Pan Proposal Form

FAN PROPOSAL CUM EVALUATION FORM Type: FAN – P / FAN - I Name of the FAN Status of the FAN (Individual / Sole Proprietorship / Partnership / Corporate) Key contact person Business location address

City:

Taluka:

Dist:

State:

PIN Code:

Residence address

City:

Taluka:

Dist: Contact detail

State:

Office

:

Resi

:

Mobile

:

Pin Code:

E – Mail ID : Whether business & office address same

Yes / No

PAN Card No. FAN Terms Deposit

Cheque : Rs. Shares ( ‘A’ Category ) : Rs.

Sharing Terms VSAT Required (Yes / No) Applicable for FAN - P INFRASTRUCTURE DETAILS Office (Owned / Rented) Office Area

Sq. ft. :

NCFM Certificate details NSE Cash

Name:

No:

BSE Cash

Name:

No:

Derivatives Current Broking Tie Ups Yes / No (If Yes) Specify the details of company with existing Proposal

Name:

No:

No. of Clients Brokerage Structure Brokerage sharing pattern Gross Brokerage avg. per month (for 6 months)

Is there any IndiaiInfoline Branch nearest to your office? Yes / No (If Yes) Specify the distance in kilometers with complete address of Branch

Is there any other IndiaInfoline Franchisee nearest to your office? Yes / No (If Yes) Specify the distance in kilometers with complete address of Franchisee

Expected customer acquisition L = Lakhs M = Months (Duration) Applicable for FAN - P & FAN - I Meeting with FAN by Senior IIL official other than FAN introducer or the RM who is managing the FAN

Net-wroth

Upto 5L

5L – 10L

Above 10L

Upto 3M 3M – 6M Date of Meeting

Location

Name of the official meet: Employee code: Designation Comments on Background and Business potential:

Signature

Financial Status / Net Worth Educational Qualification FAN Referred by

Name:

Emp. Code:

FAN Introduced by

Name:

Emp. Code:

FAN Managed by Location / Code of branch who handles this FAN

Name:

Emp. Code:

Name:

Branch Code:

For Office use: FAN code Approved By

Name : Signature :

Date

Guideline for FAN Proposal filing: •

Brokerage sharing terms & deposit should be clearly written in FAN application letter.

•

FAN application letter should be signed by proprietor / all partners / all directors with stamp.

•

PAN card scan should clearly visible.

•

If FAN office & residence address both are same then clearly write this in Fan proposal form.

•

Do not add sebi fees in security deposit in FAN application letter.

•

Brokerage sharing of FAN should be clearly written. E.g. If Fan sharing is 55% then it should be written as 55 % for Fan & 45% for company.

•

Meeting with FAN by BM & above is mandatory and TM should visit FAN within 15 day of its activation.

Guidelines for FAN-P Infrastructure: • • •

Infra Requirement: - 3 Computers, Dot Matrix printer, Scanner, 3 Telephone lines & UPS Manpower: - 2 Dealers / RM’s & 1 Support Staff If Certificates are not available then submit the same at the time of Compliance formalities.

(On FAN’s letterhead) Date: To, India Infoline Ltd. 75, Nirlon Complex, Off. W.E. Highway, Goregaon East Mumbai-400 063

Sub: Application for Business Association with your company Dear Sirs, With reference to the above, I am interested in associating with you for all your products including BSE Remisiership, BSE Subbrokership, NSE Subbrokership, NSE Authorized Person, Mutual Fund and Insurance distribution. I am aware that proposal and commercial terms is recommended to management which is brokerage sharing ratio as -------------- & deposit ----------------------- acceptable to me/us & which is subject to approval of management of IIL with same term or on modified term. Looking forward to a mutually beneficial relationship with you. Thanking you, Yours faithfully Signature of the applicant Proprietor/Partner/Director with Rubberstamp