sbicap securities A Tradition of Trust vt Application No Type of Account: |) Online Branch Client Name vt Sudnwyee SSL Branch Code _) Name BH AUVAOAR IFA Code ___ Name SBI/Asso.Name 4h SBI/Asso. Branch Code(.0 3.4 § Name WILNMBALG Chul TL/CM Code Name Scheme Code S81 EMP. = Corporate Name £ SEBI/ IRDA Registration N Aa ‘Stock Broker NSE/BSEINCDEXIMCX 1NZ000200032 Dt. 1209/2018 CLIENT REGISTRATION FORM (Broking, Demat & Mutual Fund SIP) cost Depository Participant IN-DP-CDSL-314-2017. Ot, 13/02/2017 NSDL Depository Participant IN-DP-NSDL-369-2074 DL. to062014 IRL ‘Approved Person IRDARWARZ/2015I061 ~DI. 1202/2015 NDML Approved Person IRDANR1/2014/069 Dt. 0701/2015 3 Registered Office Address ca SBICAP Securities Limited s _ ‘Corporate identity Number (CIN) : US5999MH2005PLC155485 - »* =" Marathon Futurex, A & B Wing, 12th Floor, N.M. Joshi Marg, Lower Pare!, Mumbai 400013 Phone: 022-42273300/3301 | Fax: 022-42273301 E-mail: helpdesk@sbicapsec.com | Website: www.sbismart.comTRADING CODE DEMAT NO. |_| No. @ cen athe IKRA Registration pany stating the instructions checklist for filing of the KYC A 4 Then tor cia BG “a Rogivatag [YC Form Doturnt captures the badeinemaion abot | - © | hapten Form _ KRA Registration | in individual for KRA Registration A £ i loasiecisc le Demat and | Docunent captures ie udertatng an fom We ceri wih @ idundertaking (FATCA) | Trading Account _| respect to complance with the provisions ofthe FATCA Act 4 t @ ‘Bank and other details Demat and | [Document captures the bank and other details about the individual ik é (or Trading and Deposton) Trading Account _|relevent o his trading and depository account Document capures the additonal nfonaion aod be rani (©) [pasion caer Demattccout [DenatAccont [Dacunen! abt he zs [4 ip [Sade ct cages dre and Donat and Det of epesiony snc cargos and brokerage cages wile Depostery Senie Charges Trading Account| agpicable to you Vang account Docurent caus th additonal infomation od the dial (a) [atta clas or Tang Aecont [Trang crane [DGEHTRL a a | o ee ae Denatand [Deas nominees specie bythe Gon or bab depos ana (h) [Nomination Form (OP + Trading) Trading Account ding account " (| Notes for Depository Account ‘Demat Account | Document stating the notes for opening of depository account A @ Document stating the Rights & Obigatons of stock brokertrading | member, su>broker and cent orradeg on exchanges (ncuding |g | ag ction ght and obigatonsin case of intemedeess tochnlogy based wing) 1 [RekDssoereDocoon 00) —_[Tradngreum [Psat dell ree ceed ceaginBesenrios | 5 | arp [Certain appcabo plies and procedwes of SSL signficantto the |p | at.ay (| Riots and obigations Trading Acrount () | Polices and Procedures, Trating Account |2t ee [DP-Rights ard Oblgatons (Vandatory aa igs and Obligations of Beneficial Owner (my egecee Being opened wih |Denat Account | rte seory Patpant a | 3536 Terms and conditions cum Regisvaton Prescribed by depository, Required torecsive SMS dlrs for (n)_|fom for teceiving SMS alerts rom [Demat Account |the transactions executed in the demat account crety fem the B | 3738 Jopst depository Document detain do's and 3s fer tading on exchange fo the| (0) | cudance note Tring Account [Document sing 8 | sos PARTI - LIST OF VOLUNTARY DOCUMENTS NED RTOS? © Tere RS ating cum |ocument indicate te tye of eect thatthe ce ined (0) |hcice of accounts cum Profle Sheet He open ané abit profing ofthe cient on various demographic | A 3 insurance parameters account b ere ; Dentand | Reurd ranting ils atoning 7 te [Authorisation for cept of Conract Dematand —_|Requrefor issuance of Contact Notes, Statement of Account and (©) Nett ardoter documents n=l raging Account |oher documents on te cients eile eal & | a ama a(n mia maracas (| ih [@)_| Mando fo Mutual Fund SIP ‘MaualFurd [Document capes the madate for Wutul Fund SP a_| 8 ()_NAGHTECSIAWo Dept Mandate [Muna Fund [Mandate fr Auto Debit of SIP Amount a_|_13 (a) [gers and Conditions for Mutual Ford Janie Fund | Tes end Conlon for Investing in Mutual Fund SIP a | Tn) |ConsenttorEngury KC Detais [Data Staring | Consent or sharing RYC Dstals a_| 8 rating oun lary and Lined purpose auhensatonn favour of Broker () | Debit Authorisation Demat Account |'©92bitthe cent bank account or ecavery of Account Opening A v7 ‘Account | Charges / Annual Maintenance Charges & DP Charges Es Trading oun | Voluntary and Limited purpose POA in favour of Broker for ® ‘oA |Demat Account _| operetional requirements as per client authorization / instruction x ives Vlunary Glanses for rating account Clauses required for smocth operatons ofthe cients account, {| don mandatory) Trading Account erat trading clauses. #;_| SeDear Customer, ‘Welcome to SBICap Secunties Limited (SSL) ‘We look forward to your Business and to the pleasure of serving you. To start with, we request you to complete the account opening forms, and submit the required documents. We have designed the forms for ease of completion with simple instructions at relevant places to guide you afong. Should you face any difficulty in understanding the requirements, please do not fesitate to contact our staff who will be willing to assist you. SBICAP Securities Limited (SSL) in association with State Bank of India offers Demat Trading and Bank accounts, integrated fully to offer you a Delightful trading experience which allows you to seamlessty invest onfine in Equity, Derivatives, Mutual Funds and Equity and MF Systematic Investment Plan (SIP) ‘You can also invest in these products through our pan India branch net work, Some of the facilities on offer are, - Instant Funds/ Share transfer facility - Review of Margin Status, Holding Report, Order and Trade Book on a reat time basis - Placing of After Market Orders at your convenience - Ontine real time advice/ recommendations - Incisive research reports L, well: timed advisory services - Convenient onfine facility for investment in Mutual Funds, SIPs - Telephonic Assistance through centralised Helpdesk, It shall be our endeavour, as always, to provide you a truly satisfying service. Regards SBICAP Securities Limited Registered & Corporate Office:- Marathon Futurex, 12th Floor, A & B Wing, Matatlal Mill Compound, N.M. Joshi Marg, Lower Parel, Mumbai 400013 Tel: 91-22-4227 3300 + Fax: 91-22-4227 3331 + E-mail: helpdesk@sbicapsec.com www.sbiemart.com Compliance Officer: Mrs. Dhanashree Kenkre Phone: 022-42273301 + E-mail: compliance@sbicapsec.com Managing Director: Mr. Sarbeswar Lenka Phone: 022-42273301 + E-mail: md@sbicapsec.com For any grievance/dispute please contact at the above addresses or ‘SSL at complaints@sbicapsec. com or on 1800-22-3345 (Toll Free) ‘Customers can send in their DP related grievances to : DP.Grievance@sbicapsec. com In case not satisfied with the response please contact: NSE at ignse@nse.co.in or on (022) 2659 81 90 / 1800 22 0058 BSE al is@bseindia.com or on (022) 2272 80 97SAA er? uu Know Your Client (KYO) Application No.: Application Form (For Individuals Only) 06: bic: securities SBICAP SECURITIES LIMITED Please fill ENGLISH and in BLOCK LETTERS with back ink For office use onty Account Type: eee CoSimplified (for tow risk customers) [1Smatt Application Type UERiew update (79 tnd yori) «YC CLOOL CELLO) tmandatry or update request) Pra Festtare Made Nae Cast Nae pee leeeeeres) RAVE SHANIAeIA Ht eats Green Nome BHANWAR UAL | SHiA‘RA iL rere orel LL Sluiant SINARINA Date of Bin BO - 06-4145) 008 document suomited| DH (PAN CAID Place of Bith Country ef Birth Gonder: V/NeMale CIF-Femaio [7-Transgender Marital Status: |") Marid \2/Tnmaried [Others NNationatty: \Z1N- indian Comers Tax Reskdency: [1] Only India [linda & Other County” CI Any Other Country’ Residential Status:W7 Resident Indwvidual Non Resident indian ("1 Foreign Natonal_ []Person of Indian Origin es Esa career mr TEGPSIG6 3.8 vey BHMDUGIIS CLS 4) roo oferty submited for PAN exempt casos (¥) L] UID (Aegheer [Passport] Voter 1D [1] Diving License Ocean ie ZS ence (Crom Sotr ie secur SKGomantcose)(®) (O-Otners (Li Professional | Self Employed (] Retired [1 Housewife 1 Student) > 5 B-Busipese-E}-X-Not Categonsed Rote Type of ois inary Resiciont (Cl: connesronDeNce /LOcAL ADDRESS DETAS [Li correspondence 7 Residence Proot ot Address: ZU (Aashear) Ciessport Cl orivng License voter identity Card CU NREGA Job card Sinaia 1 Unity Bi (el, lecrcty /Gae bit) BarkAle Statement} Aletment Leer [lOthers tres (UG! IMAL! ABADL HAMUIM AINGAIRM! {aied i tne2 |G AMG! ey | ei it rie aI J hy Town Vilage: LL) bit |G iQ init 2 site owen Bae AS THANen rico (33155 15) CIES Seni SST LSM SLION Sa ein coma SEE ProotofAderass: 71 UID (Aachvat sesport Cl Driving License Voter Went Card——«CINREGA Job Card ae Cluny ei a Eleewe rea Tih) [Bank Ne Statement) Aliment Lstr lothers Une 1 me +7 16LAIME) | 1915! | IABiolvIe! te2 LIE LI im 1 Cty Tom /Valege, ‘state L I ‘Not more than 2 month old Vly / Expiry de of proof ef vécross submited von [] To: tree [| appa aasa pie max PHT teen Ap SHANNEN CCSOGHACT. CoML om mune ri SN at eee ‘pence wera beans Ramon Ear teeineadege eeepc an see ate + They enue ons mat fe Cara Rg bro SHEE te ee wd era a one : AS Hi-T Proce: BIHAVIMAGHI ‘Sat melmpeen Aca * i cients a Tax Residence of any oter counties please provide Countyicounries of tax residency, TIN number, TIN issuing Countries, Cerificate of Resiiency and copy of TIN in separate (annexure provided on Page no 10). Designation rene Mane othe eninge PSI SHAH =“ (PVOoneondate| 24H / t2/ 2046 Signature of VerifierBANK AND OTHER DETAILS (FOR TRADING & DEPOSITORY) DESIGNATED BANK ACCOUNT DETAILS. Branch Name | WVILAMBAUG CHewle Bank Name 581 Branch Code Go 31¢ BranchiAddress. BH ALrAbN e Account Type L-Saving Current (Others (Specify in case of NAI/ NRE / NRO). Account. 13161 1/415 [7] 2] Gloly |r] Mich Code | 31 Giulololalo iz |iwsccoe | 6 ia itini aloléle | Please fill multiple bank accounts registration form for additional bank accounts. INCOME / OCCUPATION / PEP DETAILS 4. Gross Annual Income Details (Please tick): []Bolow 1Lac [475 Lacs []$-10Locs {| 1025 Lacs []>25 Lacs (Specify) 2. Occupation (Please tick any one) (]Zervice [ Privale Sector +P ibie Sector igor Service) Business Professional C]Agricutturist [7] Retired (] Housewife ~ [] Student T1dthers (Please specify) 3, Please tick, if applicable: [”] Polticaty Exposed Person [| Related to a Politically Exposed Person (For definition of PEP. please rafer guideline overteaf) 4. Any other information DECLARATION AND UNDERTAKING (FATCA) For the purposes of taxation, | am a resident in he following counties and my Tax lentfcation Number (TIN}/unctional equivalent in each country is Fi ‘set out below or | have indicated that a TINunctonal equivalents unavailable (kindly fil detais of ol tax residence if more than one} inst Holder: Countrylcountries | Tax Identification a Documents provided oftax residency | Number (TIN) (copy of certificate of residence or copy of TIN) Documents Required: indly provide the documentary evidence of residence or TIN for ail the countries listed in the above table. We certhy that: a) ») 2 8) e) 9) » y The information provided inthe Form is in accordance with section 285BA ofthe Income Tax Act, 1961 read with Rules 114F to 114H of the Income tax Rules, 1962 The information provided by melus in the Form, is Supporting Annexures as wel as in the documentary evidence provided by metus ae, to the best of our knowledge and Dele, true, correct and complete and that lve have not withheld any material informaton that may affect the assessmenl/categorization ofthe account as a Reportable account or otherwise We permitauthorise SBICAP Securities Limited (the Company’) to collect, store, communicate end process information relating othe Account ‘and al transactions therein, by the Company and any o its aflales wherever sivated including sharing, transfer and cisclosure between them ‘and to the authorities in andor outside India of any confidential information for compliance with eny law or regulation whether domestic or foreign, |, We undertake the responsibility to declare and disclose within 30 days fom the date of change, any changes that may take place inthe information provided in the Form, its supporting Annexuces 2s well as in the documentary evidence provided by us or if any certification becomes incorrect and to provide fresh self certification alongwith documentary evidence. We also agree thal cur failure to disclose any material fact known to us, now or in future, may invalidate our application and the Company ‘would be within its right (0 put restrictions in the operations of myfour account or close it or report to any regulator andlor any authority designated by the Government of India (GO!) /RBI or the purpose or take any other action as may be deemed appropriate by the Company if the deficiency isnot remedied by us within the stipulated period. | /We hereby accept and acknowiedge thatthe Company shall have the right and authority 10 carry out investigations from the information _avaitable in public domain for confining the information provided by me /us othe Company, It shall be my / our responsibilities o educate mysel/ ourself and to comply tal mes wit all relevant laws relating to reporting under section 285A of the Act read with the Rules thereunder. We also agree to furish such information andor documents as the Company may require from ime to tine on account of any change in kaw either in India or abroad inthe subject matter herein, : (We shal indemnity the Company for any loss that may arise to the Bank an account of providing incorrect or incorglete information RA] Date ®- Qo rho Pt ace; BHALNAGAR — Name: 12AVTONLY FOR DEMAT ACCOUNT We request you to open a Demat Account” my name as er the deta furshed inthe KYC Applicaton For and following atonal deta: 2tos. C1 nsot Type of Account (Please tick whichever Is applicable) \ZT individual Ordinary Resident C1] ncviual Director ) tndvdual Drector’s Relatve CI ndvdual HUFIAGP C1 individual Promoter Individual Margin Trading AIG (MANTRA) | Margin Account C1] Others (Specify) Hy ly Ia lel dla le ielr 13 E ADVI SHA 8H BIR « the Seed b ame fb Tied Holder ©] DELL | Guardian Details (Wwhiste’Sole holder is'a|minor)) [For account of a minor, two KYC Application Forms must be fled Le. one forthe guardian and another for the minor (lo be signed by guardian)] Name of the Guardian PAN No. Relationship of guardian with minor ‘Automatic Credit we authorise you to eazive cre in my / out account wihout any instruction frm mel us VZives Ono POAOperation | account tobe oneratod trough Power of Attornay Zves Ono ‘SMS Alert Mandslory if you ae ging Power Of Atiomey (PoA). Eneure thatthe mobile numberie provided nthe KYC Appleton Form aa First Holder ‘aves Ono Second Holder? Oves Ono Thi Holser* Oves Ono asi ideo if yes, please complete registration Iirough deposiory webste, [BO can view hisher ISIN balances, transactions and valve othe portfolio anne trough Deposiory website Trust Gos owy) | \We wish io avallihe TRUST fackty using ihe Mobile umber registered for SMS Alert Facity Ine wish to register the fofowing clearing member IDs under myiout below mentioned BO ID registered fr Trust Stock Exchange Name 1 Clearing Member Name Clearing Member 1D (Optional) ECs Do you wish lo receive dividend | interast directly in to your Designated Bank Account through ECS™ LYes [1] NO peas, ECS (if not marked, the default option would be ‘Yes') [ECS is mandatory for locations notified by SEBI from time to time] BSDA‘ Facility 1 We wish to avail the BSDA facility ives Ono Account Statement {71s per SESIRaguiation _C1Oally Clweetly —_ClFonmighty Cl Monty Standard Documents | (jeiectronic C1 Physical 1 We request you to send Electronic Transaction-cum-Holding Statement at Sole / First Holders Email ID sialedin the AoF = YET ves C1 NO. DECLARATION The sles end regulatons ofthe Depository and Depository Participants pertaining fo an account whic aren force row have beon read by melus and Ye have understood the same adie agree to abide by end lobe bound by he rules asain force rom ime tome for such accounts. le hereby declare hal he deta umished above ate tue and oorac ote best of mylour kncwiedge and bet and Uwe underteke lo inform you of any changes thee, immesalely 1Wo further agro that any fale! misleading information given by melus or suppression of any materia information wil onder my accounl able fr terminaon and suitable action. n case of noncesient accoumt, lve also dear that Ive nave comple and wil connue o comply wih FEMA regulabons. we acknowledge fe recep of copy of he document. Rights and ‘Obigatons of the Beneicial Onner and Depository Parcipa™. oe aiso agree that in case our demat account opened under BSDA faciy doesnot meet te elgibiy for BSDA facily as per guideines issued by SEBI or any such ‘authory at any point of time, my ‘our BSDA accaunt willbe converted to regu demat account witout futher reference to melus and willbe levied charges as applicable to eguaracceunts a informed by the DP. c a Ss a a Qe 6 oil Hae Name: QAUt Name Nan sn or nsDL Accu ler“ Onyior OSL Accor Heder a8v0id) = oF 3 5 @ g 6 Ss a 2 a a @ 2 8 8 & A i i | a 3 2FE ‘ACCOUNT OPENING, TRADING & DEPOSITORY CHARGES, Trading Account Charges: Account Opening Charges 850+ KRA Charges as apolcable ‘SCHEDULE OF BROKERAGE / CHARGES AND TAXES > ‘Segment Delivery FRE nt soca ae Minimum Cash Market 0.50% 075% 0.075% £005 Fature 0.05% 0.08% 0.05% z001 Denes Option &100/- T50- 50 Future 0.03% 0.015% 0.015% Gurency Derivatives, OpnenF 30) 720- 20. Partot ‘TERMS AND CONDITIONS (@} The cent willbe charged brokerage, commission, fees, depository charges, charges for short messaging alerts and applicable statutory leviesitaxes including service tax, securities transaction tax, other taxes, and transaction expenses as they exist from time to time, (0) SBICAP securities Ltd. (SSL) shall from time to time subject to Exchange!Depository provisions and restrictions imposed in this behalf by SEBI, determine and modify the amount of brokerage, charges, commission, fees, and other charges plus applicable taxes payable per transaction by the cient. Such changes will be inated to the Client by ordinary post and published on the SSL website in writing and as mutual agreed upon. y ‘The cliant shall abide by the above terms and conditions and pay applicable charges as levied by SSL to subscribe for any praduct'scheme(s} 2 Ror ese a) DEPOSITORY SERVICE CHARGES: HEAD CHARGES Accouni Mainfanance Charge incivial 7501-5000 for esalerent Accaunl Maintenance Charge Non indviual = 10001. ‘Closure of Acsount i ‘On-Market (Sell Markel / Of Market ( of transaction value of each ISIN) ‘wih POA (applicable foc On Maret Instructions ony) 0.01% (Min. 221/ Max. 300/-) For struction submited through internet 0.01% (Min. €21/- Max. €3001-) Forinstuston submited trough Branches 109s (Min, €307-Max, € 50,000 Exe Changes 107 periSIN Toate submis Buy market and oft market wil Rejection / Failed instruction _ © 10/- per failed instruction Domaterialsation | Rematerialisaton — For each request fom - Demateriatsaton 35 Extra foreach cerifiale- Dematriaisalon T5i = omateriatsaton (For each reqvest form) 35) plus € 70> for every Runered securlles or pan here ‘or a fist fee of € 10F- per certificate whichever is higher Pledge Creation/Closure/Confirmation/invocation ( of valuo for each ISIN In each request) WSSLISBI is the counter party 0.02% of Value or Min © 25!- whichever is higher (Plus COSUNSDL Charges) HSL is net the counter party 0.049% of Valve of Min €50/- whichever is higher (Plus COSLNSDL Charges) ‘Additional Accounts Statements By Cowier 730 By Email Nil "ele (1) The ave mene hares ae exc lapels intr eves! ini cing Secs Tax. 2) Senet Owner (80) fhe Donat Arcot wl be charged spicele ‘Satur eves nes sing Server Tan. es he) ext Hom rete (3) Mong od cote age har sat = connec wih Deraausison erste so808 ‘ante maling pst sare wi ba recovered acu bass, The valu shares anche s cvs 25 poe COSL NSDL ocr and res.) Tore wa be 3 charge Fs, 10 for tener ny chan sucess slempl irene! payment wougs del Gear ECS. (6) The deosloy sewees we abe to dseoninabon # SSL wrable fo ‘ecovet charge fom fe cst fey roasenwhatsowrer Ih sch cass hee wl bea cape Fis. 20 fr esamplon al sevens a serces il be resued ater minioun of {ee wre eto od lp ores et Cerra Press Cel Satan (Ar sever Pa inca ove wte aed seu er Peas 2ppicabe ro tr tine. 5. resvas he wpe rvs the ti suse tom lure ote, ay change a wi wl be communicates to he 30 win 30 dos prot note by er cxdnay pes cou. The sd ‘eve av as be payed on SSL wets www Sarat con fo G08 rmatentanmancaton, 60 eqused ae noe spseable i Seayede te SS wate KOM Une. 4 ss -sH03) Nome: QU 1. Name: Name: Date: Date Date: *Perkot_Excuing al satuor lvls. Ary concession card ales sect approval fam the competent uty mee‘TRADING ACCOUNT RELATED DETAILS: \We request you to open a Trading Account in my name as per the details furnished in the KYC Application Form and fallowing| additional details DESIGNATED DEMAT ACCOUNT DETAILS DP Name Vj 5 5- Depository {bcos NSDL BeneficiaryName | Qpy/t SHANIAP A a = DPID Ss l2lolultiztolel lemmo | TOT ITAL ‘TRADING PREFERENCES (ase sani he reovant bores hee you wish o ade The segment nt chosen shuld be stuck of bythe cient) (Cash Market ® x FA] — iDerivatives FH National Stock ee a Exchange of India| Currency FH Derivatives 2 [[2Cash Market . FH| = Derivatives FH Bombay Stock Yo 4 Exchange Currency FH CBSE Star FH Derivatives 2 MF oe PAST ACTIONS PLEASE (v) AS APPLICABLE JZT hereby declare and confirm that | have not been prohibited / deberred from dealing in securities and no penalty has been imposed on me for violation of security awsiother economic offences by SEBI or any other reguiatory authorities | also declare that no financial / criminal penalties or proceedings are pending against me. | hereby undertake to notify you forthwith of changes inthis regard and shall not do anything in violation of such orders, if any ata later date. | give hereunder details of action taken by SEBI/ Stock Exchanges / any other authority for violation of Securities laws / other economic offences during last three years. DEALING THROUGH SUB-BROKERS AND OTHER STOCK BROKERS é (a) If client is dealing through the sub-broker, provide the following details Yes aN ‘Sub-Broker (ifyes) Sebi Registration No, Registed office address Phone: Fax Website: (b) Whether dealing with any Other Stock Broker (registered win multiple members, provide detais of a) Yes LZTNo Name of the Stock Broker (yes) | Name of Exchange (i yes) | Client Code: (as given by the other broker] | |_| Details of disputestdues pending frome such stock broker sub-broker ‘ADDITIONAL DETAILS {a) eContract | Whether you wish to receive Physical Contract Note (PCN) OR Electronic Contract Note (ECN) CIPCN (ECN (c} investment/Trading Experience _ UZTNo prior investment experience CL Years of experience [Specty E-mailid] PR 6G S@GNNIL. com (b}eBroking | Whether you wish to avail internetiwireless trading facility AYES ONO (@) Do you wish to receive trade confirmation SMS/email direct from the exchanges? J4¥ES TINO DECLARATION 1. We hereby declare that the deta funished above are true and comectto the best of myfourknowedge and bei and live undertake to inform you of any changes therein, immediately. In case any ofthe above information is found fo be false or untrue or misleading or misrepresenting, | amiwe are aware that we may be held ible fort 2. We confirm having readfbeen explained and understood the contents ofthe document on policy and procedures ofthe stock broker and the lari sheet 3._ Ave further confirm having read and understood the conten of the ‘Rights and Obligations’ documents} | addtional clauses for providing InternetfWireless Based Trading ([BT) /'Risk Disclosure Document Guidance Note and Policies & Procedures. We do hereby agree to be bound by such provisions as outined in these documents. We have also been informed thatthe standard set of documents has been displayed for Information on stock broker's designated website, if any Date: Place: BAU A/AG A Ae ee 3 4 g 3 (S¥S.L137 HOO7G U! PUe HSITONS U! W9y oy) UISea AUTHORITY FOR MAINTENANCE OF RUNNING ACCOUNT VOLUNTARY \ hereby authorize SBICAP Securities Limited (SSL) to maintain a running account insteed of an account on ‘settlement to settlement basis’ for payout of funds / securities due to me unless specifically requested by me otherwise, All the funds and secunties kept to my credit by SSL may be treated as upfront margins / securties deposit, at SSL’s discretion, fr allowing exposure to me. Under this arrangement | shall not claim any interest on the funds and securities kept i the running account wth SSL also declare that | have been duly informed, that | reserve the right to revoke the authorization by giving notice in writing to you , and also understand thatthe revocation made by me shal! not be applicable against the oustanding obligations across exchanges and that youu shall retain such secures / funds expected to be required for meeting the obligations! margin obligations for next 5 trading days, as calculated in the manner spectfied by the member/exchanges | further agree and confirm that such periodic settlement of running account may not be necessary, either on a monthly or quarterly basis, if i. Lam availing margin trading facilty as per SEBI circulars. ii. Ihave provided funds received towards collaterals / margins in the form of Bank Guarantee (BG|/ Fixed Deposit Receipts (FDR). Please note that | would like the mandatory settlement of the funds and secures (if anplicable) as indicated below. (tick against your preference) [[\wonthly Basis TA Quarterly Basis ‘Nole: This authorization shal be vai if signed by the cient oly and not by any authorized person on his behalf ot any holder of Power of Attomey. bee: __ 6 we Place: BAVMAGAR eee Pax AUTHORITY FOR DIGITAL DOCUMENTS . VOLUNTARY V We hereby authorize SBICAP Securtis Limited (SSL) and consent to send the documents / communications at my / our designated email address, as mentioned in Account Opening Form instead of physical copies and the delivery of documents so made shall be effective and deemed delivery to meet the requirement of providing the said information. | agree to adhere with the terms and conditions laid down in Rights and Obligation Document (s) and same will be binding on me until revocation of this authorisation. | also deciare that I have been duly informed, that | reserve the right to revoke the authorization by giving notice in writing to SSL We undertake to inform you of any change in my email id in writing immediately. es = Date : Rot FHT aor Poe GHAUAMGA R ay ‘ACKNOWLEDGEMENT CUM DECLARATION 4. We acknowledge hereby the receiot of and confirm having ead and understood the contents of the ‘Rights and Obligations’ document(s) / additional clauses for providing Internel Wireless Based Trading (IB)! Risk Disclosure Document / Guidance Note | Polcies & Procedures and tariff sheet . We do hereby agree to be bound by such provisions as outlined in these documents. \We have also been informed that the standard set of documents has been displayed for Information on website waww.sbismart. com, 2. | We further acknawiedge hereby the receipt of Right and Obligation of Beneficial Owner and depository participant and Terms and Conditions-cum-Registration / Modification form for receiving SMS Alerts from CDSL through email/Hard copy. We have read and understood the above and le agree to abide by the same. 3. \We further confirm having read and understood the contents of Voluntary Clauses for Trading and Conditions for availing Mutual Fund (mf) Initial Public Offer (ipo) facilties. (Jie do agree to be bound by such provisions as outinedin these documents and agree to abide by them and any amendments thereto made by the SSL from time to time. [1 WWe do not agree by such provisions as outlined in these documents. Ow « ; 5 FH soe Hoa Name: RAT Name: Name: Date: =eon FORM FOR INDIVIDUALS ONLY (Demat & Trading Account) ponccounowatel Wo HI LAAJI TSE [J matna coo SOLIS: We the Scle holderiJoint holders/Guardian (n case of minor) hereby declare that EL We do not wish to nominate any one for this Demat & Trading Account. OR We nominate the following person who is enilled to receive securty and fund balances lying in mylour account, pariculars whereof are given below, i the event of the death of tha Sole holder or the death of al the Joint Holders, NOMINEE-1 DETAILS (NOMINEE-2 DETAILS: NOMINEES DETAILS: Name: HAMAR Ee = NA ee Address: SH AIM A Address ‘Address iy: stat oy Sate ory Sale Pin County Pin County Pr County Fac Tel Far Tel Fax Te. Mee Mobie Neb E-mal 0: Emal id Exmal 0: Relabonship win Nominee (any) EFETFIET2 Retaenship wih Nominee (any): Re.atenship wth Nominee (Fay 06 of Nominee: DoBot Nominee: DoB of Nominee: /IDENTIFICATION DETAILS OF NOMINEE Pan : PAN A saber F165 2SOL BIXS sone 00 adhe UD. e Others Others 3 Koti (nominee is @ minor) ‘As the, Nominee is a minor as on date, MWe appoint following person to act guardian and to receive the secures inthis account on behalf of the Nominee inthe event of death of he Soleolderfll ont holders S {GUARDIAN DETAILS) ‘GUAROIAN-2 DETAILS) ‘GUARDIAN DETAILS a Nano Nare = s Adseess Across ares 3 3 Fa oy Sie oy Sie ow Sate. 2 Pin Country Pn County Pin aunt 2 Fax: Tel Faw Tel Fax: Ta, a bie Mobic Mobi = EsmaiD E-mailID E-mail: 8 Relationship wh Nonines (any) Relaonship wit Nominee any Relonstip wi Nonines any a 08 o Nori: 008 of Nominee: 08 of Nominee: 5 IDENTIFICATION DETAILS OF GUARDIAN 2 PAN PAN Pa 8 pair 1 far 100 fata 70D 8 others Ofer Others = i -«Signaure ol Guarsian Snare ofGuatian ___ Signature ot Guardian | veniee Cees aminoos z Percentage of alacation of securites : = [LS % % %| 2 “Residual Securities (Please tick Itany) : This nomination shall suspersede any prior nomination made by me(us and also any testamentary document executed by me/ Us. , cs a o @ we ml = Z Name:_ fs Name: Name: Details of Witness e é page eee eer Name AGHL Name 1 Address BuAvMAGN NR Address 134 UV AIG HAIR wr 4 lr ee No 11 S1GS rosso eta “esa otitis Ieaeolmapb nines leas chosse any ene nono wh wl bere] wea secures rane aeration of eutes a ph define aoa you "scars reso rmoge fen meee ve redo rae ev lesa ae any ] “Any ono te own cn rove rican cl fe necirae aon, C1 Saurus Unk Abu be att ent C3OeRat AeroNOTES FOR DEPOSITORY ACCOUNT 1, All communication shall be sent at he address of the Sole/First holder only. 2, Thumb impressions and signatures other than English or Hindi or any ofthe other language rot contained in the 8th Schedule of the Constitution of India must be attested by a Magistrate or a Notary Public or a Special Executive Magistrate. 3, Instructions related to nomination, are as below: 1. The nomination can be made only by individuals holding beneficiary owner accounts on their own behalf singly or joint, 'Non- individuals including society, trust, body corporate, partnership firm, karta of Hindu Undivided Family, holder of power of attorney cannat nominate. If the account is held jointly all joint holders will sign the nornination form. 1. Aminor can be nominated. In that event, the name and address of the Guardian of the minor nominee shall be provided by the beneficial owner, Ml, The Nominee shall not be a trust, society, body corporate, partnership firm, Karta of Hindu Undivided Family or a power of ‘Attorney holder. A non-resident indian can be a Nominee, subject fo the exchange controls in force, from time to time. IV, Nomination in respect of the beneficiary owner account stands rescinded upon closure of the beneficiary owner account. ‘Similarly, he nomination in respect of the securities shall stand terminated upon transfer of the securities \V. Transfer of secures in favour of a Nominee shall be valid discharge by the depository and the Participant against the legal hel. Vi. The canceltation of nomination can be made by individuals only holding beneficiary ewner accounts on theit own behalf singly or jointly by the same persons who made the original nomination. Non- individuals including society, trust, body corporate, partnership firm, karta of Hindu Undivided Family, holder of power of atlomey cannot cancel the nomination. If the beneficiary owner account is held jointly, all joint holders wil sign the cancellation form, & % | VIL Oncancellaion of the nomination, the nomination shal stand rescinded and the depository shall not be under any obligation Z to transfer the secures in favour of the Nominee fi] 4. Forreceiving Statement of Account in electrons form: =] 1. Cent must ensure the confidentiality ofthe password of the email account 3] 1. Client must promptly inform the Participant i the email address has changed. ©] A Ghent may opt to terminate this facility by giving 10 days prior notice, Similarly, Participant may aiso terminate this facility a By giving 10-days prior notice =| 5, Stike off whichever is not applicable 6. Bank Proof: |, Photocopy of the cancelled cheque having the name of the account holder where the cheque book is issued, (or) IW. Photocopy of the Bank Statement having name and address of the BO Ml. Photocopy of the Passbock having name and address of the BO. (or) IV. Letter from the Bank, \V. In case of options (i), (i) and ((v) above, MICR code of the branch should be present / mentioned on the document. INTRODUCERS DETAILS (OPTIONAL) | Name HASMUI4 HK. AKON A ‘Status of the introducer OSub-broker Laferisr ClAuthorised Person Existing Client Clmployee of A& S C2 Other (Speciy) NE_| Ps a & ES a Address iy Ginunaone oa GUIRAT Foes 3 1 Contact Details ee lee BEC SY ELE — OFFICE USE ONLY Client interviewed By Neme.cl te enpiyes | TSH Al brat = as Employee Code e200 _* | Designation (31-4 Date 24 afro ‘Signature of the interviewer | We undertake that we have made the cient anare of Policy and Procedures, taf sheet and al the non-mandatory documents. We have also made the clent aware of Rights and Obligations’ document (s), RDD and Guidance Note. /We have givenisent him a copy ofall the KYC documents. VWe undertake that any change inthe Policy and Procedures, tar sheet and all the non-mandatory documents would be duly intimated tothe cents, INve also undertake that any ‘change inthe ‘Rights and Obigations’ and ROD would be made available on mylour website if any, for the information ofthe cients, For SBICAP Securities Limited oy— SLE Voluntary Date. 15, ‘SBICAP Secures Lid 12th foo, ARB Wing, Marathon Futurex, N/M Joshi Marg, Lower Par! (East), Mumbai - 400013 Ref. Customer Id PAN» Deer SirMadam, ‘Subject: Systematic Investment Plan (SIP) Mandate (ie, Med Mrs./ Ms,Bs. following SIP(s) forthe atove mentonad customer id Me. futher authorize SBICAP Secutios to place the SIP request with he aforesaid Asset manegement company(es) and to sgn such ‘documents /authotizatons on my /our behaf for ging effec othe seid rarsacton. Hereby request SBICAP Securit lo kindy commence the Sr. No. ‘Scheme Name ‘Amount | SIP dates (tick able) _ | Tenure (m months) (ick) 1_ | SBIBluechip Fund 1 [o10[ 520 [o28| ose | Oa | C60 2_ | SBISmall& Midcap Fund fer |o1) 020 |o25| 096 3 [ICICI Prudential Value Discovery Fund | 4 /o10! 20/125 0% 4 _ [ICICI Prudential Bluechip Fund jor |o10 20/025) 136 5 _| Reliance Large Cap Fund | {or B20 025 036 6 _| Reliance Growth Fund Lo _ {or Cte 20 | 136 7 —__ |r |c10| G20 || 36 | O48 | 8 _ jor 020 |925| 0196 | 148 | *Berpetual means no end dale. Fr operational purposes, te sid SIP wl be regstered for #89 months, Nat: f) SP requecy wil bo selected as ‘Monthly deout (2) Scher opts wil be selected a Grow” by clout We trey cont toving read theapecale es ard condos metre over 6 te website and such aha eppleable lems xd condos ss was etd) SSICAP Sorures inter varos Ass Managem Conpnes (MCS) / Rita and Tash Arts (TA) fom neo re an shal BY Hee 2 ines. Ie ogee tet shalbe my espanol eviig tee Terms and Condon, incig by criig tus the Sos. Yours Truly, “ ruta Signature of the Client Name of the Client ya | , vy movecsauronean ww || [ (2 ote TT (MAMBATE INSTRUCTION Foret = _ voty cae ‘Sparwor Bark Cod | We very autoriae | BSE Lnited to deb tek”) |SEICACESBANRESE NRO/ODEE - samaverumter || I Lil rit eel | mick To - 7 z reauenor (C] My [iy [Hoty [Tv 7] As on present Aetroen (Mande Reteree No) | a fatwa 2 (Uniqs et Ce UC) | age er ot of ana processing ce cea Taco (| Mowe not Jeo sy bss mv ir ey a 8 i se cca fe oe |_| em vero }. 2 3 _ “eas csr ho ts tts sey treed a8 amar fe ee ny Cee» oe mace Moe Toccoa ‘Rt en ne i a nr ctang Pearson enetan asaiae in = Corpraeor i bt wen ON OS, 2Terms & Conditions: {The minimum gap between clent registration date and SIP start date shouldbe 30 days and maximum 60 day, “Bark Mandate status isnot approved on ts Instaiment date (30 days from te dat of cent registration) then order wil get rejected due to unsuccessful auto debit from clients bank account, * Aer generation of 3 subsequent odes, the mandate sii remains as ‘NOT APPROVED”, such SIP registration wl be auto cancelled by the system, + SIP cannot bo cancelled ifinstalment date is faling within next 14 days. * _Ondve to date of SIP instalment, the funds wil be erect debited from the clans’ bank account meniioned in NACH form, wil be responsibiliy of ckent to maintain necessary balance in his / her designated account The funds will be direct credted to BSE and SSL willnot have any role to play pines arin that "We are elite to invest in mutual funds as pe the existing applicable rues and regulon presorbed by SEI! AMC / RTAs and SBICAP Securities, sn hereby further con having read the appicable terms and conditions mentioned onthe website and such other applicable terms and coniens as would e laid dwn by SBICAP Secures Liited or various Asset Management Companies |AMC's) 1 Registrar and Transfer Agents (RTAS) from time to time and shall atide by the same at all times. We agree that it shal be myfour responsibilty for ‘egulaly reviewing these Terms and Conditions, including by continuing to use the Services, You are requested to process my/our SIP request as above,Gonder: Male CFemale [Others Date of Birth: Profession: []Business []Service —[] Self-employed Dlothers: Marital Status: [] Single (Married PAN: Aadhar: |_| | | | Litt ty Gross Annual income Details (Please tick): CBelow1Lac C1-5SLacs (5-10 Lacs [110-25 Lacs (1>25 Lacs (Specify) (CU. CORRESPONDENCE /LOCAL ADDRESS DETAILS, Address Line + Line 2 Syston Vio: | tt | Lt | PE LT PE | lotic] | | PE TP PP PP ae LLIEL ITT itt ttt td 1} Pin Post cose: CLCURRENT/ PERMANENT/ OVERSEAS ADDRESS DETAILS Same as Conespendence/ Local Address detals Address ne + Line 2 Cty /Toun ving: |] | | | i tt | tt | 1 | | Dito I — CLLitLit tt tt tt LY} einroctcede: || | 1 11d ‘Country: Ll Li Lt Cleonracr vetans: a Tel. (om I [] Teh Res) [| Mobile FAX CH [ema T Preferred Mode of Communication: 4, Telephone / Mobile O] 2, EMail 2. PREFERRED PRODUCTS Loan [iMutual Fund []Pension Products C)General insurance [Credit Card LJOthers CJAllof the above ia DECLARATION: | hereby D authorize [1d not authorize (ick whichever applicable) SBICAP Securities Liited (SSL) for sharing of any of my informatio forthe purpose of opertion of ne trading & demat account cr for marketing and fering of venous products end services of SSL and /or any ofthe products) ‘ofits group companies, subsiciares and afiiates. | hereby authorise SSL or its relevant group companies, subsidiaries and offlates asthe case may De to contact me trough any mode including "making calssendiag SMS alerts on my registered meble phone numberor sending e-mals to my registered e-nal for marketing relaed information. ' hereby contin that ths decarationiconsent shal supersede, substiute and replace anyother consenconimatin isued by me inthis regard previously and shall apply whether or not my registered mobile umber has been regstered on "Do nat Cal egisty. Date: ‘SignatureDEBIT AUTHORISATION Client Name RAVI SHAWHPR Address 16 Ad agnor nanuman GAR Town, GYAnoAwnGAR —— ’, ARINSTHAN - 33 5513 —$6pa (Banker Name) ALLAN GAUG chHoml¢ BrLAUVAGAR ——___ Reference: Saving Current we SH ALHF2 GOLL __ Dear Sir, Subject: Debit Authorisation We entered into an understanding to open a beneficial owners account Trading Account with SBICAP Securities Limited (SSL) for availing their Depository and Trading feces. ‘Ad for the purpose of provting seamless Depositary and Trading facityby SSL |/ Wehave execuled a Power of ttrney in favour of SS t0 give structions fo the BANK for any matter concerning the purpose including debting the BANK ACCOUNT for Account Opening Charges, Depository Transacton Annual Maintenance Charges, fees towards any SSLs producs and services availed by ‘me from time to time and Other Charges applicable as mentioned in the table below or as will be intimated to me / us by SSL from time to time and payable by me/ us in respect of the above mentioned DP/Trading accounts, Wo, tho undersigned, hereby authorize THE BANK, to transfer al or any funds ftom my / our above mentioned account to sSlas may be requested for by SSL for the above mentioned charges. We confrm that requests and / or instructions given by SSL for transfer of such funds shall be completely binding on me/us. 1V We undertake that | ve shall alvay's maintain suffcient balances o enable SSL to recover | debt the aforesaid mertioned charges {rom the account and live shall not actin any manner to impair the rights of SSL to recover / debit the charges. Head Frequency Amount ‘Account Opening Charges (Individual) Once * 850/- Plus KRA Charges (As Applicable) “Account Opening Charges (Non Individual) Once 10007 Plus KRA Charges (As Applicable) ‘Annwal Maintenance Charges (Individual) Yearly @750- “Annual Maintenance Charges (Non Individual) Yearly = 1000/- _ DP Charges ~ Monthly ‘As per DP Tariff Other Charges Monthiy As Aoplicable Products / Services ‘As Applicable “As Appicable a ( Dotale of Account Holders) in Bank | . rue) : ‘retHolder Name (YAY 228 sH06 5 THO6 ‘Second Holder Name ‘Third Holder NameSECURITIES LIMITED. Depository Services Lid. _MARNTHION FUTUREX.12TH FLOOR, A & BWWING, NM, JOSHIMARG, LOWER PAREL, MUMBA! Meurasha:400013 ‘Phone -022:90278300-01, Fax-022:30273420, Email -helpseskemsbicapseccom complancecorporate@®sticapsec com, Ge wm orem oR Aran Kaw mig HORE eV pasa aia Ea sano FTO rae caaiee [ome TE oe en ood [ss am rena —— en fsa power oc od ‘ar Sa cer ar ann Se TNE erm row caroaucan Tom cmc | vaca RS OL ‘oman st AssTN lem cnteoaien fromm Sear aaa ape moins c140H, HOM sun ache ama io F aie eon amanme FR Bam i i — ata oe nme me] [Is Client in Existing Database ? NO ‘est Name: RAVI ] Middle Name PAN No : IGGPS9863B = ‘an Status : Existing and Valid ‘ast Name = SHANKER ntryDate : 24/12/2018 | Scheme : SBIEMP Rectified Scheme = ank Name : SBI ravi.shanker683@gmail.com Bank Account NO : 38115726011 Mol 2No : 7597215738 ectified Email Rectified MobileNo : fe KYC Status : PICKED UP-->Right Person-->Not Busy-->Approved For A/c opening-->Correct Email ID & Scheme puree Name Matches Pan Matches Email Matches Mobile Matches ceuity | No No No No CE_Suspended Memb | No No No No NMI_ABCD | No No a ~|No CON thitration_BSE No No No No rbitration_NSE No. No. No No. ‘SE_Defaulter_And_Exp | No No No No ‘SE_REGULATORY_DEF | No No No No ustom No No No No ustom_Group_Watchli | No No NOS — vestatus Not Applicable No No No mployee Id No No No. ranch Code: 214 Branch Name: KOHIMA Circle Name: North East DSL No No No. No SDL No ‘No No No7 ‘srrerey fentrst AINA Wey INCOME TAX DEPARTMENT GOVT. OF INDIA ward) een hen ord Permanent Account Number Card IGGPS9863B wy SHANKER 04062017 m fe hrs Nae |S DHANWAR LAL SHARMA . row ur ft | ate of eth Re 30/08/1993 wertert/ Signsture d @ IN-PERSON VERIF: SATION) SBICAP Securities Ltd. Pee EEE DP iD: 12047200 SBICAP Securities Ltd. NSE: INB 231052938/IN 231082938 DP ID: 12047200 BSE: INB 0 NSE: INB 231082038/INF 2310620: BRANCH: Bhavnagar (9055) bit VERIFIED WITH ORIGINAL SBICAP Securities Ltd. DP ID: 12047200 NSE: INB 231052938/INF 231052938 BSE:INB 0110530314 ¢ BRANCH: Bhavnagar (0062) DATE; 23(2*' ENPLOYEE CODE:_0200 JENPLOYEE NAME: Vishal Shah EMPLOYEE SIGNATURE:Ravi Shanker 3442 4638 6131 VERIFIED WITH ORIGINAL SBICAP Securitios Ltd, DP ID: 12047200 NSE: INB 231052938/INF 221052938 BSE: INB 011053034 ff BRANCH: Bhavnagar (0062) pate. 4912 2! ; Bhavnagar (0062) 30 ae ae orl, 46, ah 08, BERT OTA, ara. 335513, Sitkanwer Lal Sharma, 16, nai aad. Rajasthan = 335513 Vio : 9108 0102 7279 8643, VERIFIED WITH OR IGINAL Satay Securitios Ltd, * 120. NSE: (Mey 2310529998SL Wag tee | State Bank of ae arte siz Name — tRAVI SHANKER TEATA 8 aeartt Trees HBr Te Fee) Designation? Junior Associate (Customer Support & Sales) ae bea Sapa rc al 7851979 Seanned by CamSeanner . { yeRxiexeb WITH ORIGINAL) SBICAP Securities Ltd. DP ID: 12047200 Sit NSE: INB 231052938/INF 231052938 BSE: INB 011053031 ar (0062) OaTEag 42! 18Due of th 30.08.1993 wow: Blood group : B+ve srerrarts re: eergency Contect Mo, : VS97215738 wre art aR Pt at Lost Card if Found Scanned by CamScanner VERIFIED WITH ORIGINAL Soar pete Ltd. 12047200 NSE; INB 2510K2sGuinie 231052938 BSE: INB 011053031, BRANCH: Shavnagar (0062) DATE: *>Hs2 1y,RAVI SHANKER ‘5/0 BHAWAR LAL SHARMA 16, NAL ABADT NAT ABADI HANUMAN STATE BANK OF INDIA BHAVNAGAR, NILAMBAUG CHOWK P.B.NO.21 NILAMBAUG CHOWK Brench Code : 60318 Branch Phone : 2439562 1FSC:S81NOO60318 MICR:364002012_ Account No. : 38115726011 Pioguek. 1 SBCHQ-GEN-PUB IND-NONRURAL-INR Currency : INR GANGANAGAR 335513, ate : 21/12/2018 Time : 10:58:43 k-mail: RAVILSHANKAR6S3@GMAIL.COM Cleared Balance : 0.00 Uncleared Amount = 0.00 4+Mop Bal: 0.00 Limit = 0.00 Drawing Power: 0.00 Int. Rate: 3.50% p.2. Nominee Name: Statement From 02/12/2018 to 24/12/2038 Page No. Post Value Details chg.No- Debit credit Balance Date Date, pnoucHT FORWARD : _— Ae fe 3 ey . Se oe j weenie WITH ORIGINAL) SBICAP Securities Ltd. | notes we oe te t 2047200 | MSE: ING 23105298INF 2310829 BSE: Ii 5 seaneny Oe: NB 011053031 EMPLOYEE CODE:_0200 EMPLOYEE NAME: Vishal shan _\\Q EMPLOYE Q Statement Summary Dr. Count 0 cr. Count 0FOR OFFICE E USE ONLY BRANCH CODE [BRANCH NAME | ACCOUNT TYPE Gionune COOFFLINE Clonly Trading Cont Demat CiTrading & Demat F&O ACTIVATION (PMLA) | Coves: (no STAFF Ores no STAFF Member Cives Qo REMARKS ves Lino TFANY Name : - Sache: Karmnquilor a alge a See ae E (Claccerr Oresect Name : Ssclub-tronguikor nage | __Claccerr [REJECT Nar Dato Date: Qlaccept Grevect Date: _? Nas me: Claccerr CoReJect lami Name Name Date Date Name: Approved by Date: Date: Name: ‘Approved by : Date Date: If rejected return