Legal and Compliance Department

Religare Securities Limited

New Delhi

APPLICATION FOR CREATION OF CTCL USER ID

S.NO. Particulars Required Details
1 Name of Person in whose name the CTCL USER ID is
to be allotted (must be NCFM / applicable certificate
2 holder)
Father's Name
3 Date of Birth
4 Mention segment I.e Future & Option or Capital Market -
Cash in which CTCL User ID is required:
5 Mapin/ TIN No. of CTCL user ID applicant (attach copy)
6 Permitted certificate e.g. NCFM( attach legible copy of
certificate showing all the details) mention Regn No.
7 Certificate Validity Date/ Test Date (please tick the
appropriate)
8 Whether applicant for CTCL USER ID is Employee of
Religare/ Employee of registered Sub - Broker /
Emoployee of NSE Registered Authorised Person/
Remisier on BSE
9 If emplyee of registered Sub - Broker / NSE Registered
Authorised Person pls give name and address of Sub -
Broker with MAPIN NO. or Name and Address of
Authorised Person
10 Residential Address Of person in whose name CTCL
USER ID is required (Please attach proof)
11 Permanent Address Of person in whose name CTCL
USER ID is required
12 Full Address of place where CTCL Terminal shall be
used
13 Branch/ Sub Branch Code
14 Mode of Connectivity: Dial-up/ Lan/ Leased Line/ Pstn/
Isdn/ Vsat
15 No. of Existing CTCL User ids allotted at that location
16 CTCL Server Location
17 Signature of CTCL User ID Applicant

18 Signature of Sub-Broker / NSE Registered Authorised

Person (if employee of Sub - Broker / Authorised
Person)
I hereby declare that I am aware about the Rules, Regulations and Bye Laws of the National Stock Exchange
of India Limited and Procedures as adopted by Religare Securities Limited. I agree to become a user of
Religare Securities Limited in the _________segment. I would intimate Religare Securities Limited immediately
on any change in my status. I hereby agree to abide by the Rules, regulations and Bye-Laws of the Exchange
and understand that appropriate action may be initiated by the Religare Securities Limited in case of violation
of the Rules, Regulations and Bye Laws of the Exchange or any of the procedures as adopted by the Religare
Securities Limited. I certify that I have not applied for any other User ID on the same segment for which this ID
is now being applied for. I will not allow anybody else to access / use the trading system using the user ID so
alloted to me.

Signature of the person in whose name ID is to be issued.

Signature of Religare person recommending the user ID