STATEMENT OF HOLDINGS OF OFFSHORE DERIVATIVE INSTRUMENTS TO BE SUBMITTED BY FOREIGN INSTITUTIONAL INVESTORS / SUB ACCOUNTS IN TERMS OF SEBI CIRCULAR NO. FITTC/CUST/14/2001 DATED OCTOBER 31, 2001.
STATEMENT FOR THE PERIOD ______________________________
| FII NAME | |
| FII REGISTRATION NO. | |
| SUB ACCOUNT NAME (IF APPLICABLE) |
|
| SUB-ACCOUNT CODE (IF APPLICABLE) |
STATEMENT NO. ____________
| Information on Investors | General Information on Offshore Derivative Instrument | Quanity and Value Information on Offshore Derivative Instrument | Quantity and Value Information on Underlying Indian Securities | |||||||||||||||||||||||||||||||
| A | B | C | D | E | F | G | I | J | K | L | M | N | O | |||||||||||||||||||||
| Sr. No. | Name and Location of the person to whom the Offshore Derivative Instruments are issued. | Name and Location of other person in case back to back Offshore Derivative Instruments has been issued against the instument mentioned in A | Type of the investor (e,g hedge funds , corporate, individual, pension fund, trust etc) This information should be given for column 'B', in case column 'B' information is Nil furnish information for column 'A' | Name of the Offshore Derivative Instrument | Nature of underlying securities (Equity/ Debt/ Derivatives) | Name of the Indian Company (In case underlying is Equity /Debt) Name of the derivatives in case underlying is derivative | Issue Date of Offshore Derivative Instruments | Maturity Date of Offshore Derivative Instruments | Face Value of Offshore Derivative Instruments | Maturity Value of Offshore Derivative Instruments | Opening Balance | Issued / Renewed | Redeemed/ Cancelled | Outstanding | Opening Balance | Issued / Renewed | Redeemed/ Cancelled | Outstanding | ||||||||||||||||
| Qty | Value | Qty | Value | Qty | Value | Qty | Value | Qty | Value mentioned in column 'O' of the last preceding Statement | Qty | Value | Qty | Value | Qty | Value as on the last date of Statement | |||||||||||||||||||
| USD | INR | USD | INR | USD | INR | USD | INR | USD | INR | USD | INR | USD | INR | USD | INR | |||||||||||||||||||
| Total | ||||||||||||||||||||||||||||||||||
We undertake that we/associates/clients have not issued / subcribed / purchased any of the offshore derivative instruments directly or indirectly to/from Indian residents/NRIs/PIOs/OCBs during the Statement Period.
Date:
1. Offshore derivative Instuments will include Participatory Notes, Equity - Linked Notes, Capped Return Note, Participating Return Note, Investment Note and similar instruments issued by FIIs/SA s outside India against their underlying investments in India.
2. This Statement shall be submitted by FIIs/ SA s on a fortnightly basis and should be sent by E-mail to nithinsb@sebi.gov.in or santoshks@sebi.gov.in within three working days of the closure of the fortnight.
3. Values in USD and INR should be rounded off to the nearest million
4. Value in USD should be given as at the issuance date and corresponding INR value at the exchange rate prevailing on the date of issuance except in column 'M' and 'O'.
5. Value refered in column 'O' should be value of the underlying at the closing rate prevailing in the National Stock Exchange of India on the last day of the statement
6. This Statement should be prepared in three sections:
First section should contain information on Offshore Derivative Instruments with underlying as Equity,
Second section should contain information on Offshore Derivative Instruments with underlying as Debt and
Third section should contain information on Offshore Derivative Instruments with underlying as various Derivatives traded in Indian Stock Exchanges.
7. The statement in question is a fortnightly statement e.g. 1st to 15th and 16th to last date of each month.