Normal AOF Without Nominee (1)
Normal AOF Without Nominee (1)
Application No. 5*
INDEX OF DOCUMENTS
CHECKLIST OF DOCUMENTS
Application No.(Signed on both sides) Cheque Leaf (Cancelled original)
Bank Mandate (Signed) Address Proof (Signed photocopy)
PAN Card Copy (Signed photocopy) Income Proof
Version: 1.1
1
Stock Broker SEBI Regn.: INZ000010231 | SEBI RA Regn.:INH000004680 | SEBI Depository Regn.: IN DP CDSL: IN-DP-192-2016 | AMFI REGN No.: ARN-104096 | NSE Member id: 14300 | BSE Member id: 6363 |MCX Member ID: 55945 | Investment Adviser Regn No: INA000014252
Registered Address - IIFL House, Sun Infotech Park, Road no. 16V, Plot no. B-23, MIDC, Thane Industrial Area, Waghle Estate, Thane, Maharashtra - 400604.
Compliance Officer: Ms. Namita Godbole, Email: [email protected], IGID: [email protected], Support desk helpline: 8976689766
Application No. 5*
IDENTITY DETAILS
Name of Applicant MR MUKTI PRASAD PADHY
Maiden Name
Mother Name
Date of Birth 02/09/2006 Gender M Marital Status UNMARRIED
Status INDIVIDUAL Sub Status Individual-Resident Negative Nomination Please sign across photograph
Proof of Address provided Validity/Expiry Date Proof of Address provided Validity/Expiry Date
Place : GANJAM
Date : 2025-02-22
(Originals Verified) Self Certified Seal/Stamp of the Intermediary should contain Seal/Stamp of the Intermediary should contain
Document copies received Staff Name: Suraj Suresh Solkar Staff Name: Suraj Suresh Solkar
Designation: Operations Executive Designation: Operations Executive
(Attested) True copies of documents Name of the Organization: 5Paisa Capital Ltd. Name of the Organization: 5Paisa Capital Ltd.
received Main Intermediary Signature: Signature:
Date: 2025-02-22 Date: 2025-02-22
Version : 1 2
Application No. 5*
ACCOUNT OPENING FORM
Please fill in ENGLISH and in BLOCK LETTERS
CLIENT DETAILS
Client Name PAN Occupation
MR MUKTI PRASAD PADHY ILDPP3086F STUDENT
Annual income / Net worth (If applicable) 0-1Lac Trading Experience 0Year Income Proof
I wish to trade in NSE CASH NSE FO NSE Currency MF
BANK DETAILS
Bank A/C No. A/C Type Bank Name Bank Branch IFSC Code MICR Code
7635001500026160 Savings PUNJAB NATIONAL BANK SORODA, PUNB0763500 761024502
DEPOSITORY ACCOUNT DETAILS (For Trading & DP) Account Type : Resident Individual
Client Name Aadhar PAN Occupation
FIRST HOLDER MR MUKTI PRASAD PADHY 3350 ILDPP3086F STUDENT
SECOND HOLDER
THIRD HOLDER
I wish to open Depository Account with CDSL.
Signature
PAST REGULATORY ACTIONS (Last 3 years)(To be hand filled)
Particulars Name of Authority MM/YYYY
1208250060824675
DECLARATION Politically exposed person NO Related to politically exposed person NO
1. I/We wish to receive Electronic Contract Note (ECN), Electronic Transaction-Cum-Holding Statement and Electronic Annual Report (EAR) on my email id [email protected]
2. I/We wish to avail the facility of internet trading / wireless technology
3. I/We hereby authorize you to receive credits automatically into my/ our Demat Account maintained with 5paisa Capital Limited.
4. I/We hereby authorize you to operate the Demat Account through Power of Attorney (PoA) and accordingly will be provided SMS alert facility on my registered mobile number
5. I/We hereby authorize you to credit interest / dividend, directly to my bank account details provided above through ECS
6. I/We do not wish to receive Delivery Instruction Slip (DIS) since the account will be operated through POA
7. I/We hereby request you to send me the DP Account Statement quarterly by email
8. 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.
9. 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.
10. I/We confirm having received a copy of the following documents and further confirm having read and understood the contents of these documents:
• Rights and Obligations of Stock Brokers, Sub-Brokers and Clients as prescribed by SEBI and Exchanges • Policies and Procedures applicable to clients.
• Rights and Obligations of Beneficial Owner and Depository Participant as prescribed by SEBI 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 . Risk Management
Policy including the Policy and procedure w.r.t. Voluntary freeing / unfreezing of the online access of the trading account. 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 further understand that any change in the said documents including the “Policies and Procedures” shall be made available on the website of 5paisa and also intimated to me through circulars in
internet trading platform/e-mails. I/We shall keep myself updated of the same.
11. I/We agree that the broker shall not be held responsible for any breakdown of the system either due to the fault of the systems of the broker /the exchanges or otherwise.
12. I/We agree that I/we will not be compensated by the broker for any loss opportunity viz. notional profits on buy/sell orders which could not be executed due to any reason whatsoever, including
but not limited due to time lag in the execution of the order or the speed at which the system of the broker/ the exchanges is operating, any shutting down by the broker of my/our system for any
reason or the broker disabling me/us from trading on its system for any reason whatsoever
13. The rules and regulations of the Depository and Depository Participants pertaining to an account which are in force now have been read by me/us and I/we have understood the same and I/we
agree to abide by and to be bound by the rules as are in force from time to time for such account. I/We hereby declare that the details furnished 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/we am/are
aware that I/we may be held liable for it.
14. I/We hereby confirm that the Email ID and Mobile number provided by me for this account belong to me and should be used for purposes of all communications.
15. To register for EASI, please visit www.cdslindia.com. EASI allows a BO to view his ISIN balances, transactions and the value of the portfolio onlne.
16. I/We confirm that details provided by me/us are true and correct. I/We have invested or desirous to invest in the Scheme(s) Mutual Fund under Direct Plan and agree to comply with the terms and
conditions of the Scheme related documents.
17. I/We hereby give you my/our consent to share/provide the transactions data feed/portfolio holdings/ NAV etc. in respect of my/our investments under Direct Plan of all Schemes managed by you,
to the above mentioned RIA.
18.I would like to instruct the DP to accept all the pledge instructions in my account without any other further instruction from my end.
19. I/We hereby consent to receiving information from CVL KRA through SMS/Email on the above registered number/Email address. I hereby authorize 5Paisa Capital Ltd. to fetch my KYC details
from KRA for account opening purpose only and hereby confirm that the details provided therein are correct. In case of any change thereof, I shall intimate 5paisa about the same immediately.
20. 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.
21. I/We would like to share the email ID with the RTA.
22. I/We do not require the Delivery Instruction slip (DIS) booklet for the time being, Since I / We have issued a POA/registered for eDIS with 5Paisa capital LTD. for executing delivery instructions
for settling stock exchange traders [settlement related transactions] effected through such power of Attorney Holder - Clearing Member or for executing delivery instructions through eDIS. However ,
the Delivery Instruction Slip (DIS) booklet should be issued to me / us immediately on my / our request at any later date.
23. I/we have understood the information requirements of the FATCA & CRS instructions and hereby confirm that the information provided by me/us in the form is true, correct, and complete. I/We
also confirm that I/We have read and understood the FATCA & CRS terms & conditions and agree to the same.
Signature
Version : 1 3
Application No. 5*
TARIFF SHEET
Trading Account Processing Charges Other Charges
FREE Account opening fee Standard charges
Normal Pledge / Unpledge / Invocation
Broking Charges Charges
Rs.20 + Applicable GST
• Document handling charges amounting to Rs 100/- shall be • Charges levied by the regulatory authorities for availing of
leviable for customers who intend to receive documents like ESign facilities shall be paid by the customer on actual basis.
contract notes and other related documents additionally in • Charges quoted above are for the services listed and any
Physical mode. services availed other than the ones listed above will be
• *For customers availing our Call Center service, there will be charged separately.
an additional charge of Rs 20 Per Executed order + GSTover • The above charges are exclusive of GST, Securities
and above normal Brokerage. Transaction Tax, other charges , stamp duty and IPFT, if
• Value of the transaction will be in accordance with rates applicable and the same shall be charged to the Client’s
provided by Depository. account on actual basis.
• Statutory and other levies being charges related to the • *Charges/Service standards are subject to revision at sole
execution and/or settlement of transactions shall be discretion of 5paisa Capital Ltd after due intimation to the
separately chargeable as in force from time to time. customer over E-mail / SMS / such other notification as may
• Brokerage is also applicable in case of expiry of futures and be. Management also reserves the discretion to partly/fully
exercise and assignment of option contracts and Physical waive any charges and the right to freeze, discontinue or
Delivery @ Rs.20/- per order. suspend any account, if required.
• Payment gateway charges will be Rs 10 + GST Per • The AMC (Account Maintenance Charge) will be charged
Transaction (No Levied on Transfer done via UPI) quarterly.
I/ We have understood and accepted the Schedule of Charges as stated here in above.
SOLE / FIRST HOLDER SECOND HOLDER THIRD HOLDER
SIGNATURE
Version : 1 4
Application No. 5*
AUTHORIZATION LETTER
Running Account Authorisation to 5paisa Capital Limited
a) I would like to keep securities purchased by me with you as collateral for giving me exposure limits in my trading account/margin obligation. I authorize you not
to transfer shares/securities purchased by me to my demat beneficiary account and keep them with yourselves. I also authorise you to pledge these shares/
securities with the Clearing Member/ Exchange/Custodian, at your discretion. In case any of the shares/securities are sold in subsequent settlements, you may
take this as a standing instruction to adjust against my previous purchase positions in any of Exchanges.
b) Whenever I require delivery of any shares/securities, I shall send you a request. I understand that such payout of securities will be made subject to your risk
management policies.
c) In case there is a debit balance in my account, you are authorized to sell at any point of time the shares/ securities held by me/ held on my behalf, at your sole
discretion. Any profit or loss made on such transactions will be to my account as it would have occurred on normal purchase/sale made by me.
d) I also agree to pay the balance amount, if any after deducting credit of sale of shares.I also request you not to issue cheques /make payments settlement wise
unless specifically demanded by me, as payin and payout are very close and therefore exchange of cheque becomes unnecessary paper work.
e) I/We understand and agree that no interest will be payable to me/us on the amounts or securities so retained with you.
f) I further authorise you to set off/ adjust any of my debits/dues in any segment of any Exchange with credits of any other segment(s) of any Exchange(s) in my
account within the period of settlement of my account (Securities and Funds) as opted by me.
g) The Securities lying in client beneficiary account on my/our behalf and/or credit balances lying in my/our ledger account of any segments of any Exchanges can
be considered as margin for the any segments of any Exchanges.
h) I/We understand that this authorization shall remain valid until revoked by me/us. I/we undertake to clear all my dues arising during the validity of this
authorization else the member shall recover all my/our dues in my/our ledger till date. I also undertake to clear all my dues to you before serving revocation of
this authorisation else the member will recover all my dues in my ledger till date and then effect the revocation.
i) I /We further wish to have settlement of my account (funds and securities):- (Tick any one option) : [l] Once in Quarter [ ] Once in Month
I /We understand that settlement amount shall be subject to retention of requisite securities/ funds towards outstanding obligations and margins in my account
calculated in the manner specified by SEBI/ Exchange and details mentioned in the “Statement of Account” at the time of settlement. I /We authorise you to
send the statement of account on funds and securities as on the date of settlement to my internet trading account or e-mail id registered with you. I /We
understand that I /We can obtain a copy of the same from any of your Branch offices.
I/We also undertake to bring any dispute arising from Statement of Accounts or settlement so made to your notice within seven working days from the date of
receipt of funds/securities or Statements as the case may be. So kindly maintain my/our account as a running account basis for funds and securities.
AUTHORISATION FOR RECEIPT OF CONTRACT NOTES AND OTHER DOCUMENTS IN DIGITAL MODE
I/We hereby consent to receive from 5paisa Capital Limited the digital contract notes, bills, ledgers, transaction statements, demat statement of accounts/ holding statement
(s)/bills/other statements, notices, circulars, amendments and such other correspondence documents, records by whatever name called in electronic form duly authenticated
by means of a digital signature as specified in the Information Technology Act 2000 and the rules made thereunder to my below mentioned email id (said email id). E-mail Id:
[email protected] I/We further hereby agree that the 5paisa Capital Limited. shall fulfill the legal obligation, if the above documents
are sent electronically to the said e-mail id and I/We am/are aware that I/we will not receive the statements / documents in paper form. In this regard, I/we further confirm
and agree that:
(i) The above is my/ our personal E-mail id. The same has been created by me/us and not by someone else. I/We shall take all necessary steps to ensure
confidentiality and the secrecy of the login and password of the abovementioned e-mail account. 5paisa Capital Limited shall not be liable to or responsible for
any breach of secrecy. I/We am/are aware that the statements/ documents may be accessed by other entities in case the confidentiality/secrecy of the login
name and password is compromised. I/We will be solely responsible for the security of the information provided on my/ our aforesaid e-mail id.
(ii) E-mails sent to any of the above mentioned e-mail accounts, which have not bounced back, shall be deemed to be duly delivered to me/Us. I am aware that
non-receipt of bounced email notification by the member shall amount to delivery of the Contract Note and other documents to the above mentioned email ID
(s).
(iii) 5paisa Capital Limited shall not take cognizance of out-of -office/ out of station auto replies and I/We shall be deemed to have received such electronic mails.
(iv) Such Statements shall be deemed to have been delivered on the day when the e-mail is sent by 5paisa Capital Limited.
(v) 5paisa Capital Limited shall not be liable or responsible for any Statement received from frauds or impostors or any consequences thereof.
(vi) 5paisa Capital Limited shall not be liable for any problem, which arises at my/our computer network because of my/our receiving any Statement from5paisa
Capital Limited.
(vii) I/We shall inform 5paisa Capital Limited by way of a letter in writing duly signed by me or inform through internet platform if there is any change in the Email
given above.
(viii) I/We undertake to check the Statement and bring the discrepancies to your notice within the time period as specified under the relevant agreements entered
into with 5paisa Capital Limited. My/Our non-verification or not accessing the Statement on regular basis shall not be a reason for disputing the same at any
time.
I/We shall immediately inform 5PAISA CAPITAL LIMITED about change in email address, if any. I/We further agree that5PAISA CAPITAL LIMITED will not be
responsible for non receipt of documents sent via electronic delivery due to change in/incorrect email address/correspondence address as mentioned or any
other reason which inter alia include technical reasons or malfunction of my/our computer system/server/internet connection etc. Further I/We agree and
undertake to indemnify 5PAISA CAPITAL LIMITED and its group companies, that they will not be held liable/ responsible for any losses, claims damages, cost and
liabilities etc. caused to me/us due to misuse of this information or pursuant to any litigation cases, complaints, actions, etc that may arise in future on account
of my/ our above authorization request.
Declaration
I/We confirm having received a hard copy of the following documents and further confirm having read and understood the contents of these documents.
SMS Alerts Facility by depository : I/ We consent to CDSL providing to the service provider such information pertaining to account/ transactions in my/ our
account as is necessary for the purposes of generating SMS Alerts by service provider, to be sent to the said mobile number. I/We have read and understood the
terms and conditions mentioned above and agree to abide by them and any amendments thereto made by the depository from time to time. I/We further
undertake to pay fee/ charges as may be levied by the depository from time to time. I/ We further understand that the SMS alerts would be sent for a maximum
four ISINs at a time. If more than four debits take place, the BOs would be required to take up the matter with their DP.
Terms &Conditions For Distribution of Securities.
Terms and Conditions for availing Mutual Fund Service System (MFSS) facility and BSE StAR MUTUALFUND offered by NSE and BSE respectively.
Terms and Condition for availing systematic investment in Mutual fund/Securities
The above declaration has been read and understood by me/us. I/We am/are aware of the risk involved in dispensing with the physical contract note and do
hereby take full responsibility for the same.
SOLE / FIRST HOLDER SECOND HOLDER THIRD HOLDER
Signature
Version : 1 5
Application No. 5*
DP ID:
Mumbai:
CDSP – DP ID 1 2 0 8 2 5 0 0 6 0 8 2 4 6 7 5
Keeping in view my past and proposed transaction and holding, I would like to continue / avail normal demat account.
I have also noted that being a normal demat account (Non BSDA), normal AMC as per the company’s demat tariff would
be applicable. The tariff for normal demat account (NON BSDA) are already provided and agreed under tariff sheet in KYC
Form and changed through intimation by the company from time to time.
1. I/we hereby confirm and understand that by providing this authorization we specifically waive of the right to assess
my demat account as BSDA account even if applicable by eligibility.
2. Salient Features of BSDA are kept on www.5paisa.com. Click here for salient features of BSDA account. I/we
hereby confirm to have read and understood the salient features of BSDA account.
3. I/ we confirm and understand that my demat account would be charged and treated as normal demat account (NON
BSDA) until opted otherwise by a written communication to 5Paisa.
Signature
Place: GANJAM
Version : 1 14
Application No. 5*
Consent/ Authorization to avail Margin Trading with 5paisa Capital Limited
Date: _________
To 5paisa Capital Limited,
1st Floor, IIFL House, Sun Infotech Park
Road No 16V, Plot No. B-23,
Thane Industrial Area, Wagle Estate,
Thane – 400 604
n I/we am / are interested in activating my/our account for avail margin trading funding with5paisa Capital Limited. I/we hereby
authorize you to activate my/our account for the above mentioned funding as per my consent.
n
I/we agree and understand to the terms and conditions of Margin Trading Funding provided by 5paisa Capital Limited. I/we do
hereby agree to be bind by such provisions as outlined in these documents and act in accordance with the same while availing
the margin trading funding. I/we hereby undertake to refer to the updated policies and procedure as posted on5paisa website
and abide by the same.
n I/we confirm and agree to receive all the communication such as confirmation of orders/trades, margin calls, decisions/calls to
liquidate the collateral/ positions / security on my registered email address or registered mobile number provided with 5paisa
Capital Limited send electronically by 5paisa Capital Limited.
n
I/We hereby agree that the margin funding shall carry such rate of interest as is provided in the Tariff sheet or as may be
communicated subsequently, from time to time over an email or SMS or such other form of communication, for any
changes thereof.
n
I/we understand that by availing the funding to trade under Margin Trading, i/we authorize 5paisa Capital Limited to treat
all my/our trade in group I securities, which are not covered by 100 % margin (i.e Cash in ledger) as trades under Margin
Trading Funding and accordingly i/we authorize 5paisa capital limited to report all such trades to the exchange(s) on next
day as Margin Trading Trades.
n
I/we understand and acknowledge that 5paisa Capital Limited would consider entire clear ledger credit balance in normal
trading ledger for adjustment against the margin trading funding trades (Ledger) and would levy the interest on the net
debit balance in the MTF Ledger.
Commodities Segment
n
I/We the undersigned have taken cognizance of circulars issued by SEBI / Commodity Exchanges from time to time on the
guidelines for calculation of net open positions permitted in any commodity and I/We hereby undertake to comply with the
same. I/We hereby declare and undertake that I/we will not exceed the position limits prescribed from time to time by
Commodity Exchanges or SEBI and such position limits will be calculated in accordance with the circulars on position limits
as modified from time to time. I/We undertake to inform you and keep you informed if I / any of our partners / directors /
karta / trustee or any of the partnership firms/companies / HUFs / Trusts in which I or any of above such person is a partner
/ director / karta / trustee, takes or holds any position in any commodity forward contract / commodity derivative on
Exchanges through you or through any other member(s) or Exchanges, to enable you to restrict our position limit as
prescribed by the above referred circular of Exchanges as modified from time to time. I/We confirm that you have agreed to
enter order in commodity forward contracts / commodity derivatives for me / us as your clients on Commodity Exchanges
only on the basis of our above assurances and undertaking. I/We further undertake to bear any liable/penalty/charges
levied by Commodity Exchanges / SEBI.
Signature
Version : 1 15
Policy on Handling Valid Till Triggered (VTT) and Valid Till Date (VTD) Orders
1. Background
SEBI observed that certain members offered Good Till Cancelled / Good Till Triggered orders or
orders of similar type to their clients which enabled these clients to place buying and selling orders
by specifying the price and also the time frame for which an order would remain valid for placing on
the Stock Exchange platform.
However, in case of corporate actions, such orders could lead to absurd trades thereby putting the
investors at risk of facing losses. Since the aforesaid types of orders were offered voluntarily by
members, mechanism for handling such orders varied from member to member. For corporate
action, while certain members opted to cancel such orders, while other brokers chose to not cancel
the same. In view of the above, it was decided in consultation with SEBI and Broker’s Industry
Standards Forum that the members, who offered Good Till Cancelled / Good Till Triggered orders or
orders of similar type, will be required to formulate a policy for the same.
The objective of the policy is to ensure consistent handling, minimize investor risk, and comply with
regulatory requirements.
2. Purpose
This policy establishes the procedures for managing Valid Till Triggered (VTT) and Valid Till Date
(VTD) orders more specifically in the event of corporate actions such as stock splits, bonus issues,
and other related events.
3. Scope
This policy applies to all VTT and VTD orders who may be impacted on account of subsequent
corporate actions like stock split / Bonus issue etc. It includes mechanisms for order cancellation,
modification, and client notification.
4. Definitions
• Valid Till Triggered (VTT) Orders: Orders that remain valid until triggered by a specified
condition or event.
• Valid Till Date (VTD) Orders: Orders that remain valid until a specified date.
• Corporate Actions: Events such as stock splits, bonus issues, and other similar actions that
impact the financial instruments held by investors.
Order Cancellation
• Client Notification:
◦ Notify the client of the order cancellation via email / In app notification / SMS.
◦ The notification must include:
▪ Details of the corporate action.
▪ Reason for the order cancellation.
◦ Timing: The email notification must be sent at least one trading day before the ex-date
of the corporate action. Only working days are considered for this notification.
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.
Version : 1 16
Application No. 5*
Nominee Declaration
Declaration form for opting out of nomination [Annexure B to SEBI circular No. SEBI/HO/MIRSD/ RTAMB/CIR/P/2021/601/ dated July 23,
2021 on Mandatory Nomination for Eligible Trading and Demat Accounts]
To Date 2 2 0 2 2 0 2 5
UCC/ DP ID 1 2 0 8 2 5 0 0
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 witness, along with name and address are required, if the account holders affixes thumb impression, instead of signature
Application No. 5*
First/Sole Holder Second Holder (if any) Third Holder (if any)
Indicate ( ) your Tax India U.S.A Others India U.S.A Others India U.S.A Others
1.
Residency/Citizenship/Nationality
If ticked on “Others” and/or “U.S.A”, please provide all details under point no. 2,3,4,5 below:
DECLARATION
I / We hereby declare, agree and confirm the following:
a) The details furnished above are true to the best of my knowledge and belief and shall undertake to inform 5 Paisa Capital Limited within 30 days, in case of
any change in the above given status on a future date;
b) If I /we am/are U.S. person or tax resident of a reportable foreign jurisdiction (other than U.S.), my account details, would be reported by 5 Paisa Capital
Limited to the relevant tax authority, or information may be shared with concerned Asset Management Companies (AMCs) or such other product providers, to
whom FATCA/CRS norms are applicable or to any of the Government Agencies / Tax authorities / Regulators / Exchanges / Depositories of India or of any
country other than India;
c) If my / our Country of Birth is US, however, I / We declare that I/ We are not US Person, I / We shall provide a certificate of relinquishment of citizenship
(Loss of nationality) OR a self certification stating reasons for not having such a certificate despite relinquishing US citizenship OR not obtaining US citizenship
at birth.
FH SH TH
The U.S. government introduced the ForeignAccount Tax ComplianceAct, 2010 (FATCA) for obtaining information on accounts held by U.S. taxpayers in other
countries. Further, Organization for Economic Co-operation & Development (OECD) and G20 countries agreed for automatic exchange on information through
Common Reporting Standards (CRS). The Government of India has signed an Inter-Government Agreement (IGA) with US and has also joined the Multilateral
Competent Authority agreement (MCAA) for automatic sharing of information with member countries of OECD and G20. By virtue of India signing an IGA with
US and joining MCAA, Indian financial institutions will have to provide the required financial information to Indian tax authorities which in turn would forward
reportable information to US IRS and member countries of OECD and G20 countries.
In order to implement FATCA and CRS norms in India, 5 Paisa Capital Limited is required to implement procedures to identify U.S. account holders or other
jurisdictions reportable accounts, perform due diligence and obtain documentary evidence wherever required and report details of such accounts to relevant
tax authority.
US Person means: In case of individuals, U.S. person means a citizen or resident of the United States. Persons who would qualify as U.S. persons could be
born in United States, born outside the United States of a US parent, Naturalized citizens, Green Card Holders, tax residents.
Who is Reportable Person (Non US) under Common Reportable Standards (CRS)? Under Common Reportable Standards (CRS), reportable person means
Tax residents of a reportable foreign jurisdiction other than U.S. (Please note the above information is provided only for quick reference to customers. You are
requested to consult a legal/ tax advisor if in doubt.)
Documents to be collected if Customer’s Country of birth is U.S. but declare that he/ she are not a U.S. person
1. Certificate of relinquishment of citizenship (Loss of nationality certificate); OR
2. Self certification for stating reasons for not having such a certificate despite relinquishment U.S. citizenship; OR
3. Self certification for stating reasons for not obtaining U.S. citizenship at birth
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3) I/We have agreed with tariff sheet and terms and conditions contained therein.
5) I/We have agreed to provide authorization for receipt of contract notes and other documents in digital mode.
6) I/We have agreed to provide Consent / authorization to avail Margin Trading with 5paisa Capital Limited.
7) Mode of operation for execution of transactions (Transfer, Pledge & Freeze) will be anyone of the holder.
9) 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.
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