(If yes give ARN No.________________________. Please attach the photocopy.

8. Other Exams:__________________________________________________________________________________

9. Identity Status (Tick what is applicable) : Service [ ] Business [ ] Retired [ ] Housewife [ ] Others [ ]

10. Details of above (if possible) e.g.-nature of activity, part time/full time:______________________________________

______________________________________________________________________________________________________

 .No of years of experience in selling financial products:
11  .Financial Product (Tick the financial products you are selling and also rank in order of preference/convenience
in the space provided

  Fixed Deposit [ ] _________ Post Office Schemes [ ]________ RBI Bonds [ ]_________
  Mutual Funds [ ]_________ Life Insurance [ ]________ General Insurance [ ]

3.PAN/GIRNo.:____________________________

14 .Circle/Ward/Dist:________________________

15.Bank details : Name:_____________________            Branch:______________________           A/C No: ________________________

A/CType:            Saving □ Current [ ] NRE [ ] NRO [ ]              Payment Mode: Cheque □ Dd [ ] ECs [ ] Bc [ ]

16. What services or support you expect from us:________________________________________________________

17. Any other service or support you expect which has not been mentioned above:

a)
b)
c)
d)

18 Suggestions for strengthening our business relationship and increasing your sales mobilization.
a)______________________________________________________________________
b)______________________________________________________________________
c)______________________________________________________________________

Declaration: I / We confirm that the above particulars are true and correct. I/We am/are ready
to accept the terms and conditions as laid by you from time to time

Place:

Date: Signature of Applicant

(Please provide us one passport size photograph with proof of address, and
copy of PAN Card / Voter ID / Ration Card (as identity proof).

Terms & Conditions
1. You will be designated as member of Bajaj Capital Advisors Network.

2. In the event an application of the client has been rejected/refused/returned, you shall not be entitled to receive any remuneration.

3. In the event of pre-mature withdrawal of the fixed deposit by the client, you agree that BCL shall have
the right to recover and/or adjust the remuneration paid to you.

4. In consideration of you having been empanelled with BCL, you agree not to accept any investment in cash and/or in your own name and shall at all times obtain
and maintain all necessary authorization/registration.

5. You covenant with BCL that at the time of entering into this arrangement there are no existing breaches
of law, regulation and/or notifications. During the continuance of this arrangement you agree to abide by all applicable laws.

6. You may appoint such number of persons in any capacity. However, there shall be no privity of contract
between BCL and such persons and BCL shall not, in any way, be liable or responsible for the
actions/omissions of such persons. You agree to hold BCL indemnified fromany claims,
loss or damage arising from the actions/omissions of yourself and/or such persons

7. You shall not guarantee any returns to investors nor make any representation or advertisement,
in any manner and/or of any nature, to investors without the specific authorization of BCL and where permitted,
shall only use advertising/promotional material authorized/permitted by BCL.

8. BCL reserves the right to terminate this arrangement (i) at any time without assigning any reasons;
(ii) immediately in the event of breach of any of the terms and conditions or any applicable law including those prescribed by SEBI, AMFI.

9. The appointment made hereunder does not in any manner create or seek to create any employer-employee
or master-servant or agent-principal relationship between BCL and yourself. You shall have no right to bind BCL in any manner whatsoeve

10. Any dispute arising out of the interpretation or construction of the appointment made hereunder
shall first sought to be settled amicably, through discussions, deliberations, failing then the courts at
Delhi shall have exclusive jurisdiction to try the matter.

I/we have read, noted and accepted the above terms and conditions. Signature of Applicant

For Office Use Only

Approved By:_______
Code No._________
Allotted:__________
Date:____________