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    Business Associate Information Form-Subbrokerapplicationform

    Uploaded by

    kavya.r

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd

    Business Associate Information Form-Subbrokerapplicationform

    Uploaded by

    kavya.r
    12 views6 pages

    Original Title

    Business_associate_information_form-subbrokerapplicationform

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    © © All Rights Reserved

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    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    12 views6 pages

    Business Associate Information Form-Subbrokerapplicationform

    Uploaded by

    kavya.r

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    of 6

    BUSINESS ASSOCIATE INFORMATION FORM

    To,
    Wellworth Share and Stock Broking Limited
    501, Akruti Orion, 5th floor,
    Shraddhhanand Road,
    Vile Parla (East),
    Mumbai – 400057

    Dear Sir / Madam,

    I / We request you to register me/us as your Business Associate and enable me/us to market your
    broking services pursuant to the Memorandum of Understanding/ Agreement entered into with you.
    In this regard, I/we give the following information.

    BUSINESS RELATED DETAILS

    Name of Business Entity

    Individual / Partnership / Company

    PAN No. (Firm/Company)

    Date of Registration if Partnership/Company

    Place of Business

    Address

    Pin:
    Phone No (Office) (Code & No)

    Fax (Office) (Code & No)

    Type of Premise : Ownership / Lease

    Area of the Office (Sq. Ft.)

    Details of Bank Account

    DETAILS OF PROPRIETOR / DOMINANT PARTNER / DOMINANT DIRECTOR (as applicable)

    Name of Proprietor / Partner / Director

    Partner's / Spouse's name

    Percentage Holding (if applicable)

    Date of Birth

    Nationality

    Residential Address

    Residential Phone No
    Mobile No
    Other occupation, If any
    Educational Qualification
    Business Experience
    Type of service rendered
    No of years
    Income Tax PAN No
    Proof of Identity
    Proff of residence
    Email Adress

    TAILS OF PARTNER IN CASE OF PARTNERSHIP/ DIRECTORS IN CASE OF COMPANY (FILL THESE


    TAILS FOR ADDITIONAL PARTNERS/ DIRECTORS) whichever is applicable.
    1)Name of Partner/ Director

    Fathers / Spouse's name

    Date of Birth

    Nationality

    Residential Address

    Residential Phone No

    Mobile No

    Other occupation

    Educational Qualification

    Investment business experience

    Type of service rendered

    No of years

    Incomem Tax PAN No

    Proff of identity

    Proff of Residence

    Email Adress

    2)Name of Partner/ Director


    Fathers / Spouse's name

    Date of Birth

    Nationality

    Residential Address

    Residential Phone No

    Mobile No

    Other occupation

    Educational Qualification

    Investment business experience

    Type of service rendered

    No of years

    Incomem Tax PAN No

    Proff of identity

    Proff of Residence

    Email Adress

    3)Name of Partner/ Director

    Fathers / Spouse's name

    Date of Birth

    Nationality
    Residential Address

    Residential Phone No

    Mobile No

    Other occupation

    Educational Qualification

    Investment business experience

    Type of service rendered

    No of years

    Incomem Tax PAN No

    Proff of identity

    Proff of Residence

    Email Adress

    APPLICABLE IF HOLDING SUB-BROKERSHIP OF OTHER BROKERS

    Details of other sub - brokership

    Name of the broker

    Period since holding sub-brokership

    The information furnished above is true to the best of my knowledge and belief, and I undertake to immedi-
    ately keep you informed in writing of any changes therein. I also declare and agree that if any of the above
    statements are found to be incorrect or false or any information or particulars have been suppressed or
    omitted therefrom, the above mentioned company / firm / ______________________________ and I would
    be liable to be debarred from doing business of marketing in broking services. I also agree to furnish such
    further information as the member or the Exchange may require from me and I agree that if I fail to give
    such information, the member shall have the right to cancel the above mentioned company / firm /______
    ___________________________ Business Associate arrangement.

    Date: ______________________ Signature: __________________

    Place: _____________________ Name: ______________________

    Note:
    1) If any information required to be given does not fit in the form, an annexure may be used.
    2) Proof of identity - Self Attested : PAN Card / Driving License / Passport / Voter Card (provide any one)
    3) Proff of adress - Self Attested : Ration Card / Passport / Voter's Card / PAN Card / Driving Licence/
    Bank Passbook (provide any one)

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