be
given.
9. In case of Merchant Navy NRI’s, Mariner’s declaration or certified copy of CDC (Continuous Discharge Certificate) is
to be submitted.
10. For opening an account with a Depository participant or Mutual Fund, for a minor, photocopy of the School Leaving
Certificate/Mark sheet issued by the Higher Secondary Board/Passport of Minor/Birth Certificate must be provided.
11. Politically Exposed Persons (PEP) are defined as individuals who are or have been entrusted with prominent public
functions in a foreign country, e.g., Heads of States or of Governments, senior politicians, senior
Government/judicial/military officers, senior executives of state-owned corporations, important political party officials, etc.
B. PROOF OF IDENTITY (POI):
List of documents admissible as Proof of Identity:
1. PAN card with photograph.
2. Unique Identification Number (UID) (Aadhaar) / Passport / Voter ID card / Driving license.
3. Identity card/ document with applicant’s Photo, issued by any of the following: Central/State Government and its
Departments, Statutory/Regulatory Authorities, Public Sector Undertakings, Scheduled Commercial Banks, Public
Financial Institutions, Colleges affiliated to Universities, Professional Bodies such as ICAI, ICWAI, ICSI, Bar Council etc.,
to their Members; and Credit cards/Debit cards issued by Banks.
C. PROOF OF ADDRESS (POA):
List of documents admissible as Proof of Address: (Documents having an expiry date should be valid on the date of
submission)
1. UID/Passport/Voters Identity Card/Ration Card/Registered Lease or Sale Agreement of Residence/Driving
License/Flat Maintenance bill/Insurance Copy/Unique Identification Number (UID) (Aadhaar).
2. Utility bills like Telephone Bill (only land line), Electricity bill or Gas bill - Not more than 3 months old.
3. Bank Account Statement/Passbook - Not more than 3 months old.
4. Self-declaration by High Court and Supreme Court judges, giving the new address in respect of their own accounts.
5. Proof of address issued by any of the following: Bank Managers of Scheduled Commercial Banks/Scheduled Co-
Operative Bank/Multinational Foreign Banks/Gazetted Officer/Notary public/Elected representatives to the Legislative
Assembly / Parliament/Documents issued by any Govt. or Statutory Authority.
6. Identity card/document with address, issued by any of the following: Central/State Government and its Departments,
Statutory/Regulatory Authorities, Public Sector Undertakings, Scheduled Commercial Banks, Public Financial
Institutions, Colleges affiliated to Universities and Professional Bodies such as ICAI, ICWAI, ICSI, Bar Council etc., to
their Members.
7. For FII/sub account, Power of Attorney given by FII/sub-account to the Custodians (which are duly notarized and/or
apostille or consularized) that gives the registered address should be taken.
8. The proof of address in the name of the spouse may be accepted.
D. EXEMPTIONS/CLARFICATIONS TO PAN:
Sufficient documentary evidence in support of such claims to be collected.
1. In case of transactions undertaken on behalf of Central Government and / or State Government and by officials
appointed by Courts e.g. Official liquidator, Court receiver etc.
2. Investors residing in the state of Sikkim.
3. UN entities / multilateral agencies exempt from paying taxes / filing tax returns in India.
4. SIP of Mutual Funds up to ₹50,000/- p.a.
5. In case of institutional clients, namely, FIIs, MFs, VCFs, FVCIs, Scheduled Commercial Banks, Multilateral and Bilateral
Development Financial Institutions, State Industrial Development Corporations, Insurance Companies registered with
IRDA and Public Financial Institution as defined under section 4A of the Companies Act, 1956, Custodians shall verify

7
the PAN card details with the original PAN card and provide duly certified copies of such verified PAN details to the
intermediary.

E. LIST OF PEOPLE AUTHORIZED TO ATTEST THE DOCUMENTS:

1. Notary Public, Gazetted Officer, Manager of a Scheduled Commercial / Co-operative Bank or Multinational Foreign
Banks (Name, Designation & Seal should be affixed on the copy).
2. In case of NRIs, authorized officials of overseas branches of Scheduled Commercial Banks registered in India, Notary
Public, Court Magistrate, Judge, Indian Embassy / Consulate General in the country where the client resides are permitted
to attest the documents.

F. ADDITIONAL DOCUMENTS IN CASE OF TRADING IN DERIVATIVES SEGMENTS – illustrative List:

Copy of ITR Acknowledgement Copy of Annual Accounts

In case of salary income - Salary Slip, Copy of Form 16 Net worth certificate

Copy of demat account holding statement. Bank account statement for last 6 months
Any other relevant documents substantiating ownership of Self-declaration with relevant supporting
Assets. documents
*In respect of other clients, documents as per risk management policy of the stock-broker need to be provided by the
client from time to time.

G. BANK ACCOUNT PROOF:

1. Copy of cancelled cheque leaf/passbook/bank statement specifying name of the constituent, MICR Code or/ and IFSC
Code of the bank should be submitted.

H. Demat Master or recent holding statement issued by DP bearing name of the client.

I. FOR INDIVIDUALS:
1. Stockbroker have an option of doing 'in-person' verification through a web camera at the branch office of the stock-
broker /sub-broker's office.
2. In case of non-resident clients, employees at the stock-broker's local office, overseas can do in-person verification.
Further, considering the infeasibility of carrying out 'In-person' verification of the non- resident clients by the stock-broker's
staff, attestation of KYC documents by Notary Public, Court, Magistrate, Judge, Local Banker, Indian Embassy /
Consulate General in the country where the client resides may be permitted.

I. FOR NON-INDIVIDUALS:
Clients also have the option to do their own ‘in-person’ verification via video captured through mobile or computer or
internet connected device with ability of demonstrating that it was live and conducted for the purpose of verification.’
1. For non-individuals: Form need to be initialized by all the authorized signatories.
2. Copy of Board Resolution or declaration (on the letterhead) naming the persons authorized to deal in securities on
behalf of company/firm/others and their specimen signatures
3. In case of non-individuals, name, designation, PAN, UID, signature, residential address and photographs of persons
authorized to deal in securities on behalf of company/firm/others

8
 INDEX
MANDATORY DOCUMENTS AS PRESCRIBED BY SEBI & EXCHANGES
SR. NO. NAME OF DOCUMENT BRIEF SIGNIFICANCE OF THE DOCUMENTS PAGE NO.
 KYC Form – Document captures the basic
information about the constituent and an instruction
/ check list.
1. Account Opening Form 1 – 14
 Document captures the additional information about
the constituent relevant to Trading /Demat account
and an instruction / check list.
Document detailing the rate/amount of brokerage &

Booklet - 1
2. Tariff Sheet other charges levied on the client for trading on stock 15 – 16
exchange(s) & DP Service charges / Fee Structure.
Collects details of any nomination made for the
3. Nomination Form 17 – 18
account
Internet & Wireless Internet & wireless technology-based trading facility
4. Technology provided by stock-broker to client.
19

Declaration of Most Important Terms and Conditions

5. MITC
(MITC)
23

6. Acknowledgement Copy of Acknowledgement 25

Document stating the Rights & Obligations of stock

broker/trading member, sub-broker and client for
7. Rights & Obligations trading on Exchanges / Depository Participant 2-6
(Including additional rights & obligations in case of

Booklet - 2
interne/wireless technology based trading.
Risk Disclosure Document Document detailing risks associated with dealing in
8. (RDD) the securities market.
7-9

Document detailing do’s and don’ts for trading on

9. Guidance Note
exchange, for the education of the investors.
10

Document describing significant policies and

10. Policies & Procedures procedures of the stock broker (to be added by the 11 – 15
stock broker).
VOLUNTARY DOCUMENTS
Running Account  Authorization Letter for Running Account
11. Authorization & Issuance  Option form for issue DIS (Delivery Instruction Slip) 20
of DIS Booklet
Booklet - 1
Booklet
 Letter for Authorization for Electronic Contract Notes
(ECN)
12. ECN / SMS & Email Alerts 21
 SMS And Email Alerts to Investors by Stock
Exchange
 Declaration from client
13. Declaration / Consent 22
 Commodity option consent

With respect to Member-Constituent Relationship and

Undertaking/Authorization
14. Mandatory & Voluntary (optional) documents 16 - 17
Booklet - 2

executed.

Rights & Obligations - Rights & Obligations relating to Margin Trading

15. 18 - 19
MTF Facility.

9
 MEMBERSHIP DETAILS
Moneylicious Securities Private Limited
Name of Trading Member
Hereinafter referred to as Dhan or Moneylicious
Stock-Broker (INZ000006031) effective 06.04.2015
SEBI Registration Number
Depository Participant (IN-DP-289-2016) effective 19.09.2016
Trading Member Code: 90133 & Clearing Code: M52027
NSE
- Cash, F&O, Currency, Commodities
Trading Member Code: 6593
BSE
Exchanges and Segments - Cash, F&O, Currency, Commodities
Trading Member Code: 56320 & Clearing Code: 7085
MCX
- Commodities
CDSL Membership: IN-DP-289-2016, DP ID - 83400
14D, 4th Floor, Shri Krishna Chambers, 78, Bentinck Street, Kolkata -
Registered Office Address
700001, West Bengal, India
302, 3rd Floor, The Western Edge I, Off Western Express Highway,
Borivali (East), Mumbai - 400066, Maharashtra, India
Correspondence Address
Phone: (91) 9987761000
Fax: (91) (22) 4311 6601
Mr. Manish Garg
Compliance Officer Email Id: [email protected]
Phone: (91) 8655740961
Mr. Pravin Jadhav & Mr. Jay Prakash Gupta
CEO / Director Details Email Id: [email protected]
Phone: (91) 8976718243
Mr. Jay Khatnani, Head - Customer Service
Customer Service Email: [email protected]
Phone: (91) 9987761000
CIN U74999WB2012PTC184187
Website www.dhan.co
For any grievance, please email Dhan on [email protected], [email protected] or call us on (91) 9987761000

If you are not satisfied with the response, please contact the concerned exchange at:
NSE [email protected] or contact at 1800-266-0058
BSE [email protected] or contact at +91-22-2272-1234/33, Fax No. +91-22-2272-3677
MCX [email protected] or contact at 022 - 6731 8888
CDSL [email protected] or contact at 1800-22-5533
You can also lodge your grievances with SEBI at https://scores.sebi.gov.in. For any queries, feedback or
assistance, please contact SEBI office or toll-free Helpline at 1800-22-7575 / 1800-266-7575

Disclosure in Terms of SEBI Circular No,: SEBI/MRD/SE/CIR-42/2003 Dated November 19, 2003
Moneylicious Securities Private Limited engages in proprietary trades on BSE/NSE/MCX exchanges,
encompassing both cash/derivatives/currency and commodity segments.

10
 TRADING AND DEMAT ACCOUNT RELATED DETAILS
A. BANK / DIVIDEND BANK ACCOUNT DETAILS (DEFAULT)
Bank Name State Bank of India

Bank Branch Address chestnut plaza,opp eden woods, glady alwares rd ,thane ,pin - 400616

Bank Account No. 00000020278913232 A/c Type ✔ Savings Current

MICR Code 400002154 IFS Code SBIN0004314

B. DEPOSITORY DETAILS (DEFAULT)

Depository Name MONEYLICIOUS SECURITIES PRIVATE LIMITED

Depository Type ✔ CDSL NSDL DP ID 12083400

Beneficiary Owner Name KEANE AGNELO PINTO

Beneficiary ID (BO ID): 1208340015307263

C. OTHER DETAILS

1. Annual Income ✔ Below 1 Lac 1-5 Lac 5-10 Lac 10-25 Lac 25 L – 1 Cr Above 1 Cr
OR
Net worth (Net worth should not be older than 1 year) Rs. _______ as on Date

Private Sector Public sector ✔ Professional Business Government Service

2. Occupation
Agriculturist Housewife Student Retired Others ______

3. Please Tick Politically Exposed Person Related to a Politically Exposed Person ✔ NA

Whether you wish to receive (a) Physical contract note ✔ Electronic Contract Note (ECN)
If ECN Specify your Email ID: ______________________________________________________________________
[email protected]

Whether you wish to avail the facility of internet trading/wireless technology/mobile trading ✔ Yes No

Number of years of Investment/Trading Experience: NIL ✔ 1-5 Years > 5 Years

D. IN WHAT CAPACITY DO YOU TRADE IN COMMODITY

Value Chain Participant ✔ Others

In case you are trading in the capacity as a Farmer/FPO, Domestic Financial Institutional investor or foreign participant
then please send us the intimation on [email protected]

E. PAST ACTIONS

Details of any action/proceedings initiated/pending/ taken by SEBI/ Stock Exchange/any other authority against the
applicant/constituent or its Partners/ Promoters/ Whole-Time Directors/ Authorized Persons in charge of dealing in
securities during the last 3 years: ___________________________________________________________

F. ADDRESS IN THE JURISDICTION DETAILS WHERE APPLICANT IS RESIDENT OUTSIDE INDIA FOR TAX PURPOSE

Address

City / Town District PIN Code

State / U. T. Country / ISO Code

11
G. DEALINGS THROUGH SUB-BROKERS AND OTHER STOCK BROKERS
1. If Client is dealing through the Sub-Broker, provide the following details:
Sub-Broker’s Name SEBI Registration Number
Registered Office Address
Phone Fax Website
2. Whether dealing with any other Stock Broker/Sub-Broker (If applicable, kindly provide following details
Name of Stock Broker Name of Sub-Broker, if any
Client Code Exchange’s
Details of disputes/dues pending from/to such stock broker/sub-broker_________________________________
H. INTRODUCER DETAILS (Optional)
Full Name of the Introducer Address & Mobile Number

Status of the Introducer

Type of the Introdcer: Sub-broker Existing client Authorized Person Others

Signature of the Introducer

I. TRADING PREFERENCE
*Please sign in the relevant boxes where you wish to trade. Please strike off the segment not chosen by you.
NSE, BSE &
EXCHANGES NSE, BSE
MCX
Cash/Mutual
All Segments F&O Currency Debt Commodity
Fund

If you do not wish to trade in any of segments / Mutual Fund, please write to us at [email protected]

DECLARATION
1. I/We hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief
and I/We undertake to inform you of any changes therein, immediately. In case any of the above information is found to
be false or untrue or misleading or misrepresenting, I am/ We are aware that I/We may be held liable for it.
2. I/We confirm having read/been explained and understood the contents of the document on policy and procedures of
the Stock Broker and the Tariff Sheet.
3. I/We further confirm having read and understood the contents of the ‘Rights and Obligations’ document(s) and ‘Risk
Disclosure Document’. I/We do hereby agree to be bound by such provisions as outlined in these documents. I/We have
also been informed that the standard set of documents has been displayed for Information on Stock Broker’s designated
website, if any.
4. 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 Laws as 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 making this 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 that any false / misleading information given by me/ us or suppression of any material information will render my/
our account liable for termination and suitable action.
NAME OF THE ACCOUNT HOLDER SIGNATURE OF THE ACCOUNT HOLDER
KEANE AGNELO PINTO

Place MUMBAI

Date 08/05/2024
12
 ADDITIONAL DETAILS FOR OPENING A DEMAT ACCOUNT – FOR INDIVIDUALS
Application No. 1103150139 DP Internal Reference No. 1103150139

DP ID 12083400 Client ID 15307263

UCC Code CZZD20228O Date 08/05/2024

(To be filled by the applicant in BLOCK LETTERS in English)

I/We request you to open a demat account in my/ our name as per following details:-
HOLDER’S DETAILS
Sole / First Holder Name KEANE AGNELO PINTO 1st PAN ERKPP6342F
Exchange Name & ID NSE - 90133 , BSE - 6593 and MCX - 56320 1st UID xxxxxxxx9598
2nd PAN
Second Holder Name
2nd UID
3rd PAN
Third Holder Name 3rd UID
*In case of Firms, Association of Persons (AOP), Partnership Firm, Unregistered Trust, etc., although the account is opened in the name of the
natural 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)

Status Sub-Status

✔ Individual Resident Individual-Director

✔ Individual Individual Director's Relative Individual HUF/AOP
Individual Promoter Minor

NRI Repatriable NRI Non-Repatriable

NRI NRI Repatriable Promoter NRI Non-Repatriable Promoter
NRI – Depository Receipts

Foreign National Foreign National Foreign National Depository Receipts

ADDITIONAL DETAILS
Whether you wish to receive *standard documents in electronic form ✔ Yes No

Whether you wish to receive the confirmation, account statements and any other
correspondence electronically or physically Physical ✔ Electronic

Please specify your choice of receiving a copy of KYC form Physical ✔ Electronic
I / We would like to instruct the DP to accept all the pledge instructions in my /our
✔ Yes No
account without any other further instruction from my/our end.
I/We would like to receive Statement of Account / Transaction-cum-Holding Statement
✔ Yes No
/ Daily Margin Statement and All Other Statement at my registered email ID

I / We would like to share the email ID with the RTA ✔ Yes No

I / We instruct the DP to receive each and every credit in my/ our account ✔ Yes No
I / We would like to receive the Annual Report Physical ✔ Electronic
I/ We wish to receive dividend / interest directly in to my/or bank account as given below
through ECS (If not marked, the default option would be ‘Yes’) ✔ Yes No
[ECS is mandatory for locations notified by SEBI from time to time]

13
 On registered Mobile Number (Mandatory if you are giving Mobile Number:
SMS Alert Facility Power Of Attorney (POA). Ensure that the mobile number is
provided in the KYC application form +91 9167073158
Account Statement
Requirement As per SEBI Regulation Daily Weekly Fortnightly ✔ Monthly

I/We hereby opt for ✔ Regular Demat Account BSDA Account

I/We would like to receive client copy of containing following.

 Rights and Obligations of Stock Rights and Obligations of Stock Brokers, Sub-Broker /AP /APs
and Clients as prescribed by SEBI and Exchanges
 Rights and Obligations of Beneficial Owner and Depository Participant as prescribed by SEBI
Physical ✔ Electronic
and Depositories
 Risk disclosure Document for Capital, Currency, Stock and Commodity Derivatives Segment
 Guidance Note-Do’s and Don’ts for Trading on the Exchange (s) for Investors
 Policies and Procedures applicable to clients.
I/We wish to avail the TRUST facility using the Mobile number
registered for SMS Alert Facility. I/We have read and understood ✔ Yes No
the Terms and Conditions prescribed by CDSL for the same.
I/We wish to register the following clearing member IDs under my/our below Conditions Annexure
Transactions Using – 2.6 mentioned BO ID registered for TRUST
Secured Texting
Facility (TRUST). Stock Exchange
Clearing Member Name Clearing Member ID (Optional)
Name/ID
NSE / 90133 Moneylicious Securities Private Limited INZ000006031
BSE / 6593 Moneylicious Securities Private Limited INZ000006031
MCX / 56320 Moneylicious Securities Private Limited INZ000006031
To register for easi, please visit our website www.cdslindia.com
Easi allows a BO to view his ISIN balances, transactions, and value of the portfolio online.

NAME OF THE ACCOUNT HOLDER SIGNATURE OF THE ACCOUNT HOLDER

KEANE AGNELO PINTO
UCC Code CZZD20228O
DP BO ID 1208340015307263
Place MUMBAI
Date 08/05/2024

FOR OFFICE USE ONLY

UCC / Client Code CZZD20228O
Documents verified with Originals / Client Interviewed By / In-Person Verification done by
Organization Name: MONEYLICIOUS SECURITIES PRIVATE LIMITED
Employee Name Satish Jangaiah Battu Employee Code 100369
Designation KYC OFFICER Branch Name Head Office Stamp & Signature of
Authorized Signatory
Date 08-05-2024
Signature
Place INDIA
I / We undertake that we have made the client aware of ‘Policy and Procedures’, tariff sheet and
all the non-mandatory documents. I/We have also made the client aware of ‘Rights and
Obligations’ document (s), RDD and Guidance Note. I/We have given/sent him a copy of all the
KYC documents. I/We undertake that any change in the ‘Policy and Procedures’, tariff sheet and
all the non-mandatory documents would be duly intimated to the clients. I/We also undertake that
any change in the ‘Rights and Obligations’ and RDD would be made available onmy/our website, if
any, for the information of the clients.

14
 TARIFF SHEET
Brokerage, Charges, Fees applicable for your Investment, Trading and Demat account with Dhan
Charges related to Exchange Transactions & Other Applicable Charges and Fees
Type of Trade / Transaction Amount / Fees / Brokerage / Charges (GST extra)
Delivery (Equity / ETF) Zero Brokerage
Intraday (Equity / ETF) ₹20/- per Executed Order or 0.03% of Turnover - whichever is lower
Futures :- Equity / Currency / Commodity ₹20/- per Executed Order or 0.03% of Turnover - whichever is lower
Options :- Equity / Currency / Commodity ₹20/- per Executed Order
Square Off by System / Dhan ₹20/- per Executed Order (in addition to brokerage for all segments)
Call & Trade Service ₹50/- per Executed Order (in addition to brokerage for all segments)
IPO Bid or Allotment Nil
Buyback / OFS / Takeover ₹20/- per Executed Order
Mutual Fund Transactions Charges Nil
DP Charges ₹12.50 for every transaction (instruction) in the Scrip / ISIN
Note: Above charges do not include taxes. GST at applicable rates shall be applied separately.
Clients who opt to receive physical contract notes will be charged ₹100 per instance plus courier charges. A brokerage
of 0.1% of the contract value will be charged for contracts where the client provides/takes physical delivery to/from
exchanges. All physical settled contracts (Futures & Options) will also carry an applicable Exchange charge. Brokerage
of ₹20 per executed order is also charged on expired, exercised, and assigned Options contracts.

Brokerage will not exceed the rates specified by SEBI and the Exchanges. All Statutory and Regulatory charges, taxes
will be levied at actuals. In addition to the brokerage, the following charges will also be levied. These charges do not
include taxes.
Additional Charges Applicable on Exchange Transactions
Other Charges Description of Charges
Exchange Turnover Charges Charges levied by exchanges on each transaction
Securities Transaction Charges (STT) Direct Tax levied under the Securities Transaction Tax (STT) Act
Commodity Transaction Charge (CTT) Direct Tax levied by the Government for certain commodities
Stamp Duty Charges levied by State Governments where investor resides
SEBI Turnover Fees Charges levied by SEBI on each transaction
Clearing Charges Charges levied by the Clearing Member
GST Goods and Service Tax (GST) applicable
I agree with the terms and conditions mentioned above. I agree to pay the charges as per ones mentioned above with
respect to my account (investment / trading / demat / user) on Dhan. I understand that the tariff is subject to change and
I shall keep myself updated with the same from the pricing section on Dhan website.

NAME OF THE ACCOUNT HOLDER SIGNATURE OF THE ACCOUNT HOLDER

KEANE AGNELO PINTO

UCC Code CZZD20228O

DP BO ID 1208340015307263
Place MUMBAI

Date 08/05/2024

15
 ADDITIONAL TARIFF SHEET & STRUCTURE
Type of Trade / Transaction Amount / Fees / Brokerage / Charges (GST extra)
Investment Account Related Charges & Demat Transaction Charges
KYC & Account Opening Fees & Annual
Zero
Platform Fees (AMC)
Market Trades - Buy (Credit) Nil
Market Trades - Sell (Debit) ₹12.50 for every transaction (instruction) in the Scrip / ISIN
Dematerialisation / Rematerialisation (Including
₹250 per certificate + Courier charges
MF)
Bounced Contract Note (Physical Contract Note
Up to ₹ 500/- per instance up to 5 pages & in multiple thereof
dispatch)
Courier charges per Demat/Remat ₹300 per courier
Pledge (Creation / Closure/Invocation) ₹12.50 for every transaction (instruction) in the Scrip / ISIN
Margin / MTF / Cuspa (Pledge / Unpledge/
₹12.50 for every transaction (instruction) in the Scrip / ISIN
Invocation)
Margin Repledge Zero
Off Market Transfer (Debit) ₹12.50 for every transaction (instruction) in the Scrip / ISIN
MF Re-Purchase / Redumption ₹12.50 for every transaction (instruction) in the Scrip / ISIN
Beneficiary addition in Demat account (For Off
₹ 25 per Demat account
market transfer)
Inter Settlement Pay-in Charges (From Dhan's
₹12.50 for every transaction (instruction) in the Scrip / ISIN
POOL A/c)
Payment Related Charges
Top-Up via UPI & Netbanking / Withdrawal Nil
Account Freezing / De-Freezing Charges / Modification / DDPI
Account Freeze Nil (frozen / dormant as per regulations / guidelines)
Account De-Freeze / Reactivate ₹25/- per request
Online Modification’s / Addition ₹25/- per request
DDPI Activation ₹100/- (Inclusive of GST)
Periodic Statements / Ad Hoc Statements / Non-Payment of Dues / Obligations & Other Charges
By Email (Periodic) Nil
Physical (Periodic / Ad Hoc Request) ₹500/- per request for 10 pages + ₹50/- every additional page + Courier charges
By Email (Ad Hoc Request) ₹20/- per request
Bounced Cheque Charges ₹500/- per bounced cheque
KRA Upload / Download ₹50/- per request
Rate of Interest applicable on non-payment of
13% per annum
dues or obligations related to depository
*Above charges do not include taxes. GST at applicable rates shall be applied separately.
**CDSL charges, if any, are included in the amounts listed above.
For all purposes, the bill date shall be construed as the demand date and the bills will be considered as the bill cum notice for payment and Dhan
reserves the right to freeze trading / depository / user account for debit transactions in case of non payment of charges after two days from the bill
date.
I agree to pay the charges as per ones mentioned above with respect to my account (investment / trading / demat / user) on Dhan along with the
transaction charges as included in this Account Opening Form. I understand that the tariff is subject to change and I shall keep myself updated with
the same from the pricing section on Dhan website. All charges are non refundable. Taxes, Statutory and Regulatory charges are as applicable.
Express Courier Charges as applicable.
Note: The charges quoted above are for the services listed. Apart from these, Dhan may also offer additional paid services. Dhan will be informing
the customers with regards to such services and charges associated with the same will be billed separately by intimating on an upfront basis.

NAME OF THE ACCOUNT HOLDER SIGNATURE OF THE ACCOUNT HOLDER

KEANE AGNELO PINTO
UCC Code CZZD20228O
DP BO ID 1208340015307263
Place MUMBAI
Date 08/05/2024
16
 NOMINATION FORM
Moneylicious Securities Private Limited
302, 3rd Floor, Western Edge-I, Off. Western Express Highway, Borivali (East), Mumbai – 400066, Maharashtra
I/We wish to make a nomination and do hereby nominate the following person(s) who shall receive all the assets held in
my / our account in the event of my / our death.
Applicant Name DP BO ID
UCC / Client Code Date
NOMINATION DETAILS
NOMINATION CAN BE MADE UPTO DETAILS OF 2nd DETAILS OF 3rd
DETAILS OF 1st NOMINEE
THREE NOMINEES IN THE ACCOUNT NOMINEE NOMINEE
Name of the nominee(s)
1. (Mr./Ms.)
Equally [If not % % %
Share of each equally,
2.
Nominee please
Any odd lot after division shall be transferred to the first nominee mentioned in the form.
specify %]
Relationship With the
3.
Applicant (If Any)
Address of Nominee(s)

4. City / Place:
State & Country:
PIN Code
Mobile / Telephone No. of
5.
nominee(s)
6. Email ID of nominee(s)

Nominee Identification details

– [Please tick any one-off following
and provide details of same]
PAN Card
Aadhaar (UID)
7.
Driving License
Voter ID
Passport
Others

SR. NOS. 8-14 SHOULD BE FILLED ONLY IF NOMINEE(S) IS A MINOR:

Date of Birth {in case of
8. minor
nominee(s)}
Name of Guardian (Mr./Ms.)
9. {in
case of minor nominee(s)}
Address of Nominee(s)

City / Place:
10. State & Country:

PIN Code
Mobile / Telephone no. of
11.
Guardian
12. Email ID of Guardian
Relationship of Guardian with
13.
nominee
17
 Guardian Identification details
– [Please tick any one-off following
and provide details of same]
PAN Card
Aadhaar (UID)
14.
Driving License
Voter ID
Passport
Others

SIGNATURE OF
NAME(s) OF HOLDER(s)
HOLDER(s)
Sole / First Holder

Second Holder

Third Holder

* Signature of witness, along with name and address are required, if the account holder affixes thumb impression, instead
of signature
Note:
1. This nomination shall supersede any prior nomination made by the account holder(s), if any.
2. The Trading Member/Depository Participant shall provide acknowledgement of the nomination form to the account
holder(s).

DECLARATION FORM FOR OPTING OUT OF NOMINATION

To,
Moneylicious Securities Private Limited
302, Western Edge I, Off Western Express Highway,
Borivali (East), Mumbai – 400 066, Maharashtra.

UCC Code CZZD20228O Date 08/05/2024

DP ID 12083400 Client ID 15307263

Sole / First Holder Name KEANE AGNELO PINTO

Second Holder Name

Third Holder Name

I / We hereby confirm that I / We do not wish to appoint any nominee(s) in my / our trading / demat account and understand
the issues involved in non-appointment of nominee(s) and further are aware that in case of death of all the account
holder(s), my / our legal heirs would need to submit all the requisite documents / information for claiming of assets held
in my / our trading / demat account, which may also include documents issued by Court or other such competent authority,
based on the value of assets held in the trading / demat account.

SIGNATURE OF THE ACCOUNT HOLDER(s)

Signature of the 1st Holder Signature of the 2nd Holder Signature of the 3rd Holder

18
 INTERNET & WIRELESS TECHNOLOGY BASED TRADING FACILITY PROVIDED BY
STOCK BROKERS TO CLIENT
To,
Moneylicious Securities Private Limited
302, Western Edge I, Off Western Express Highway,
Borivali (East), Mumbai – 400 066, Maharashtra.
All the clauses mentioned in the 'Rights and Obligations' document(s) shall be applicable. Additionally, the clauses
mentioned herein shall also be applicable.
1. Stock broker is eligible for providing Internet based trading (IBT) and securities trading through the use of wireless
technology that shall include the use of devices such as mobile phone, laptop with data card, etc. which use Internet
Protocol (IP). The stock broker shall comply with all requirements applicable to internet based trading/securities trading
using wireless technology as may be specified by SEBI & the Exchanges from time to time.
2. The client is desirous of investing/trading in securities and for this purpose, the client is desirous of using either the
internet based trading facility or the facility for securities trading through use of wireless technology. The Stock broker
shall provide the Stock broker’s IBT Service to the Client, and the Client shall avail of the Stock broker’s IBT Service, on
and subject to SEBI/Exchanges Provisions and the terms and conditions specified on the Stock broker’s IBT Web Site
provided that they are in line with the norms prescribed by Exchanges/SEBI.
3. The stock broker shall bring to the notice of client the features, risks, responsibilities, obligations and liabilities
associated with securities trading through wireless technology/internet/smart order routing or any other technology should
be brought to the notice of the client by the stock broker.
4. The stock broker shall make the client aware that the Stock Broker’s IBT system itself generates the initial password
and its password policy as stipulated in line with norms prescribed by Exchanges/SEBI.
5. The Client shall be responsible for keeping the Username and Password confidential and secure and shall be solely
responsible for all orders entered and transactions done by any person whosoever through the Stock broker’s IBT System
using the Client’s Username and/or Password whether or not such person was authorized to do so. Also the client is
aware that authentication technologies and strict security measures are required for the internet trading/securities trading
through wireless technology through an order routed system and undertakes to ensure that the password of the client
and/or his authorized representative are not revealed to any third party including employees and dealers of stock broker.
6. The Client shall immediately notify the Stock broker in writing if he forgets his password, discovers security flaw in
Stock Broker’s IBT System, discovers/suspects discrepancies/ unauthorized access through his username / password /
account with full details of such unauthorized use, the date, the manner and the transactions effected pursuant to such
unauthorized use, etc.
7. The Client is fully aware of and understands the risks associated with availing of a service for routing orders over the
internet/securities trading through wireless technology and Client shall be fully liable and responsible for any and all acts
done in the Client’s Username/ password in any manner whatsoever.
8. The stock broker shall send the order/trade confirmation through email to the client at his request. The client is aware
that the order/ trade confirmation is also provided on the web portal. In case the client is trading using wireless technology,
the stock broker shall send the order/trade confirmation on the device of the client.
9. The client is aware that trading over the internet involves many uncertain factors and complex hardware, software,
systems, communication lines, peripherals, etc. are susceptible to interruptions and dislocations. The Stock broker and
the Exchange do not make any representation or warranty that the Stock broker’s IBT Service will be available to the
Client at all times without any interruption.
10. The Client shall not have any claim against the Exchange or the Stockbroker on account of any suspension,
interruption, non-availability or malfunctioning of the Stock broker's IBT System or Service or the Exchange's service or
systems or non-execution of his orders due to any link/system failure at the Client/Stock brokers/Exchange end for any
reason beyond the control of the stock broker/Exchanges.

NAME OF THE ACCOUNT HOLDER SIGNATURE OF THE ACCOUNT HOLDER

KEANE AGNELO PINTO
UCC Code CZZD20228O
DP BO ID 1208340015307263
Place MUMBAI

Date 08/05/2024

19
 RUNNING ACCOUNT AUTHORIZATION
To,
Moneylicious Securities Private Limited
302, Western Edge I, Off Western Express Highway,
Borivali (East), Mumbai – 400 066, Maharashtra.
To optimize the operational efficiency of my/our trading account, I/we request Dhan to maintain a running balance in
my/our account, as opposed to effecting fund/securities settlements on a settlement-to-settlement basis.
I/We authorise you as under:
1. I/We hereby give my/our consent to maintain a running balance in my/our account and retain credit balance in any of
my/our account and to use the unused funds towards my/our margin/pay-in/other future obligation(s) of any segment(s)
of any or all the Exchange(s)/Clearing corporation unless/I/We instruct /revoke you otherwise.
2. I/We request you to settle my/our fund and securities account (choose one option)
Once In a Calendar Month ✔ Once in a Calendar Quarter
Further I/We understand that settlement is for all funds except the funds given towards collaterals/margin in form of Bank
Guarantee and/or Fixed Deposit Receipt.
3. The settlement of running account shall be done by you in accordance with the circulars/guidelines issued by
SEBI/Exchanges from time to time and as per the Risk Management Policy of Dhan available on its website.
4. I/We hereby confirm that I/We shall promptly notify you of any disputes arising from the statement of accounts or
settlement so made in writing, preferably within 7 working days from the date of receipt of funds/securities or the statement
of account, or any related statement, as applicable.
5. Further, I/We authorise you to deposit/repledge any or all the securities kept as collateral by me/us with the Exchanges
and/or their Clearing Corporation/House/Member towards margin, as permitted from time to time.
6. I/We can request for the release of pay-out any time after adjusting all dues towards Dhan.
7. I/We hereby confirm that I/We have the right to revoke the aforementioned authority at any time. This authorization for
the running account shall remain in effect until such time as it is duly revoked by me/us.

NAME OF THE ACCOUNT HOLDER SIGNATURE OF THE ACCOUNT HOLDER

KEANE AGNELO PINTO
UCC Code CZZD20228O
Place MUMBAI
Date 08/05/2024

OPTION FORM FOR ISSUE DIS (DELIVERY INSTRUCTION SLIP) BOOKLET

To,
Moneylicious Securities Private Limited
302, Western Edge I, Off Western Express Highway,
Borivali (East), Mumbai – 400 066, Maharashtra.
Dear Sir,
I/We hereby state that: (Select one of the options given below)
Option 1: I/We require you to issue Delivery Instruction Slip (DIS) booklet to me/us immediately on opening my
CDSL account though for executing delivery instructions for settling stock exchange trades settlement related
transactions) effected through such Clearing Member.
OR
✔ Option 2: I/We do not require the Delivery Instruction Slip (DIS) for the time being, However, the Delivery
Instruction Slip (DIS) booklet should be issued to me/us immediately on my request at any later date.

NAME OF THE ACCOUNT HOLDER SIGNATURE OF THE ACCOUNT HOLDER

KEANE AGNELO PINTO

DP BO ID 1208340015307263
Place MUMBAI

Date 08/05/2024

20
 LETTER FOR AUTHORIZATION FOR ELECTRONIC CONTRACT NOTES (ECN)
To,
Moneylicious Securities Private Limited
302, Western Edge I, Off Western Express Highway,
Borivali (East), Mumbai – 400 066, Maharashtra.
I/we have been/shall be dealing through you as my broker on the Capital Market and/or Futures & Options and/or
Currency Derivatives and/or Commodity Market and/or Interest Rate Futures Segments. As my broker i.e. agent I direct
and authorize you to carry out trading/dealings on my behalf as per instructions given below.
I/we understand that I/we have the option to receive the contract notes in physically or electronic form. In pursuance of
the same, I/we hereby opt to receive contract notes in electronic form. I understand that for the above purpose, you are
required to take from the client “an appropriate email account” for you to send the electronic contract notes. Accordingly,
please take the following email account /email id on your record for sending the contract notes to me/us:
Email ID [email protected]

I/we also agree that non-receipt of bounced mail notification by you shall amount to delivery at my email account / email id.
I/we agree not to hold you responsible for late/non-receipt of contract notes sent in electronic form and any other communication
for any reason including but not limited to failure of email services, loss of connectivity, email in transit etc.
I/we agree that the log reports of your dispatching software shall be a conclusive proof of dispatch of contract notes to
me and such dispatch shall be deemed to mean receipt by me and shall not be disputed by me on account of any non-
receipt/delayed receipt for any reason whatsoever.
I/we understand that I/we required to intimate any change in the email id/email account mentioned herein above needs
to be communicated by me through a physical letter to you, provided however that if we are internet client then in that
event the request for change in email id/email account can be made by me through a secured access using client specific
user id and password. Please treat this authorization as written ratification of my verbal directions/authorizations given
and carried out by you earlier. I/we shall be liable for all losses, damages and actions which may arise as a consequence
of your adhering to and carrying out my directions given above.
I/we understand that you shall send physical copy of the contract note within 24 hours if you received a bounced email.
NAME OF THE ACCOUNT HOLDER SIGNATURE OF THE ACCOUNT HOLDER
KEANE AGNELO PINTO
UCC Code CZZD20228O
DP BO ID 1208340015307263
Place MUMBAI
Date 08/05/2024

SMS AND EMAIL ALERTS TO INVESTORS BY STOCK EXCHANGES

To,
Moneylicious Securities Private Limited
302, Western Edge I, Off Western Express Highway,
Borivali (East), Mumbai – 400 066, Maharashtra.
I/We request you to enroll me for SMS and Email facility, offered by the Exchanges, pursuant to the mentioned SEBI
Circular. (CIR/MIRSD/15/2011, dated 02.08.2011)
I hereby declare that following are my mobile number and email address. Further, I authorize Dhan that the same may
be used for giving me any information / alerts / SMS via my mobile and/or email address.
Mobile 9167073158 Email ID [email protected]

I further declare that the above-mentioned information is provided by me and is true and correct.
\

NAME OF THE ACCOUNT HOLDER SIGNATURE OF THE ACCOUNT HOLDER

KEANE AGNELO PINTO
UCC Code CZZD20228O
Place MUMBAI
Date 08/05/2024
21
 DECLARATION

To,
Moneylicious Securities Private Limited
302, Western Edge I, 3rd Floor,
Off Western Express Highway,
Borivali (East), Mumbai – 400 066.
I/We undersigned hereby declare that I/We have not been involved in any unlawful activities and I have not been declared
a defaulter or my name is not appearing in the defaulter database as per SEBI/ Various Exchange/ Regulatory bodies,
etc.
PAN Number ERKPP6342F Client Name KEANE AGNELO PINTO
I further declare that the above-mentioned information is provided by me and is true and correct.

NAME OF THE ACCOUNT HOLDER SIGNATURE OF THE ACCOUNT HOLDER

KEANE AGNELO PINTO
UCC Code CZZD20228O
DP BO ID 1208340015307263
Place MUMBAI
Date DD / MM / YYYY
08/05/2024

COMMODITY OPTION CONSENT

To,
Moneylicious Securities Private Limited
302, Western Edge I, 3rd Floor,
Off Western Express Highway,
Borivali (East), Mumbai – 400 066.
Maharashtra, India.

I/We am/are interested in availing the facility of trading in Options on Commodity Derivatives offered by
Moneylicious Securities Private Limited. And dealing in Commodity Future through a Trading account. I/We do
hereby undertake that I/we am/are competent in all respects to participate to trade in Options on Commodity
Derivatives as may be permitted by Moneylicious Securities Private Limited / SEBI from time to time. I/We
hereby confirm having read and clearly understood the contents of the “Additional Risk Disclosure documents
for Options Trading”. I/We do hereby agree to be bound by such provisions as outlined in these documents.
I/We have also been informed that the standard set of documents has been displayed for information on stock
broker’s designated website, if any. I/We hereby also agree and confirm that Moneylicious Securities Private
Limited. may demand additional exposure margin for any particular option position or from a particular client as
per its own discretion. I/We hereby also agree and confirm that Moneylicious Securities Private Limited. may
liquidate any of my open option position in case of margin shortfall including shortfall arise on account of
devolvement margin requirement on devolvement of option positions into futures. This undertaking is in addition
to the undertaking given by me/us earlier to Moneylicious Securities Private Limited. I/We request Moneylicious
Securities Private Limited. to provide all necessary facilities to enable me/us for trading in Options on
Commodity.

NAME OF THE ACCOUNT HOLDER SIGNATURE OF THE ACCOUNT HOLDER

KEANE AGNELO PINTO
UCC Code CZZD20228O

DP BO ID 1208340015307263
Place MUMBAI
Date DD / MM / YYYY
08/05/2024
22
 MOST IMPORTANT TERMS AND CONDITIONS (MITC)

(For non-custodial settled trading accounts)

To,
Moneylicious Securities Private Limited
302, Western Edge I, 3rd Floor,
Off Western Express Highway,
Borivali (East), Mumbai – 400 066.
Maharashtra, India.

1. Your trading account has a “Unique Client Code” (UCC), different from your demat account number. Do not allow
anyone (including your own stock broker, their representatives and dealers) to trade in your trading account on their
own without taking specific instruction from you for your trades. Do not share your internet/ mobile trading login
credentials with anyone else.
2. You are required to place collaterals as margins with the stock broker before you trade. The collateral can either be
in the form of funds transfer into specified stock broker bank accounts or margin pledge of securities from your demat
account. The bank accounts are listed on the stock broker website. Please do not transfer funds into any other
account. The stock broker is not permitted to accept any cash from you.
3. The stock broker’s Risk Management Policy provides details about how the trading limits will be given to you, and the
tariff sheet provides the charges that the stock broker will levy on you.
4. All securities purchased by you will be transferred to your demat account within one working day of the payout. In
case of securities purchased but not fully paid by you, the transfer of the same may be subject to limited period pledge
i.e. seven trading days after the pay-out (CUSPA pledge) created in favor of the stock broker. You can view your
demat account balances directly at the website of the Depositories after creating a login.
5. The stock broker is obligated to deposit all funds received from you with any of the Clearing Corporations duly
allocated in your name. The stock broker is further mandated to return excess funds as per applicable norms to you
at the time of quarterly/ monthly settlement. You can view the amounts allocated to you directly at the website of the
Clearing Corporation(s).
6. You will get a contract note from the stock broker within 24 hours of the trade.
7. You may give a one-time Demat Debit and Pledge Instruction (DDPI) authority to your stock broker for limited access
to your demat account, including transferring securities, which are sold in your account for pay-in.
8. The stock broker is expected to know your financial status and monitor your accounts accordingly. Do share all
financial information (e.g. income, networth, etc.) with the stock broker as and when requested for. Kindly also keep
your email Id and mobile phone details with the stock broker always updated.
9. In case of disputes with the stock broker, you can raise a grievance on the dedicated investor grievance ID of the
stock broker. You can also approach the stock exchanges and/or SEBI directly.
10. Any assured/guaranteed/fixed returns schemes or any other schemes of similar nature are prohibited by law. You will
not have any protection/recourse from SEBI/stock exchanges for participation in such schemes.

NAME OF THE ACCOUNT HOLDER SIGNATURE OF THE ACCOUNT HOLDER

KEANE AGNELO PINTO
UCC Code CZZD20228O
DP BO ID 1208340015307263
Place MUMBAI

Date DD / MM / YYYY
08/05/2024

23
 SELF- CERTIFICATION FOR INDIVIDUAL FATCA/CRS DECLARATION FORM
SEBI has issued a circular dated August 26, 2015 advising all registered intermediaries to implement FATCA and CRS as per the
circular. Please seek appropriate advice from your tax professional on your tax residency and related FATCA & CRS guidance.

FATCA RELATED INFORMATION

Are you a US Person? YES ✔ NO
Is your Tax Residency other
than India? YES ✔ NO
If any of the above is yes, please indicate all the countries in which you are a resident fo tax purpose and the associated Tax ID Number below:

Country of Tax Residency*

Tax Identification Number**

Identification Type
*To include all countries other than India, where investor is Citizen/Resident/Green Card Holder/ Tax Resident in those respective countries.
**Incase Tax Identification Number is not available, kindly provide its functional equivalent.

DECLARATION AND UNDERTAKING

The Customer/account holder certifies that:
$ The information provided in the Form is in accordance with Section 285BA of the Income Tax Act, 1961 read with
Rules 114F to 114H of the Income-tax Rules, 1962.
% The information provided by me/us in the Form, its supporting Annexures as well as in the documentary evidenceprovided by me/
us are, to the best of our knowledge and belief, true, correct and complete and that I/we have no withheld any material information
that may affect the assessment/categorization of the account as a Reportable account or otherwise.
C. I/we understand that the Stock Broker is relying on this information for the purpose of determining the status of the applicants
named above in compliance with CRS/FATCA. The Stock Broker is not able to offer any tax advice on CRS or FATCA or its impact on
the applicants and I/We shall seek advice from professional tax advisor for any tax questions. Further, I/We agree to submit a new
form within 30 days if any information or certification on this form gets changed. I/We agree, as may be required by Regulatory
authorities, Stock Broker shall be required to comply to report, reportable details to CBDT or close or suspend my/our account.
D. Under Penalty of perjury, I/We certify that:
1) I/We am/are ( i) Taxable as a US person under the laws of the United States of America(”U.S”) or any state of political subdivision
thereof or therein, including the District of Columbia or any other states of U.S., (ii) and state that the income of which is subject to
U.S. federal income tax regardless of the source thereof.(This clause is applicable only if the account holder/(s) is/are identified as a
US person).
2) I/We am/are an applicant taxable as a tax resident under the laws of country outside India. (This clause is applicable only if the
account holder is a tax resident outside of India
E. I/We hereby confirm that I/we am/are not a US Person or a resident for tax purpose in any country other than India, though my/our
Country of Birth suggests my/our relation with US or one or more parameters suggest my/our relation with the country outside India. I/
we am/are providing/ already provided copy of my PAN card and now providing a certificate of relinquishment of US citizenship (loss
of nationality) OR reasons for not having such a certificate despite relinquishing US citizenship OR for not obtaining US citizenship at
birth (only if born in US) Please specify reason:

08/05/2024
Date. _________________

Place. MUMBAI
________________ Signature of the applicant

FEMA DECLARATION
This has reference to my/our application for opening of a Trading & DEMAT account with you.
In this connection, I/we hereby declare that I/we have complied and will continue to comply with FEMA Regulations with
respect to buying and selling of securities in the Indian Capital Market.

Thanking you,

Signature of the applicant

24
 ACKNOWLEDGEMENT

To,
Moneylicious Securities Private Limited
302, Western Edge I, 3rd Floor,
Off Western Express Highway,
Borivali (East), Mumbai – 400 066.
Maharashtra, India.

Subject : Receipt of Account Opening Form, Voluntary Documents, Rights & Obligation of Trading & Demat, RDD, Policies
& Procedures, Guidance Notes, Tariff Sheet.
This is to acknowledge the receipt of the following documents. I / We further state & confirm that I have read and
understood all the clauses of following documents.
1. AOF – Account Opening Form (Trading & Demat)
2. Rights & Obligations of Stock Broker
3. Rights & Obligations of Beneficiary Owner & Depository Participant as prescribed by SEBI & Stock Exchanges.
4. Risk Disclosure Document (RDD)
5. Guidance Note - Do’s & Don’ts for trading on the Exchange(s) for Investors.
6. Policies & Procedures
7. Voluntary Terms & Conditions
8. Rights & Obligations – MTF
9. Investor Charter
I/We hereby acknowledge that the above documents/ process were made available/ explained to me/us.
I hereby acknowledge that I will abide by all the rules and regulatory changes that may come into 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
making this application and I/We undertake that it would be my/our responsibility to check, scrutinize the said forms and
documents within 15 days of account opening and intimate discrepancies if any therein to Dhan immediately.
Further, you can access the document containing Rights & Obligations, Risk Disclosure Documents, Do's & Don'ts,
Member-Constituent Relationship and Mandatory & Voluntary Documents, Policies and Procedures of the stock broker
from our website https://dhan.co/download-centre/ and Disclosure & Disclaimer, Terms & Conditions, Investor Charter
from our website https://dhan.co/
I also confirm that I have received the relevant clarifications, if any, wherever required from the officials of Dhan. I
hereby acknowledge that I will abide by all the rules and regulatory changes that may come into force from time to time.

NAME OF THE ACCOUNT HOLDER SIGNATURE OF THE ACCOUNT HOLDER

KEANE AGNELO PINTO
UCC Code CZZD20228O
DP BO ID 1208340015307263
Place MUMBAI
Date 08/05/2024
DD / MM / YYYY

25