FORM-A

Application for Consent

(For Office use only)

Date of receipt of the application :

Application Registration No. :

(Instructions: All the particulars must be filled. Enclosures indicated as “*” are mandatory. Put ‘NA’ wherever necessary.)

Before the Securities and Exchange Board of India

In the matter of …………………………..

1. Name/Trade Name of the Entity:

(a) Registration no., if applicable :

(b) Date of Registration, if applicable :

2. If broker, name of the stock exchange:

3. If sub-broker, name of stock broker with whom affiliated and name of the stock exchange:

4. Name of the segment (Cash/derivative):

5. Form of organization: corporate body/ sole proprietorship / partnership / financial institution (if listed co., details of listing) :

6. Names of promoters/directors/proprietors/partners:

7. Key Management persons :

8. Address/correspondence address, contact no./Fax no. and email:

9. Name and contact details (including e-mail) of the contact person (s):

10. Other registration(s) with SEBI, if applicable :

(a) Trade Name :

(b) Registration Type :

11. Case pending with SEBI/SAT/Court (Pl. specify) :

12. Case pending under 11B/Adjudication/Enquiry/others

(pl. specify)

13. Stage at which pending:

14. Last order in the pending proceedings (gist of the orders passed), if any :

15. Other actions pending/taken by SEBI, if any (with their status)

(a) Against the entity :

(b) Against its associates :

(d) Against its other promoters/directors

(e) Other details, if any:

16. Date of Show Cause Notice/Summons/Communication indicating probable cause of action, if any (PLEASE ENCLOSE COPIES)*

17. Facts of the case, in brief:

18. Specific charges alleged:

19. Terms of Consent proposal :

20. Personal meeting whether desired :

21. Original Documents to be attached :

(a) Undertaking (as per enclosed Format)

(b) Authority letter

22. List of other enclosures:

a) Last two years Annual Reports/ Tax Returns (in case of individuals)*.

b) In case of brokers/sub-brokers - brokerage earned during last 2 financial years and in current year, as on date (pl. enclose supporting documents).*

c) Any other relevant document (s)

(Signature of the applicant)

(SEAL)

Verification

I, ………………………………………………son/daughter/wife of (Name in block letters)

Shri …………………………………..being the applicant/Authorised Representative (in case of corporate entity) of ……………………. do hereby verify and affirm on oath that I have been authorized by …………to make this application and the contents of paras 1 to 22 are true to my personal knowledge and belief and that I have not suppressed any material facts.

(Signature of the applicant)

Date:

Place :

Format of Undertaking

Undertaking to be submitted alongwith the application on Rs. 200/- non-judicial stamp paper-duly notarized.

Undertakings/Waivers:

I/We, …………………, the applicant herein, as a condition of making the enclosed application to SEBI for passing of appropriate consent order, hereby declare that I/we agree and undertake that:

1. Securities and Exchange Board of India (SEBI) may enforce any claims against me/us arising from or relating to any violation of the consent order passed pursuant to this application.

2. Nothing in this Order shall preclude any investor from pursuing any other legal remedy to which the investor may be entitled.

3. The amount of settlement including settlement charges/legal expenses, if any, shall be paid by me/us to SEBI within the period as may be specified by the order.

4. If payment is not made by me/us as per the Order, SEBI may vacate the Order at its sole discretion, after giving 15 days notice in this regard without opportunity for any hearing.

5. For any person or entity not a party to these proceedings, the Order does not limit or create any private rights or remedies against me/us.

6. The Order and any dispute related thereto shall be construed and enforced in accordance, and governed by, the relevant laws.

provided, however, that SEBI may enforce any claims against me/us arising from or relating to any violation of the Order as contained herein.

7. The Order passed pursuant to this application shall conclude any/all disciplinary action the SEBI could bring against me/us for the conduct (cause of action) set forth in this application (SCN).

8. I/we agree that once the order is passed in terms of the consent terms accepted by me, I/we shall not take any action or make or permit to be made any public statement denying, directly or indirectly, any finding recorded in the Order or creating the impression that the Order is without factual basis. Nothing in this Paragraph however affects my/our (i) testimonial obligations or (ii) right to take legal or factual positions in defense of litigation or in defense of a claim or other legal proceeding in which the SEBI is not a party.

9. I/we admit the jurisdiction of SEBI on the subject matter.

10. I/we neither admit nor deny the findings of fact and conclusions of law to be part of the consent order, and consent to enter into the consent Order as may be passed by SEBI/AO as settlement of the issues contained in this application, in lines with the consent terms agreed by me.

11. I/we understand that SEBI may issue a press release or any other mode of communiqué for public information about the order passed in these proceedings and the subject matter thereof as SEBI may deem appropriate.

Further,

I/we shall waive my/our right of taking any legal proceedings against SEBI concerning any of the issues covered by the consent order, as more particularly setout herein :

12. All hearings pursuant to the statutory provisions under which the proceeding is to be or has been instituted;

13. The filing of proposed findings of fact and conclusions of law;

14. Proceedings before the Board or any officer;

15. All post-hearing procedures; and

16. Appeal/review before/by SAT/ courts.

17. Applicability of Such provisions of the Regulations or other requirements of law as may be construed to prevent any officer of SEBI from participating in the preparation of, or advising the Competent Authority as to, any order, opinion, finding of fact, or conclusion of law to be entered pursuant to the offer;

18. Any right to claim bias or prejudgment by SEBI based on the consideration of or discussions concerning settlement of all or any part of the internal proceedings;

19. Any plea of limitation for reopening the case, if I/we violate/do not comply with the consent order subsequently, and SEBI shall be free to take any enforcement action including initiation of adjudication / prosecution proceedings against me/us for such violation/non-compliance of the consent order.

20. Any plea of limitation for restarting the case if the matter is not settled by passing of consent order by SEBI. I further undertake that in such a case, the time spent during the consent proceedings shall be excluded for computing the limitation for initiating any legal proceedings against me/us.

(Signature of the applicant with seal of the company/entity)

before me

(Advocate)

Notary