Client Registration Form A recent photograph

in light background of
the
Name of Member: applicant/signatory

Type of Membership:
Client Registration Number: Please affix and sign
on the photograph
Applicable Commission: C1 C2 C3
AE Name: AE Code:
Address:
Telephone: Fax: Email:

DETAILS OF FEE DEPOSITED

Amount: Draft No/Deposit Voucher/Cheque No.:
Bank: Date:

**TO BE FILLED BY INDIVIDUAL ONLY

First Name Middle Name Last Name
Name:
Father’s/Spouse Name:
Date of Birth: [DD/MM/YYYY] Age: Occupation:
Nationality/Residential Status: Passport No/Citizenship No.:
Home Address: City:
Pin Code: Telephone: Fax:
Mobile No.: Email:
Address for communication (if different from the Home Address):
City:
Pin Code: Telephone: Fax:
Mobile No.: Email:

TO BE FILLED BY COMPANIES/CORPORATION/PARTNERSHIP FIRM/

PROPRIETORSHIP FIRM OR ANY OTHER ONLY
Name:
Date of Incorporation/Registration: [DD/MM/YYYY]
PAN Number:
Registered Office Address: City:
Pin Code: Telephone: Fax:
Website: Email:
Address for communication (if different from the above):
City:
Pin Code: Telephone: Fax:
Website: Email:
Name of the Proprietor/Managing Director/Chairman/Chief Executive Officer: _____________________
___________________________________________________________________________________

Name of the authorized person: _________________________________________________________

Name of other Exchange(s) in which the applicant is/was a member: ____________________________

___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________

Name of other Exchange(s) in which any of the director/partner/proprietor is/was a member: __________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

Permanent Account No.: ____________________

Details of Bank Account:
Name of Bank: ______________________________________________________________________
Name in Bank record: _________________________________________________________________
Branch: _________________________________ Account Type: _______________________________
Account No.: _____________________________

DECLARATIONS:
a) Whether any court case is pending against the applicant or partners/directors/promoters of the
applicant? YES / NO
b) Whether the applicant or the partners/directors/promoters of the applicant is involved any financial
irregularities and subject to any disciplinary proceedings? YES / NO
c) Whether the applicant or partners/directors/promoters of the applicant were subject to any
disciplinary proceedings in any other exchange. YES / NO
d) Whether the applicant having any active trading account under the same NCM. YES / NO
e) Whether the applicant has read, understood and fully aware of the risk disclosure and terms and
conditions of the agreement with NCM? YES / NO
(if answer is yes in clause (a) and (b) above, please furnish the details of such financial
irregularities and/or disciplinary action in a separate sheet)
I/We hereby declare that the information furnished in this application is true and correct and the
documents annexed with this application are true copies of its original. I/We undertake to inform the
Member, in writing, immediately of any changes in the information furnished by me in this application.
The Member or the Exchange will not be liable for any direct/indirect consequences arising on account of
non intimation changes in the above information.

I/We understand the contents of the Risk Disclosure Document and also agree to abide by the Bye-Laws
and Rules of the Exchange.

Signature: __________________ Thumb Print of Client:

Place: Right Left

Date:
(Seal)

DOCUMENTS TO BE SUBMITTED ALONG WITH THE CLIENT REGISTRATION FORM

1. [ ] Proof of Identity and Proof of Address.
2. [ ] Proof of Bank Account Number.
3. [ ] Self certified photo copy of the PAN Card.
4. [ ] Original Bank Deposit Voucher.
5. [ ] Resolution authorizing for application for registration and authorizing the signatory.

Verified By:
Name of NCM: ______________________________________________________________________
Name of the Authorized person of NCM: __________________________________________________
Signature of Authorized person of NCM: __________________________

Date: _____________ Seal of NCM: _________________________

Verified By:
Name of CM: ________________________________________________________________________
Name of the Authorized person of CM: ___________________________________________________
Signature of Authorized person of CM: __________________________

Date: _____________ Seal of CM: __________________________