TRADING ACCOUNT OPENING FORM

TABLE OF CONTENTS
DOCUMENT
Account Opening Form
Tariff Sheet
Acknowledgement letter
Authorization of running
account / request letter
Electronic Contract Notes
✘ Print 8 pages (3 Page to 10 page) and affix 10 signatures
MANDATORY DOCUMENTS
SIGNIFICANCE PAGE NUMBER
a) KYC Form – Document captures the basic information about 3-6
the constituent and an Instruction / Check list
b) Document captures the additional information about the
constituent relevant to trading account and an Instruction /
check list
Details the rate / amount of brokerage and other charges levied on 7
the client for trading on the commodity exchange(s)
Acknowledgement indicating receipt of documents by the client. 8
OPTIONAL DOCUMENTS
Letter of authority / request to Navia Commodities Broker P Ltd 9
Electronic Contract Notes (ECN) – Declaration 10
QUICK CHECK LIST
rd th

✘
Paste Passport size Photograph on Page 3 and Page 4 sign across (2 Photos)

✘ Sign all areas highlighted with ‘X’ symbol

Enclose Photocopy of PANCARD and address Proof with self attestation

✘

✘ Printout of Electronic Contract Note (ECN) email received from TRADEPLUS. Sign across and attach to
the KYC Form
✘ Enclose Cancelled cheque leaf to map your primary / Secondary bank account. Cheque leaf shoud
carry the IFSC Code of your bank and your Name. If not, provide last 1 month bank statement.
✘
Enclose Account Opening coupon or write the coupon code on top of page 4
✘ Write the declaration on Page No.10

REGISTERED OFFICE ADDRESS CORRESPONDENCE OFFICE ADDRESS

Subramaniam Building “Ganga Griha”, 5th Floor, No.9, Nungambakkam High
No.2, Club House Road, Chennai – 600 002. Road, Chennai – 600 034. Ph: 1800-425-75757
www.tradeplusonline.com www.tradeplusonline.com
open@tradeplusonline.com
COMPLIANCE OFFICER DETAILS SEBI Registration Number
S Krishnamurthy
Ph: +91-44-39189449 SEBI Registration No.INZ000077130
clientservice@naviacommodities.com
CEO DETAILS CLEARING MEMBER DETAILS
S K Hozefa Name: ISSL Settlement & Transaction Services Ltd.
Ph: +91-44-39189449 MCX ID: MCX/CM/CORP/1083
clientservice@naviacommodities.com

For any grievance / dispute, please contact Navia Commodities Broker P Ltd at the above address and / or email id:
support@tradeplusonline.com and / or phone number.+91-44-28214171. In case not satisfied with the response, please contact the
concerned exchange(s). For MCX, email id: grievance@mcxindia.com and Phone Number: +91-22-6731-8888.

1
 INSTRUCTION FOR FILLING THIS KYC FORM
SECTION A IMPORTANT POINTS
1. Self attested copy of PAN card is mandatory for all clients, including Promoters/Partners/Karta/Trustees and whole time
directors and persons authorized to deal in commodity derivatives on behalf of company/firm/others.
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 regional 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. 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.
SECTION B PROOF OF IDNENTITY (POI) – LIST OF DOCUEMENTS ADMISSABLE AS PROOF OF IDENTITY
1. Unique Identification Number (UID) (Aadhaar)/ Passport/ Voter ID card/ Driving license.
2. PAN card with photograph.
3. Identity card 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.

SECTION C PROOF OF ADDRESS (POA) LIST OF DOCUMENTS ADMISSABLE AS PROOF OF ADDRESS

Note: Documents having an expiry date should be valid on the date of submission
1. Passport/ Voters Identity Card/ Ration Card/ Registered Lease or Sale Agreement of Residence/ Driving License/ Flat
Maintenance bill/ Insurance Copy.
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. 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.
5. 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.
6. The proof of address in the name of the spouse may be accepted.

SECTION D EXEMPTIONS / CLARIFICATIONS TO PAN

(Note: Sufficient documentary evidence in support of such claims to be collected.)
1. 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 (subject to the continued exemption granted by Government).
SECTION E LIST OF PEOPLE AUTHORISED 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.

2
 Annexure – 1
78906300 Part - I
UCC :
KNOW YOUR CLIENT (KYC) APPLICATION FORM
(For Individuals)

(Please fill the form in ENGLISH and in BLOCK Letters)

Sign s Signature
Across
photograph
(1/10 )

SECTON A IDENTITY DETAILS

NAME OF THE APPLICANT
(as per PAN WEBSITE) BISWAJIT DEY
Father’s / Spouse Name (with Surname) MUKUL CHADRA DEY
Mother’s Name (with Surname) SHIKA DEY

GENDER ✘ MALE FEMALE MARITAL STATUS SINGLE ✘ MARRIED

STATUS ✘ RESIDENT INDIVIDUAL NON-RESIDENT FOREIGN NATIONAL (Passport copy Mandatory)
NATIONALITY DATE OF BIRTH (DD/MM/YYYY) PAN CARD NUMBER
✘ Indian Others(Please
Specify)_________________
1 6 1 1 1 9 8 3 A L C P D 0 3 8 9 C
UNIQUE IDENTIFICATION NUMBER (UID/ Aadhaar) If available 827050290291
Specify Proof of Identity Submitted ✘ PAN CARD Others(Please Specify)________________________________
SECTION B ADDRESS DETAILS
RESIDENCE/CORRESPONDENCE ADDRESS (Must be different from Proof of Identity):
32/9 GARIHAT ROAD SOUTH DHAKURIA

CITY / TOWN / VILLAGE PINCODE STATE COUNTRY

KOLKATA 7 0 0 0 3 1 WEST BENGAL INDIA
CONTACT DETAILS Tel (off) Tel (Res) Mobile No. Fax No.
NA NA 7890630060 NA
EMAIL ID (must be written in capital letters) SANDEEPTIWARY@YAHOO.COM
Specify the proof of address submitted for Residence/correspondence address AADHAR CARD
PERMANENT ADDRESS (if different from above or Overseas address, mandatory for Non-Residence Applicant):
32/9 GARIHAT ROAD SOUTH DHAKURIA

CITY / TOWN / VILLAGE PINCODE STATE COUNTRY

KOLKATA WEST BENGAL INDIA
7 0 0 0 3 1
Specify the proof of address submitted for permanent address, if any AADHAR CARD
DECLARATION
I hereby declare that the details furnished above are true and correct to the best of
my knowledge and belief and I 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 are aware that I may be held liable for it.
Signature of the Applicant (2/10)
Date : 1___/___/_____
9 0 5 2 0 1 7
FOR OFFICE USE ONLY
In person verification(IPV) Details :
Name of the Organization :NAVIA COMMODITIES BROKER P LTD
Name of the person who has done the IPV :_______________________________________________

Employee ID: ________ Designation:_________________________ Originals Verified and Self Attested Document Copies Received

Date of IPV : ___/___/_____ Signature of the Person who has done the IPV Stamp of the Intermediary

3
 Annexure – 1
Part – II (For Individuals)
Please fill the form in ENGLISH and in BLOCK Letters.
APPLICATION NUMBER COUPON CODE

Sign s Signature
Across
(3/10)
photograph

SECTION A OTHER DETAILS

GROSS ANNUAL INCOME DETAILS BelowRs.1 Lac ✘ Rs.1 – 5 Lac Rs.5 – 10 Lac
(please specify) Income Range Per annum Rs.10 – 25 Lac > Rs.25 Lac or
Net-worth as on (date) _________________ Rs. (should not be older than 1 year)
OCCUPATION Private Sector Public Sector Government Service
(please tick any one and give brief details) ✘ Business Professional Farmers Retired
House Wife Student Others (Specify)
___________________________________________
AFFILIATION Politically Exposed Person (PEP) Related to Politically Exposed Person(PEP)
(Please tick as applicable) ✘ Not Politically Exposed Person (PEP) ✘ Not Related to Politically Exposed Person

SECTION B BANK ACCOUNT DETAIL(S), if available

PRIMARY BANK NAME HDFC BANK
BRANCH ADDRESS 1 434, GARIAHAT ROAD, P. S. - LAKE, JODHPUR PARK
BANK ACCOUNT NO. 50100190572132
ACCOUNT TYPE ✘ SAVINGS CURRENT OTHERS
MICR NUMBER : 700240075 IFSC CODE : HDFC0002675
SECONDARY BANK NAME NA
BRANCH ADDRESS NA
BANK ACCOUNT NO. NA
ACCOUNT TYPE SAVINGS CURRENT OTHERS
MICR NUMBER : NA IFSC CODE : NA
Note : Provide a copy of cancelled Cheque leaf/Pass book/Bank Statement specifying name of the client, MICR Code or / and IFSC
Code of the Bank
SECTION C DEPOSITORY ACCOUNT(S) DETAILS
DEPOSITORY PARTICIPANT NAME NA
DEPOSITORY NAME (NSDL / CDSL): NA DP ID: NA
BENEFICIARY NAME: NA BENEFICIARY ID (BO ID) NA
Note: Provide a copy of either Demat Master or a recent holding statement issued by DP bearing name of the client.
SECTION D TRADING PREFERENCES
NAME OF THE NATIONAL DATE OF CONSENT FOR TRADING ON SIGNATURE OF THE CLIENT
COMMODITY EXCHANGE CONCERNED EXCHANGE (4/10)

MULTI COMMODITY EXCHANGE __________________(DD/MM/YYYY) X

SECTION E INVESTMENT / TRADING EXPERIENCE

✘ NO PRIOR EXPERIENCE _____ YEARS IN COMMODITIES _____YEARS IN OTHER INVESTMENT RELATED FIELDS
SECTION F SALES TAX REGISTRATION DETAILS (As applicable, State wise)
LOCAL SALES TAX STATE REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) NAME OF THE STATE
NA NA NA
CENTRAL SALES TAX REGISTRATION NO. VALIDITY DATE (DD / MM / YYYY)
NA NA
OTHER SALES TAX STATE REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) NAME OF THE STATE

NA NA NA

4
 SECTION G VAT DETAILS (As applicable, State wise)
LOCAL VAT REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) NAME OF THE STATE
NA NA NA
OTHER VAT REGISTRATION NO. VALIDITY DATE (DD/MM/YYYY) NAME OF THE STATE
NA NA NA
SECTION H PAST REGULATORY ACTIONS
Details of any action / proceedings initiated / pending / taken by FMC / SEBI /Stock Exchange / Commodity Exchange / any other
authority against the client during the last 3 years: NA

SECTION I DEALING THROUGH OTHER MEMBERS

If client is dealing through any other Member, provide the following details (in case dealing with multiple Members, provide
details of all in a separate sheet containing all the information as mentioned below):
Members / Authorized Person’s (AP) Name Exchange Exchange Registration Number
NA NA NA
Concerned Member’s Name with whom the AP is registered CLIENT CODE
NA NA
REGISTERED OFFICE ADDRESS: NA
Phone NA Fax NA Email NA Website NA

Details of disputes / dues pending from/to such Member / AP: NA

SECTION J INTRODUCER DETAILS (optional)
NAME OF THE INTRODUCER STATUS OF INTRODUCER AUTHORISED PERSON
EXISTING CLIENT OTHERS, Please specify_________________
ADDRESS AND PHONE NO OF THE INTRODUCER
SIGNATURE OF THE INTRODUCER
SECTION K ADDITIONAL DETAILS
Whether you wish to receive communication from Member in Electronic Form on your Email-ID ✘ YES NO
(If yes, then please fill in ECN Declaration) SANDEEPTIWARY@YAHOO.COM
SECTION L NOMINATION DETAILS
I WISH TO NOMINATE ✘ I DO NOT WISH TO NOMINATE
NAME OF THE NOMINEE
RELATIONSHIP WITH THE NOMINEE
PAN NO OF NOMINEE
DATE OF BIRTH OF NOMINEE
ADDRESS AND PHONE NO OF THE NOMINEE
IF NOMINEE IS A MINOR, DETAILS OF GUARDIAN
NAME OF GUARDIAN
ADDRESS AND PHONE NO OF THE GUARDIAN
SIGNATURE OF GUARDIAN
PRIMARY WITNESS SECONDARY WITNESS
NAME NAME
ADDRESS ADDRESS
SIGNATURE SIGNATURE
DECLARATION
1. I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I 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 are
aware that I may be held liable for it.
2. I confirm having read/been explained and understood the contents of the tariff sheet and all voluntary/non-mandatory documents.
3. I further confirm having read and understood the contents of the ‘Rights and Obligations’ document(s), ‘Risk Disclosure Document’ and ‘Do’s
and Dont’s’. I do hereby agree to be bound by such provisions as outlined in these documents. I have also been informed that the standard set of
documents has been displayed for Information on Member’s designated website, if any.
___________________________
PLACE : _________________
KOLKATA DATE: 19/05/2017
_______________(DD/MM/YYYY) X SIGNATURE OF CLIENT (5/10)

5
 FOR OFFICE USE ONLY
UCC ALLOTED TO THE CLIENT: 78906300 DOCUMENTS VERIFIED WITH ORIGINAL
NAME OF THE EMPLOYEE
EMPLOYEE CODE
DESIGNATION OF THE EMPLOYEE

DATE : (DD/MM/YYYY) 19/05/2017 SIGNATURE OF THE EMPLOYEE

We undertake that we have made the client aware of tariff sheet and all the voluntary/non-mandatory documents. We have also made the
client aware of ‘Rights and Obligations’ document (s), RDD, ‘Do’s and Dont’s’ and Guidance Note. We have given/sent him a copy of all the
KYC documents. We undertake that any change in the tariff sheet and all the voluntary/non-mandatory documents would be duly intimated to
the clients. We also undertake that any change in the ‘Rights and Obligations’ and RDD would be made available on our website, if any,
for the information of the clients.
FOR NAVIA COMMODITIES BROKER P LTD

DATE: _____________ (DD/MM/YYYY) Authorised Signatory

6
 TARIFF SHEET
I would like to subscribe to the Navia Commodities Broker P Ltd plans and request Navia Commodities Broker P Ltd
to apply any applicable monthly subscription tariff as per the terms and conditions of Tradeplus Infinity Plan of Navia
Commodities Broker P Ltd. I hereby authorize Navia Commodities Broker P Ltd to debit my Subscription
Management Portal (SMP) ledger for the subscription amount as per terms and conditions of TRADEPLUS INFINITY
PLAN.
TRADE PLUS INFINITY PLAN

✘ Subscription for a monthly fee of Rs.99/- for TRADE PLUS INFINITY PLAN. By subscribing this plan, I can do
unlimited trading in my trading account for MCX Commodity Trading Account and renew the same
automatically every month.
Or
Commodity Default Plan (0.01% with minimum of 1 paisa whichever is higher)

STATUTORY CHARGES
In addition to the above monthly subscription charges, the following statutory charges will also be levied.
Commodity Transaction Tax Stamp Duty
Transaction Charges Education and Higher Education Cess
Service Tax
 Electronic Contract Notes (ECN) is free. Physical Contract Note copies are charged at Rs.50/- per contract
note.
 Call and Trade Charges, Trade alert SMS and other charges as per terms and conditions mentioned in the
subscription management portal.
 Physical delivery of commodities will not be allowed. Agri Commodities are disabled from trading.
 Depository Participant charges as applicable.
 Terms and conditions can be subject to change.
 SMS charges Rs.99/- will be charged on monthly basis.
 Payin Charges : Atom PG Transfers - Rs.9- per transaction / Cheque Payment - Rs.15/- per transaction.
 Cheque Bounce Charges -1% of cheque value subject to minimum of Rs.250/- and maximum of Rs.1000/-
Modification charges Rs.100/- for every address details modification including bank updates. etc.,
 Terms and conditions can be subject to change.
The terms and conditions of the Navia Commodities Broker P Ltd plans have been read and understood by me. I
wish to avail the plans provided by Navia Commodities Broker P Ltd for my trading account subject to the terms and
conditions mentioned above.
I declare that I have read and understood the terms and conditions governing the Navia Commodities Broker P Ltd
TRADEPLUS INFINITY PLAN and shall agree and abide by the same.

BISWAJIT DEY
CLIENT’S NAME

CLIENT’S SIGNATURE X (6/10)

DATE (DD/MM/YYYY) 19/05/2017

7
 ACKNOWLEDGEMENT
To,
Navia Commodities Broker P Ltd
th
“Ganga Griha”, 5 Floor,
No.9, Nungambakkam High Road,
Chennai – 600 034.

Dear Sir / Madam,

I hereby acknowledge receipt of the following documents:

1. Rights and Obligations of Members, Authorized Persons and Clients

2. Risk Disclosure Document
3. Guidance Note – Do’s and Don’ts for Trading on the Exchange(s) for Investors
4. Internet & wireless Technology based Trading facility provided by Members to clients
5. Policies and Procedure
6. Terms & Conditions of Subscription Management Portal (SMP)
7. Authorization for Running Account Settlement

I understand that the voluntary documents executed by me are out of my own free will. I hereby confirm that I have clearly
understood and agree to abide by the Terms and Conditions described by Navia Commodities Broker P Ltd. I also understand
that these Terms and Conditions can be changed by Navia Commodities Broker P Ltd from time to time with prior notice of 7
days and subject to posting of the amendments and modifications therein on its website and their applicability with prospective
effect.

I state that I have read and understood all above documents including the Terms and Conditions governing commodities trading
and broking services of Navia Commodities Broker P Ltd and agree to abide by the same.

Yours faithfully,
CLIENT’S NAME BISWAJIT DEY
DATE : (DD / MM / YYYY)
CLIENT’S SIGNATURE (7/10) X
1 9 0 5 2 0 1 7

My Trade Plus Account My Number

MY ACCOUNT MY NUMBER is a unique proposition which gives the freedom to choose the number of your choice for the
account open by you. The chosen account number may be a specific pattern, a lucky number, favorite combination or just
something simple to remember! Your Trade Plus account number is 8 digit number of which you can select 8 digits basis your
preference OR choose the desired SUM of digits. Please give us your 3 preference

1. Preference 1: _________________________
78906300

2. Preference 2: _________________________

3. Preference 3: _________________________

Note:
The MY ACCOUNT MY NUMBER facility needs to be availed at the time of account opening only. Not after that. Some fancy numbers have pricing. For more
details on fancy numbers and pricing please visit www.tradeplusonline.com/fancy If all the 3 preference numbers are not available/used then we reserve
the right to allot a number of our choice. If you have choosen a fancy number but have not purchased the same, then we will allot a number of our choice.

8
 AUTHORIZATION FOR RUNNING ACCOUNT
To,
Navia Commodities Broker P Ltd
th
“Ganga Griha”, 5 Floor,
No.9, Nungambakkam High Road,
Chennai – 600 034.

I am a registered client with you, and am dealing in commodity market, and have a Navia Commodities Broker P Ltd
client code as mentioned below.

I am aware that payout/credited from the exchange(s) against settlement of transactions as per settlement cycle is
available within the prescribed time of the payout from the Exchange. It is difficult for me to make available the
required funds on every pay-in of funds obligation / margin obligation. Hence, I request you to maintain my account
on a running basis and retain the payout received / credit balance in my account for my future obligation / margin
obligation or other liabilities unless I instruct otherwise.

If payment of funds is required, I shall request you in writing or through the web option for funds withdrawal on the
web login. Further, it may be noted that if required I may revoke this authorization at any time after giving request
in writing. This running account authorization would continue until it is revoked by me. The actual settlement of
funds shall be done at least once in a monthly/quarterly if the balance available in my account is more than
Rs.50,000/-.While settling the account having outstanding obligations on the settlement date, you may retain the
requisite funds
towards such obligations and may also retain the funds expected to be required to meet margin obligations for next
5 trading days, calculated in the manner specified by the exchanges.
I shall bring any dispute arising from the statement of account or settlement so made to your notice within 7 working
days from the date of receipt of funds or statement, as the case may be. In case of non-receipt of any such
communication the statement / settlement of running account shall be considered as final as agreed and accepted
by me.
Yours faithfully,
CLIENT’S NAME BISWAJIT DEY
CLIENT’S SIGNATURE (8/10) X DATE : (DD / MM / YYYY)

1 9 0 5 2 0 1 7

AUTHORISATION FOR ACCOUNT MODIFICATION

If I were to add/modify/remove any of my detail including brokerage plans with Navia Commodities Broker Pvt. Ltd,
I authorize you to carry it out based on my request sent through an email to support@tradeplusonline.com from my
registered email address or intimation through an interface provided by you, whereto I have been allowed secured
access.

If you feel the need to do so, then at your own discretion, you may put in place appropriate mechanism to confirm the
request before or after its execution by way of a call from a recorded line, or otherwise, personal meeting, SMS or
other such other mode as you may deem fit.
Yours faithfully,
CLIENT’S NAME BISWAJIT DEY
DATE : (DD / MM / YYYY)
CLIENT’S SIGNATURE (9/10) X
1 9 0 5 2 0 1 7

9
 ELECTRONIC CONTRACT NOTE (ECN) – DECLARATION

To,
Navia Commodities Broker P Ltd
th
“Ganga Griha”, 5 Floor,
No.9, Nungambakkam High Road,
Chennai – 600 034.

Dear Sir,

I, as a client of Navia Commodities Broker Pvt. Ltd., a member of MCX, as my broker undertake as follows:

1. I am aware that the Member has to provide physical contract note in respect to all the trades placed by me unless I
myself want the same in the electronic form.
2. I am aware that the Member has to provide electronic contract note for my convenience on my request only.
3. Though the Member is required to deliver physical contract note, I find that it is inconvenient for me to receive
physical contract notes. Therefore, I am voluntarily requesting for delivery of electronic con- tract note pertaining to
all the trades carried out / ordered by me.
4. I have access to a computer and am a regular internet user, having sufficient knowledge of handling the email
operations.
5. My email id is ____________________________________________________________.
SANDEEPTIWARY@YAHOO.COM This has been created by me
and not by someone else.
6. I am aware that this declaration form should be in English or in any other Indian language known to me.

[The above declaration has been read and understood by me. I am aware of the risk involved in dispensing with the physical
contract note, and do hereby take full responsibility for the same]

(The above lines must be reproduced in own handwriting of the client -- please re-write the underlined lines above in your
own handwriting in the box provided below)

PLEASE WRITE HERE

Yours faithfully,
CLIENT’S NAME: CLIENT’S SIGNATURE (10/10) X
BISWAJIT DEY

PAN NUMBER DATE (DD/MM/YYYY) PLACE:

KOLKATA
A L C P D 0 3 8 9 C 1 9 0 5 2 0 1 7
(FOR OFFICE USE ONLY)
VERIFICATION OF CLIENT’S SIGNATURE
DESIGNATED OFFICER SIGNATURE DATE (DD/MM/YYYY)

1 9 0 5 2 0 1 7

DESIGNATED OFFICER NAME: CLIENT’S UNIQUE CLIENT CODE

78906300

10