Agency Name:
Proposed Ac�vi�es Func�on : Corporate Connector Builder Connector Freelancer
in SBICAP Securi�es
Digital Connector
Limited
Cons�tu�on : Proprietorship Partnership LLP Pvt / Public Ltd. Co.
Complete Office House No./Building Name :
Address:
Street/Area/Locality:
Town/Village Name: Land Mark :
City:
State: PIN :
Tel. No.: STD / ISD (O) Mobile No.:
Code
Email ID:
En�ty PAN
GSTIN:
Whether Proprietor or any Partners / Directors is or was a rela�ve of any person who is or was working for SBICAP Securi�es or any other group
company of SBI.
Yes No (If yes, Please give details and if no, men�on “NA”:*) __________________________________________________________
List of Documents
Proprietor PAN Card Aadhaar Card
Partnership / LLP PAN Card GST Partnership deed
Pvt. Ltd. Co. Memorandum of associa�on Ar�cle of associa�on
PAN Card GST
Others (Pls Specify)
Latest Telephone bill Copy Latest Electricity bill copy GST registra�on cer�ficate
Rental Agreement (along with u�lity bill in the name of the landlord – not older than 3 months).
Others (Pls Specify)
Details of Authorised Proprietor/Partner/ Director:
** (Please share authorisa�on le�er along with signature of other Partners / Directors)
Name :
Photograph of
Date of Birth : Proprietor/
Partner1/
Director1/
Father/Mother/
Husband Name :
PAN No. :
Mobile No. :
House No./Building Name :
Street/Area/Locality : Town/Village Name:
Land Mark :
City : State:
PIN :
House No./Building Name :
Street/Area/Locality : Town/Village Name:
Land Mark :
City : State:
PIN : Contact Person Mobile No:
Contact Person Name :
Applicant Designa�on in Organiza�on
List of Documents (Proprietor/Partner/Director etc.)(Please �ck any one)
Address Proof Driving License Passport Voter ID Card Aadhaar Card
Rental Agreement copy along with u�lity bill in the name of the landlord (U�lity bill
should not older than 3 months).
Others (Pls Specify)
ID Proof Driving License Passport Voter ID Card Aadhaar Card
Others (Pls Specify)
BANK DETAILS
Bank Name :
Account Type Savings Current Others
Bank Account No. :
IFSC Code : MICR :
Bank Address :
NOMINATION DETAILS FOR REFERRAL (For Individual and Sole Proprietorship)
I/We wish to nominate the person names below to receive the amounts of brokerage to my credit in the event of my death.
Name of the Nominee
Date of Birth (if Nominee is minor) Rela�onship with Distributor
Name of Guardian (if Nominee is minor)
Address of Nominee/Guardian
Nominee/Guardian Contact No.
DECLARATION
I/We hereby declare that the informa�on furnished herein is complete and correct in all respects. I/We undertake to abide by (a) such guidelines, code
of conduct and other circulars issued by SBICAP Securi�es Limited / Regulator that may be applicable to me/us, and the terms and condi�ons stated
overleaf as amended from �me to �me.
Hereby declare that I have met the SBICAP Securi�es representa�ve and requested to open a referral code ___________________.
Place : ______________________ ___________________________
Date: _______________________ Signature of Applicant
TO BE FILLED BY HLSE / HLSM
I have met Mr./Ms./Mrs. _______________________________________________ in person and hereby confirmed that the iden�ty and the address
men�oned in this form has been filled in my presence and I have also verified the original documents. All the signatures of the applicant have been
done in my presence at the appropriate places in this form.
Recommenda�on & Approval: (Should not be same)
(i) Recommended by Employee ID:
Employee Name:
Place of Mee�ng: ______________________ ___________________________
Date: ________________________________ Signature of HLSE / HLRM
(ii) Approved by Employee ID :
Employee Name:
Place of Mee�ng: ______________________ ___________________________
Date: ________________________________ Signature of HLSM / CH / RH
Corporate office: SBICAP Securi�es Limited
Corporate Iden�ty Number (CIN): U65999MH2005PLC155485
Marathon Futurex, B-wing, 12th Floor, Lower Parel East, Mumbai - 400013.
E-mail:
[email protected] | Call us: 022 - 6854 5502/55 | www.sbisecuri�es.in
