krchoksey shares & securities pvt.ltd. portfolio

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KRChoksey Shares & Securities Pvt.Ltd. Portfolio Management Services CLIENT REGISTRACTION KIT Individual Private Ltd Public Ltd NRE Co -op society Trust Partnership HUF NR0 Other (Specify)__________ Client Name : - ______________________________ Client Code : - ______________________________ Demat Account No : - ______________________________ A/C opens Date : - ______________________________ Name of the Portfolio Manager KRChoksey Shares & Securities Pvt Ltd Registered Office & Contact details 1102,Stock Exchange Tower, Dalal Street, Mumbai - 400001 Phone: +91-22-66965555 | Fax: +91-22-6633 8060 Corporate Office & Contact details Abhishek Bldg, 5th Floor, Dalia Ind Estate, link road Andheri (West) Mumbai 400058- Phone: +91-22-6696-5555 | Fax: +91-22-6691 9576 Investor Compliance E-mail Id [email protected] SEBI PMS Registration. No. INP000001124 Website Name www.krchoksey.com

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Page 1: KRChoksey Shares & Securities Pvt.Ltd. Portfolio

KRChoksey Shares & Securities Pvt.Ltd.

Portfolio Management Services

CLIENT REGISTRACTION KIT

Individual Private Ltd Public Ltd

NRE Co -op society

Trust Partnership HUF

NR0 Other (Specify)__________

Client Name : - ______________________________

Client Code : - ______________________________

Demat Account No : - ______________________________

A/C opens Date : - ______________________________

Name of the Portfolio Manager KRChoksey Shares & Securities Pvt Ltd

Registered Office & Contact details 1102,Stock Exchange Tower, Dalal Street, Mumbai - 400001 Phone: +91-22-66965555 | Fax: +91-22-6633 8060

Corporate Office & Contact details Abhishek Bldg, 5th Floor, Dalia Ind Estate, link road Andheri (West) Mumbai 400058-Phone: +91-22-6696-5555 | Fax: +91-22-6691 9576

Investor Compliance E-mail Id [email protected]

SEBI PMS Registration. No. INP000001124

Website Name www.krchoksey.com

Page 2: KRChoksey Shares & Securities Pvt.Ltd. Portfolio

Instructions & Checklist

Instructions for Applicants:

1. Read the form carefully and in case of any

queries, please contact the concerned officials of

our respective local office.

2. Please fill the details in CAPITAL LETTERS ONLY

preferably with ball-point pen

(1) ‘N.A.’ shall be mentioned in the columns

not applicable to the client

3. In case of Additional Information, separate

Annexure should be attached to the Form

Signatures by all joint holders on all pages of the

Portfolio Investment Management Agreement /

power of attorney / form / Acceptance of

Proposal /annexure wherever indicated.

4. Appropriate rubber stamp must be affixed along

with all Signatures for Non-Individual Clients

5. All proofs as given below are required to be

submitted and should be certified as true.

i. All proofs should be certified as true /

verified by a Chartered Accountant or

any competent authority who is

authorized to do the same OR the

originals have to be verified at the time

of account opening by the introducing

Relationship manager /Branch Manager

ii. All proofs have to be stamped with a

“Verified against Original” stamp and

also self-attested by the applicant.

iii. All proofs need to submit for all joint

holders.

6. Specific instructions shall be given by the client to

the Portfolio Manager in case the client cannot

invest in any sector / security.

7. Signatures can be in English, Hindi or any other

languages contained in the 8th Schedule of the

Constitution of India. A Magistrate, a Notary

Public, or a Special Executive/Magistrate under

his official seal must attest languages other than

8thschedule, and thumb impressions. The Name

and Address, Tel Nos of the same are to be

provided if they do the attestation.

8. For non-residents and foreign nationals, (allowed

to trade subject to RBI and FEMA guidelines),

copy of passport/PIO Card/OCI Card and overseas

address proof is mandatory.

9. Agreement should be executed within 6 months

of the date of stamp or franking.

Checklist

For Individuals

1. Recent Photographs (signed across)

2. PAN Card Certified True Copy (Mandatory)

3. Address proof (any one of the following) Certified

True Copy

i. Valid Passport (Kindly ensure that date

of ifs validity has not expired)

ii. Aadhar Card

iii. Election Card

iv. Value Driving licensee (Kindly ensure

that date of its validity has not expired)

v. Bank Statement (Not older than 2

months)

vi. Utility Bills (Telephone /Electricity Bill,

not older than 3 months)

vii. Municipal Taxes Copy

4. Bank Proof

viii. Cancelled Cheque

ix. Bank Statement 3month (Certified True

Copy) or Letter from Banker with Seal &

Signature

For sole Proprietorship

Same as individual and the following

1. Copy of the PAN Card of firm

2. Address proof of the firm (any one of the

following) Certified True Copy

x. Registration Certificate/government

license

xi. Utility Bills (Telephone /Electricity Bill,

not older than 3 months)

xii. Bank Statement (Not older than 3

months)

Page 3: KRChoksey Shares & Securities Pvt.Ltd. Portfolio

For Non-Resident Indian (NRI)

1. Recent Photographs (signed across)

2. PAN Card Certified True Copy (Mandatory)

3. Bank proof with status of (NRE or NRO) both

Saving A/c & PIS A/C

4. Cancel cheque both Saving A/c & PIS A/C

5. PIS Permission Letter with stamp

6. Passport copy

7. OCI Copy

8. Visa Copy

9. Address proof of foreign and Indian

For PARTNERSHIP FIRMS

1. Letter of partnership firm (Letter Head)

authorizing partner/(s) to execute all the

deeds/agreement on behalf of firm

2. Certified true copy of partnership deed

3. Copy of PAN Card of partnership firm (Self

Attested)

4. Copy of PAN Card / Passport / Voter ID / Driving

License of all partners

5. A Passport size photograph of all the partners

6. Proof of the Demat Account

7. Copy of last income tax return filed

8. Verification, attestation of the Signatures of

Partners by bank

9. Copies of Balance Sheet for last 2 financial years

(Copies of annual balance sheet to be submitted

every year)

10. Photographs of Partners and/or persons

authorized to deal in securities on behalf of the

Firm

For CORPORATES

1. Passport-size photographs of each of the

authorized signatories with their signatures

across the photographs.

2. PAN Card of Company

3. PAN Card of All Directors

4. Bank proof of Company

5. Address proof of Company

6. Memorandum & Articles of Association

7. Certificate of Incorporation of the company

8. Board Resolution in company letter head

9. List of Director (Name & Signature with stamp)

with latest photograph & signature on letter head

at least two Directors

10. Share Holding pattern of company on Company's

Letter Head (Required ID proof PAN CARD & Add

Proof if shareholder holding shares more than

20%)

11. Last 2 year Annual Reports

12. Last 2-year Income Tax Returns

13. Photo proof & Address Proof of all authorized

directors (Self Attested)

14. Names of authorized signatories, their

designation, photographs and their specimen

signatures duly verified and attested by the

Managing Director or the Company Secretary.

15. Company stamp require on all signatures

16. Form No 32 (If changes in director)

17. MAPIN ID of Company (If any) DIN of minimum 2

director

18. ALL Holder KRA Required with supporting

document.

19. Aadhar card of all Authorised director

Page 4: KRChoksey Shares & Securities Pvt.Ltd. Portfolio

Account Opening Form

First / Sole Holder

Sign across Photograph

Second Holder

Sign across Photograph

Third Holder

Sign across Photograph

Status (Please √)

Individual/s

HUF

Body Corporate

NRI’s (NRE)

NRI’s (NRO)

Partnership Firm

Others (specify)

1 Discretionary Service

2 Non -Discretionary

Service

3 Advisory Service

1. General information about the client

First Holder ________________________________________________________________

FIRST NAME MIDDLE NAME LAST NAME

PAN No _________________________________________________________________

Unique ID No (Aadhar) _________________________________________________________________

Nationality _________________________________________________________________

Second Holder _________________________________________________________________

FIRST NAME MIDDLE NAME LAST NAME

PAN No _________________________________________________________________

Unique ID No (Aadhar) _________________________________________________________________

Nationality _________________________________________________________________

Third Holder _________________________________________________________________

FIRST NAME MIDDLE NAME LAST NAME

PAN No _________________________________________________________________

Unique ID No (Aadhar) _________________________________________________________________

Nationality _________________________________________________________________

Telephone No _________________________________________________________________

Email Id _________________________________________________________________

Page 5: KRChoksey Shares & Securities Pvt.Ltd. Portfolio

Primary Address ________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

Mailing Address ________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

Occupation ________________________________________________________________

Introducer Name ________________________________________________________________

Introducer Address ________________________________________________________________

________________________________________________________________

________________________________________________________________

Telephone No ________________________________________________________________

Email Id ________________________________________________________________

Annual incomes for last 3 financial years and networth as on the last date of respective years, (optional)

Year Income Net worth

2. Investment profile of the client

a. No of year Investment experience in regarding securities: ______________________________

b. Indicative % of total investment portfolio proposed to be invested with Portfolio Manager (optional). ___________

c. Overall investment goals: (please tick √)

i Capital Appreciation

ii Capital Appreciation & Regular Income

iii Regular Income

Page 6: KRChoksey Shares & Securities Pvt.Ltd. Portfolio

d. Risk tolerance (please tick √)

Low

Medium

High

e. Time period for which investments are proposed to be made with the Portfolio Manager (yrs.) optional ____________

f. Systematic withdrawal* (optional)

Monthly

Quarterly

Annual basis

*Subject to minimum portfolio value of Rs. 50 lacs

3. Detailed Investment objective of the Client (please tick √)

a. Equity: Nature of equities in which investments are desired, may be indicate __________________

b. Balanced: Percentage of debt/equity. __________________

c. Debt: Government Bonds, corporate debts etc. __________________

d. Mutual Funds, Venture funds etc. __________________

e. Others. __________________

4. Bank Account Details Bank Name : - _________________________________________________ Branch Name : - _________________________________________________ Saving Bank Account Number : - _________________________________________________ PIS Bank Account Number : - _________________________________________________ IFSC CODE : - _________________________________________________ 5. DEPOSITORY, Custodian and TRADING ACCOUNT DETAILS DP Name : - KRChoksey Shares & Securities Pvt Ltd DP ID : - ________________________________________________ Client ID : - ________________________________________________ Trading Account : - ________________________________________________ Custodian Name : - ________________________________________________ Custodian Participate Code : - ________________________________________________

6. DECLRACTION The particulars and various other details furnished above are true to best of my /our knowledge and belief. I/we future agree to inform any additional details that may be required fir better & efficient execution & performance of my / our Privilege account. I /we do not have access to un-published price sensitive information in any body corporate. I/We hereby declare that the amount invested in the same through legitimate sources / channel only and does not involve and is not designed for the purpose of any contravention or evasion of any Act, Rules, and Regulations. Notification or Directions of the provision of Income Tax Act, Prevention of Money laundering Act, Anti-corruption Act or any other applicable laws enacted by the

Page 7: KRChoksey Shares & Securities Pvt.Ltd. Portfolio

Government of India or any Statutory Authority from time to time. We wish to inform you that I/We have read and understood the contents of the Disclosure Document as specified Fifth Schedule of Regulation 14 of Securities and Exchange Board of India (Portfolio Managers) Regulation 2020, along with enclosed certificate in Form C as specified in Securities and Exchange Board of India (Portfolio Managers) Regulation 2020 and provided to me/us at least two (2) days prior of entering into the Portfolio Management Services Agreement. Additional Declaration applicable to NRIs Only: I /We hereby confirm that I am / we are Non Resident of India Nationally /Origin. I/We hereby confirm that the fund for investment have been remitted from abroad through approved banking channel or form fund in my / our Non-Resident External / Ordinary Account / FCNR Account. Risk Factors: • Securities investments are subject to market risks and there is no assurance or guarantee that the objectives of the portfolios will be achieved.• As with any securities investment, the value of the portfolio can go up or down depending on the factors and forces affecting the capital markets. • Past performance of the portfolio Manager may not be indicative of the performance in the future. • KRCSSPL (PMS) Division is not responsible or liable for losses resulting form the operations of the portfolios. • The value of the portfolios offered in this document may be affected by changes in the general market conditions, factors and forces affecting capital markets in particular, level of interest rates, various market related factors and trading volumes, settlement periods and transfer procedures. • The liquidity of the portfolio investments are inherently restricted by trading volumes in the securities in which it invests. •investors in the portfolios are not being offered any guaranteed returns. First / Sole Holder Second Holder Third Holder /Authorized Signatory / Authorized Signatory / Authorized Signatory

_____________________ _______________________ __________________

Date : - ______________________

Place : - ______________________

For Office use only :-

Page 8: KRChoksey Shares & Securities Pvt.Ltd. Portfolio

Fees Schedule

The fees payable by the Client shall be as follows.

Performance fees will be charged on High Watermark basis as per SEBI Guidelines**

Nature of Fees Fees % Please tick √

Brokerage Up to 2.5%

Fixed Management Fees based on AUM 2.00% P.A.

Performance Based Management Fees ( without Hurdle Rate)

10 % Profit Sharing

Performance Based Management Fees ( with Hurdle Rate)

Between 0% to 8% NIL

above 8% 20%

Exit Load

Between 0 - 12 months 3%

Exit after 12 months to 24 months 2%

Exit after 24 months to 36 months 1%

Exit after 36 months & above NIL

Custodian Fees As Applicable at Actuals

Depository Charges As Applicable at Actuals

GST, Security Transaction Tax & Other Statutory levies As Applicable at Actuals

Client Name : - _______________________________

Client Code : - ______________________________

Signature : - _______________________________

Date : - _______________________________

Page 9: KRChoksey Shares & Securities Pvt.Ltd. Portfolio

Note:

1) Fixed Management Fees will be charged on every quarter basis.

2) Return based fee will be charged End of the Financial Quarters or withdrawal of corpus whichever is earlier.

Illustration - Computation of Performance fee by Portfolio Manager

Sr No Particulars

Intial Corpus

A Hurdal rate Return

B Performance fee over hurdle rate (B)

C Fixed Fee

D Brokerage p.a.

E Other Expenses

I Rate of return on the portfolio

Sr No Particulars Year 5

1 Amount invested by client / Opening value 5,000,000 6,592,000 4,798,976 6,612,989

2 Portfolio Returns duing the year (=I * 1) 2,000,000 -1,648,000 1,919,590 793,559

3 Brokerage and Transaction cost @ 20bps (=D * 1) 10,000 13,184 9,598 13,226

4 Other Expenses(= E*1) 25,000 32,960 23,995 33,065

5 Fixed Management Fee (= C * 1) 75,000 98,880 71,985 99,195

6

Pre-performance fee closing value of portfolio (1+2-3-4-5)

Note : If this value exceeds the high water mark, only then shall

performance fee be charged to the client

6,890,000 7,000,000 4,798,976 4,944,000 6,612,989 6,718,566 7,261,062 7,406,548

7 Returns realised by investor (pre-performance fee) (= (6-1)/1*100) 37.80% -27.20% 37.80% 9.80%

8Returns realised by investor over hurdle rate (= 7-A, and in case of

negative returns, it shall be zero)29.80% 29.80% 1.80%

9 Performance fee levied by PM (in %) (Perf. Fee = 8*B) 5.9600% 0.0000% 0.0000% 0.3600%

10Amount of performance fee recovered by PM (high-watermark

applicable) on Capital Amount (= 9*1)298,000 0 0 23,807

11 Total Charges During the year (=3+4+5+10) 408,000 145,024 105,577 169,293

12 Net Value of the portfolio at the end of year (=1+2-11) 6,592,000 4,798,976 6,612,989 7,237,255

13 Overall Returns to investor in % (=(12-1)/1) *100 31.84% -27.20% 37.80% 9.44%

14High Water Mark for calculation of performance fee for the next

performance period6,890,000 6,890,000 6,890,000 7261062

0.50%

40.00%

Year 2 Year 3 Year 4

6,612,989

8.00%

6,592,000

8.00%

20.00%

Year 1

5,000,000

8.00%

20.00%

1.50%

0.20%

1.50%

0.20%

0.50%

-25.00%

4,798,976

8.00%

20.00%

1.50%

0.20%

0.50%

40.00%

20.00%

1.50%

0.20%

0.50%

12.00%

Assumptions:

1. Performance linked fee and fixed management fee are calculated on an annual basis (i.e, performance period = 1 year)

2. All figures in the tables have been assumed for the purpose of illustration

3. Other expenses mentioned include Custody & FA charges, RTA fees etc

Amount in Rs. Amount in Rs. Amount in Rs. Amount in Rs.

Year 1 Year 2 Year 3 Year 4

Declaration:

The client is required to state in his own handwriting in above space “I /We have understood the fees and charge structure of

the Portfolio.” in above box.

Client Name : - ____________________ Signature : - _______________________________

Date : - ___________________

Page 10: KRChoksey Shares & Securities Pvt.Ltd. Portfolio

To KRChoksey Shares & Securities Pvt Ltd Portfolio Management Services Abhishek Bldg, 5th Floor, Dalia Ind Estate, link road Andheri (West) Mumbai 400058

Sub: Declarations for considering the Cash and Securities balance as a corpus in PMS account. I/We here by inform you that

1. Securities/ Mutual fund units which are detailed in Annexure 1A, out of which the securities detailed in Annexure 1B

are being retained by KRCPMS to be included in the portfolio being managed by KRCPMS division.

2. I/We further agree that for the purpose of operation KRCPMS division can consider the My Ledger Balance i.e

_________________under my PMS account i.e _______________.

3. I/We further agree that for the purpose of operation KRCPMS division can consider my demat account

no________________________________ with Depository having name as KRChoksey Shares and Securities.

4. The instruction for transferring the funds shall be subject to the realization of the cheque and of the securities will be

subject to credit of securities in the Client’s demat account for Portfolio Management Services (PMS) purpose.

5. The securities transfer request should be accompanied / preceded with Discretionary Portfolio Management Services

Agreement and all other relevant documents.

6. The securities which are not saleable due to those being untraded / unlisted would be returned to my/our depository

account in due course.

7. The payment for the difference between the amount realised and the minimum amount for the above Portfolio

would require to be made by me/us separately.

8. If the total amount received by you (value of securities received plus the additional funds received) does not meet the

minimum investment amount criteria for the above product / scheme / portfolio or if the documents received by you

are not in order, then the application may be rejected at my/our risk, expenses and consequences and you will not be

held liable for any loss or compensation on account of this.

9. Any taxation impact / disclosure of the securities transfer to the taxation authorities will be taken care of by me/us.

First / Sole Holder Second Holder Third Holder /Authorized Signatory / Authorized Signatory / Authorized Signatory

_____________________ _______________________ __________________

Page 11: KRChoksey Shares & Securities Pvt.Ltd. Portfolio

Consent to Receive Statements

LETTER FROM CLIENT FOR RECEIPT OF STATEMENTS, REPORTS & DOCUMENTS VIA E-MAIL To, KRChoksey Shares & Securities Pvt Ltd Portfolio Management Services

Dear Sir

I/We hereby consent to receive all statements, reports and other documents as may be issued by KRCSSPL (PMS) Division

(KRChoksey Shares & Securities Pvt Ltd) in respect of my/our Portfolio Management Services account(s) as mentioned below

including but not limited to reports as mentioned under Regulation 21 of the SEBI (Portfolio Managers) Regulations, 2020, in

electronic form duly authenticated by means of a digital signature as specified in the Information Technology Act, 2000 and

the rules made there under to any of my/our below mentioned e-mail account(s) (said e-mail account(s)):

(At least one is Mandatory)

E-mail account - 1

E-mail account - 2

I/We hereby agree that KRCSSPL shall fulfil its legal obligation, if the above statement, reports and other documents are sent

electronically to any one of the said e-mail account(s).

In this regard, I/We further agree that:

I. I/We shall take all necessary steps to ensure confidentiality and the secrecy of the login and password of the above

mentioned e-mail account(s). KRCSSPL (PMS) Division shall not be liable to or responsible for any breach of secrecy.

II. E-mails sent to any of the above mentioned e-mail account(s), which have not bounced back, shall be deemed to be

duly delivered to the me/us.

III. In the event any e-mail sent by KRCSSPL (PMS) Division bounces back due to insufficient space in my/our inbox or in

the event any network problem occurs, KRCSSPL shall make the required delivery by any other electronic means

(email, fax, electronic mail attachment or in the form of an available download from back office website) or in paper

base format.

IV. KRCSSPL (PMS) Division 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.

V. Such statements, reports and other documents shall be deemed to have been delivered on the day when the e-mail

is sent by KRCSSPL (PMS) Division.

VI. KRCSSPL (PMS) Division may at its discretion discontinue to send me/us the statement, reports and other documents

in physical form.

VII. KRCSSPL (PMS) Division shall not be liable or responsible for any statement, report or document received from frauds

or impostors or any consequences thereof.

Page 12: KRChoksey Shares & Securities Pvt.Ltd. Portfolio

VIII. KRCSSPL (PMS) Division shall not be liable for any problem, which arises at my/our computer network because of

my/our receiving any statement, report, document from KRCSSPL (PMS) Division.

IX. I/We shall inform KRCSSPL (PMS) Division in writing /modification form if there is any change in the information given

above.

I/We further agree that the KRCSSPL (PMS) Division 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.

I/We further agree that KRCSSPL (PMS) Division may at its sole discretion also provide such documents in physical form.

Yours faithfully,

First / Sole Holder Second Holder Third Holder /Authorized Signatory / Authorized Signatory / Authorized Signatory

_____________________ _______________________ __________________

Page 13: KRChoksey Shares & Securities Pvt.Ltd. Portfolio

Annexure 1

DETAILS OF ASSETS HANDED OVER BY THE CLIENT

A) Fund: Rs. ___________________/- (Rupees ____________________________________) only Cheque No ___________ dated ___________ drawn on________________ Bank_______ branch.

B) Securities

Sr No ISIN Scrip Name QTY

Notes:

1. The instruction for transferring the above-mentioned funds shall be subject to the realization of the cheque and of

the securities will be subject to credit of securities in the Client’s demat account for Portfolio Management Services

(PMS) purpose.

2. When securities are handed over as Portfolio Corpus, the total value of securities are valued at the previous day’s

closing prices of the securities on the Exchange on the day when they are accepted by the Portfolio Manager shall not

be less than the minimum acceptable portfolio value determined by the Portfolio Manager from time to time.

3. Additional sheets of the above format may be attached, if required. Each additional sheet shall be duly signed by all

the joint holders.

I/We agree that the above-mentioned information regarding the share transfer is true. I/We have read the notes and take full

liability of my actions thereon.

I/We hereby give authority to KRChoksey Shares & Securities Pvt Ltd sell my/our shares mentioned herein (at the prevalent market price) and activate my/our Portfolio Management Services (PMS) account. First / Sole Holder Second Holder Third Holder /Authorized Signatory / Authorized Signatory / Authorized Signatory

_____________________ _______________________ __________________

Page 14: KRChoksey Shares & Securities Pvt.Ltd. Portfolio

SCHEDULE ‘ A ‘ Application of the Client

I/We am/are enclosing herewith the documents/agreements as required for registering as a client for availing the Portfolio Management Services. I/We hereby place Rs.___________________________/- (Rupees_______________________________________________________________________________________only) AND/OR List of Securities as detailed below

SrNo. Name of Securities Quantity

1

2

Please attach separate list of Securities, if required) As initial corpus under the Discretionary / Non-Discretionary / Advisory Portfolio Management in the following Scheme(s). I/We hereby confirm that I/We have chosen the below mentioned Scheme(s)

Plan I - KRChoksey Alpha Invest

Plan II – KRChoksey Diversified

Plan III - KRChoksey Emerging Cap

Plan IV - KRChoksey - Select Multiplier

First / Sole Holder Second Holder Third Holder /Authorized Signatory / Authorized Signatory / Authorized Signatory

_____________________ _______________________ __________________

Page 15: KRChoksey Shares & Securities Pvt.Ltd. Portfolio

To, KRChoksey Shares & Securities Pvt Ltd Portfolio Management Services Abhishek Bldg, 5th Floor, Dalia Ind Estate, Link road Andheri (West) Mumbai 400058 Dear KRCSSPL (PMS) Division

1. I/We am/are furnishing herewith the details for availing of the nomination facility for my investments in the

Discretionary /Non-Discretionary and Advisory Portfolio Management Services offered by the KRCSSPL (PMS) Division

in accordance with the existing laws.

First Holder ____________________________________________________

Second Holder ____________________________________________________

Third Holder ____________________________________________________

Permanent Address _____________________________________________________

_____________________________________________________

_____________________________________________________

2. I/We hereby appoint the person(s) mentioned below to receive all the amounts/securities to my/our credit on

my/our death.

Name of the Nominee _____________________________________________________

Address of the Nominee ______________________________________________________

______________________________________________________

______________________________________________________

Signature of the Nominee ______________________________________________________

Nominee’s relationship with ______________________________________________________

Applicant

3. In the event that the nominee is a minor

Date of birth of the minor ______________________________________________________

Name of Guardian of the ______________________________________________________

minor (Mr./Ms.)

Address of the Guardian ______________________________________________________

______________________________________________________

Signature of the Guardian ______________________________________________________

Page 16: KRChoksey Shares & Securities Pvt.Ltd. Portfolio

4. This nomination will stand cancelled in the event of my/our nominee pre-deceasing me/us.

5. Acknowledgement of receipt of the amounts to my/our credit by the nominee(s)/legal heir(s) will constitute a full

discharge of the liability of the KRCSSPL (PMS) Division.

6. I/We acknowledge that in case there is a dispute between my/our nominee and any of my/our legal heirs, KRCSSPL

(PMS) Division shall be fully discharged of its liabilities and obligations if it pays the amounts that stand to my/our

credit either to my/our nominee or to my/our legal heirs.

7. I/We have read KRCSSPL (PMS) Division rules on nomination and I/we hereby confirm to adhere to such rules or

amendments thereto as may be made from time to time.

First / Sole Holder Second Holder Third Holder /Authorized Signatory / Authorized Signatory / Authorized Signatory

_____________________ _______________________ __________________