Form II

Application for Recognition of Intermediary for Access to KRA services

To
NSE Data & Analytics Limited
Exchange Plaza, Bandra Kurla Complex,
Bandra (E), Mumbai – 400051.

Dear Sir / Madam,

We understand that pursuant to SEBI (KYC Registration Agency) Regulations, 2011 and subsequent SEBI Guidelines
thereon, you are providing KRA services.

I / We ________________, a SEBI registered intermediary (“Intermediary”) are desirous of availing your KRA services. I
am / We are currently registered with SEBI in the following capacities (Tick where applicable) with SEBI registration
number _______________.

Trading Member Depository Participant Mutual Fund

Portfolio Manager Venture Capital Fund Collective Investment Scheme
Others __________________

All details required for the approval are enclosed at Annexure I.

Enclosures:-
1. Copy of SEBI Registration Certificate* 2. Copy of PAN Card
3. Copy of the latest Balance Sheet* 4. ‘Terms and Conditions’*
5. Details of Director(s) / Partners* 5. GST Certificate
* Certified by Designated Director / Whole Time Director / Company Secretary along with seal / stamp of Intermediary.

We request you to consider our application for recognition favorably.

For <Name of the Intermediary>

_____________________________________________
Name
Designated / Whole Time Director / Company Secretary
Seal of the
Intermediary
Signature

Place: _____________________ Date: _____________________

-------------------------------------------------------------------------------------------------------------------------

For Office Use

Date of Receipt
Verified By
KRA reference number

NSE Data & Analytics Limited. Page 1

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 DECLARATION

I / We agree to abide by the provisions of the SEBI (KYC Registration Agency) Regulations, 2011, and any subsequent
amendments thereof, and other SEBI / NSE guidelines as in force from time to time. In case any of the above information
is found to be false or untrue or misleading or misrepresenting, I am / We are aware that I / we may be held liable for it.
I / we undertake to inform you of changes to the information above immediately.
I/We agree, acknowledge and undertake that, I/We shall at all times be solely responsible and liable for any/all
acts/omissions of our User(s) including without limitation any unauthorized access by our User(s) leading to data
leakage, misuse of data/information and/or breach of the terms of the KRA services.
For the purpose of this Application the word “User(s)” shall mean and include the following:
a. any/all entities, individuals, employees of the Intermediary and any third parties accessing the KRA services from
and on my/our behalf
b. Any/all entities, individuals, employees of the Intermediary and any third parties to whom I/We have provided
the access to the KRA services pursuant to this application.

I, the SEBI registered intermediary, understand that NSE Data & Analytics Ltd’s KRA Services (herein after referred to as “KRA
Services”) are subject to the terms and conditions as set out below (as changed / updated from time to time entirely at the discretion of
NSE Data & Analytics Ltd).

I, am accessing and using the KRA services solely for the purposes as expressly permitted by NSE Data & Analytics Ltd.
The term “Client” shall mean and include my clients/customers.
The term “sensitive personal data or information” hereinafter collectively referred as “Data” shall have the same meaning as assigned
to it under the Information Technology Act, 2000 read along with The Information Technology (Reasonable Security Practices and
Procedures and Sensitive Personal Data or Information) Rules, 2011.
By using the KRA Services, I represent and warrant to NSE Data & Analytics Ltd to comply with any/all requirements under the
Information Technology Act, 2000 read along with The Information Technology (Reasonable Security Practices and Procedures and
Sensitive Personal Data or Information) Rules, 2011 and any/all other applicable laws/rules/regulation for data, information and
personal data protection (collectively referred as “Data Protection Laws”) at all times.
I specifically agree, acknowledge and declare that:

1. I have informed the Client about the purpose for which the Data of the Client is required and I shall use the data solely for the
purposes as permitted expressly by the Client.
2. I have taken a prior written consent either by way of a lawful contract or letter/Fax/email etc from each Client to use the
Client’s Data solely for the purposes as permitted by the Client.
3. I shall ensure at all times that the Data shall be used only for lawful purposes as permitted by the Client.
4. I shall at all times ensure that any Data shall only be collected and used when it is absolutely necessary the purposes as
permitted by the Client.
5. I shall inform the Client about any/all recipients and/or intended recipients of the Data along with such recipient’s name,
address etc along with the details of the agency/entity that may retain such Data.
6. I shall maintain the relevant documents and records (as applicable) for a period as may be prescribed under the applicable
laws.
7. I shall be solely responsible and liable for verifying the accuracy, quality, and legality of the Data provided by the Client and
NSE Data & Analytics Ltd shall be under no obligated to examine and/or verify any Data.
I agree to indemnify and hold NSE Data & Analytics Ltd, its subsidiaries, affiliates, officers and employees, harmless from any/all
claims, actions, proceedings, demands or damages, including reasonable attorney’s fees, asserted by any Client, third party or any
government or regulatory body arising out or relating to (i) breach/non-compliance of the Data Protection Laws by me (iii) any
unauthorized usage of the Data by me (iii) breach of any of the terms stated herein by me including any fraud or fraudulent
misrepresentation, wilful misconduct, gross negligence and default.

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Signature : _____________________

Annexure I

Particulars Details
Name of the Intermediary
SEBI registration Number
PAN
CIN
GST number
GST as per address*
Place of Supply
Compliance Officer Name
Designation
Email Id
Tel No.
Mobile No.
Fax No.
Contact Person Name
(for KRA activities) Designation
Email Id
Tel No.
Mobile No.
Fax No.
Registered Office Address Line 1
Line 2
Line 3
Line 4
City / Town
Pin Code
State
Country
Whether correspondence address is same as the Registered Office address:
If no, provide Correspondence address details
Correspondence Address Line 1
Line 2
Line 3
Line 4
City / Town
Pin Code
State
Country

* Details of Partners / Directors / Trustees are attached hereunder

Maximum Number of Directors and Partners of directors*:

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NSE Data & Analytics Limited. Page 4

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 Name
Designation
DIN
PAN*
Residential Address* Photograph

Tel / Mobile No

Name
Designation
DIN
PAN*
Residential Address*
Photograph

Tel / Mobile No

Name
Designation
DIN
PAN*
Residential Address*

Tel / Mobile No

Name
Designation
DIN
PAN*
Residential Address*

Tel / Mobile No

*With necessary proofs

Photograph
NSE Data & Analytics Limited. Photograph Page 5

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