PALAK HARDIK SHAH

E-3 Chintan Flat, Nayan Nagar, Saijpur Bogha, Ahmedabad-382345

FORMAT OF REQUEST LETTER TO BSL

To,
Brics Securites Ltd.,
Sadhana House, 1st Floor, 570, P.B.Marg,
Behind Mahindra Tower, Worli,
Mumbai-400018

Dear Sir,

We hereby request you to register as Sub-broker of your firm with SEBI. Please find the
enclosed along with the relevant documents.

Thanking you,

Yours truly,

Signature,
PALAK HARDIK SHAH
 PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar, Saijpur Bogha, Ahmedabad-382345

FORMAT OF CERTIFICATE TO BE FURNISHED BY SUB-BROKER

ANNEXURE “O”

From:
Palak Hardik Shah
E-3 Chintan Flat, Nayan Nagar,
Saijpur Bogha, Ahmedabad-382345

Date :

The Membership Deparment,

National Stock Exchange of India Ltd.(NSEIL)
Exchange Plaza,
Bandra Kurla Complex,
Bandra ( East )
Mumbai – 400 051.

Dear Sir,

Myself /any of the partners of the firm in which I am a partner/any of the promoters or
dominant shareholders of the company in which I have a controlling interest, do not
directly or indirectly, singly or jointly, have an equity holding of 10% or more and /or any
share in my name and/or jointly with an of my close relatives in any other trading
membership of NSE or ant sub-broker of a member of NSE.

We hereby state that the information given above is true, correct and compete to the best
of our knowledge and information. We also state that no relevant material fact has been
suppressed. We agree that in the event of any of the above statements being found false,
incorrect or incomplete, we recognize that NSE may take any action as it may deem fit,
including recommending to SEBI for cancellation of our registration as sub-broker. We
also agree to provide NSE with all such documents as may be called for and be required
from time to time by NSE or the member with whom we are affiliated as s sub-broker.

Signature of Applicant X

Name : PALAK HARDIK SHAH

Place : Ahmedabad Date :

 PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar, Saijpur Bogha, Ahmedabad-382345

FORMAT OF THE DECLARATION NO 1

Date :

From:
PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar,
Saijpur Bogha, Ahmedabad-382345

To,
The National Stock Exchange of India Ltd.,
Exchange Plaza,
Bandra Kurla Complex,
Bandra ( East )
Mumbai – 400 051.

Dear Sir.,

I hereby declate that I will not deal through/ for any sub broker and will directly deal with
investors only.

Thanks you,

Yours truly,

Name: Palak Hardik Shah

 PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar, Saijpur Bogha, Ahmedabad-382345

FORMAT OF THE DECLARATION NO 1

Date :

From:
PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar,
Saijpur Bogha, Ahmedabad-382345

To,
The Bombay Stock Exchange Ltd.,
P.J. Towers, Dalal Street,
Fort, Mumbai – 400 023.

Dear Sir.,

I hereby declate that I will not deal through/ for any sub broker and will directly deal with
investors only.

Thanks you,

Yours truly,

Name: Palak Hardik Shah

 PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar, Saijpur Bogha, Ahmedabad-382345

FORMAT OF THE DECLARATION NO 2

Date :

From:
PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar,
Saijpur Bogha, Ahmedabad-382345

To,
The National Stock Exchange of India Ltd.,
Exchange Plaza,
Bandra Kurla Complex,
Bandra ( East )
Mumbai – 400 051.

Dear Sir.,

I hereby declate that I have not introduced any fake or forged share certificate in the
market.

Thanks you,

Yours truly,

Name: Palak Hardik Shah

 PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar, Saijpur Bogha, Ahmedabad-382345

FORMAT OF THE DECLARATION NO 2

Date :

From:
PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar,
Saijpur Bogha, Ahmedabad-382345

To,
The Bombay Stock Exchange Ltd.,
P.J. Towers, Dalal Street,
Fort, Mumbai – 400 023.

Dear Sir.,

I hereby declate that I have not introduced any fake or forged share certificate in the
market.

Thanks you,

Yours truly,

Name: Palak Hardik Shah

 PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar, Saijpur Bogha, Ahmedabad-382345

FORMAT OF THE DECLARATION NO 3

Date :

From:
PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar,
Saijpur Bogha, Ahmedabad-382345

To,
The Bombay Stock Exchange Ltd.,
P.J. Towers, Dalal Street,
Fort, Mumbai – 400 023.

Dear Sir.,

I hereby declate that I have not been convicted of any offence in past and presently I am
not in trial for any offence involving fraud and dishonesty..

Thanks you,

Yours truly,

Name: Palak Hardik Shah

 PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar, Saijpur Bogha, Ahmedabad-382345

FORMAT OF THE DECLARATION NO 3

Date :

From:
PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar,
Saijpur Bogha, Ahmedabad-382345

To,
The National Stock Exchange of India Ltd.,
Exchange Plaza,
Bandra Kurla Complex,
Bandra ( East )
Mumbai – 400 051.

Dear Sir.,

I hereby declate that I have not been convicted of any offence in past and presently I am
not in trial for any offence involving fraud and dishonesty..

Thanks you,

Yours truly,

Name: Palak Hardik Shah

 PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar, Saijpur Bogha, Ahmedabad-382345

FORMAT OF THE DECLARATION NO 4

Date :

From:
PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar,
Saijpur Bogha, Ahmedabad-382345

To,
The National Stock Exchange of India Ltd.,
Exchange Plaza,
Bandra Kurla Complex,
Bandra ( East )
Mumbai – 400 051.

Dear Sir.,

I hereby confirm that I am not affiliated to any other member/sub-broker of the Exchange
or any other Stock Exchange and I do not have ant direct / indirect interest in dealing in
ant other member / sub broker firm.

Thanks you,

Yours truly,

Name: Palak Hardik Shah

 PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar, Saijpur Bogha, Ahmedabad-382345

FORMAT OF THE DECLARATION NO 4

Date :

From:
PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar,
Saijpur Bogha, Ahmedabad-382345

To,
The Bombay Stock Exchange Ltd.,
P.J. Towers, Dalal Street,
Fort, Mumbai – 400 023.

Dear Sir.,

I hereby confirm that I am not affiliated to any other member/sub-broker of the Exchange
or any other Stock Exchange and I do not have ant direct / indirect interest in dealing in
ant other member / sub broker firm.

Thanks you,

Yours truly,

Name: Palak Hardik Shah

 PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar, Saijpur Bogha, Ahmedabad-382345

FORMAT OF THE DECLARATION NO 5

Date :

From:
PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar,
Saijpur Bogha, Ahmedabad-382345

To,
The Bombay Stock Exchange Ltd.,
P.J. Towers, Dalal Street,
Fort, Mumbai – 400 023.

Dear Sir.,

I hereby confirm that I am not applied for SEBI registration through any other member
of the exchange.

Thanks you,

Yours truly,

Name: Palak Hardik Shah

 PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar, Saijpur Bogha, Ahmedabad-382345

FORMAT OF THE DECLARATION NO 5

Date :

From:
PALAK HARDIK SHAH
E-3 Chintan Flat, Nayan Nagar,
Saijpur Bogha, Ahmedabad-382345

To,
The National Stock Exchange of India Ltd.,
Exchange Plaza,
Bandra Kurla Complex,
Bandra ( East )
Mumbai – 400 051.

Dear Sir.,

I hereby confirm that I am not applied for SEBI registration through any other member
of the exchange.

Thanks you,

Yours truly,

Name: Palak Hardik Shah

DATE :

To,
The National Stock Exchange of India Ltd.,
Exchange Plaza,
Bandra Kurla Complex,
Bandra ( East )
Mumbai – 400 051.

Dear Sir,

We confirm that Mrs. PALAK HARDIK SHAH are know to us / are our client for last
2 year. They are genuine people with good integrity.

Name of the Firm of Chartered Accoutant

Seal and Membership Number Of Chartered Accoutant

Name :
DATE :

To,
The Bombay Stock Exchange Ltd.,
P.J. Towers, Dalal Street,
Fort, Mumbai – 400 023.

Dear Sir,

We confirm that Mrs. PALAK HARDIK SHAH are know to us / are our client for last
2 year. They are genuine people with good integrity.

Name of the Firm of Chartered Accoutant

Seal and Membership Number Of Chartered Accoutant

Name :