On the Letter Head

THE MANAGING DIRECTOR, OTC EXCHANGE OF INDIA, 92, MAKER TOWER, ‘F’ WING, CUFFE PARADE, MUMBAI – 400 005.

Dear Sir(s),

Member/Dealer/Sponsor Name : ______Trade Name : ______SEBI Regn. No. : ______Date of SEBI Regn. : ______

I understand that in view of the Exit Order no. WTM/RKA /MRD/25/2015 dated March31, 2015 issued by SEBI, OTC Exchange of India (OTCEI) has ceased to be a stock exchange.

It may be noted that our company / proprietary concern has deposit with the Exchange in the form of Cash / FDR / Securities as per details provided below. We request you to refund the same at the earliest in terms of provisions of the SEBI Circular No.CIR/MRD/DSA/14/2012 dated May 30, 2014.

SR.NO. DEPOSIT AMOUNT 1 Cash BMC 0.00 2 BMC FDR (FDR NO. Issuing Bank ) 0.00 3 Securities Pledge 0.00 4 Settlement Deposit 0.00 5 Lease Line Deposit 0.00 6 Additional Cash BMC 0.00 TOTAL 0.00

I / We am/ are submitting SEBI registration certificate in original or indemnity-cum-affidavit in lieu thereof for your records.

I/We further request you to deduct dues payable to SEBI and/or Exchange from our above deposit. I/We further confirm and declare that payment of above deposit as stated above, net of deduction of Exchange dues and/or SEBI dues by the Exchange and / or release of FDRs / securities pledged in favour of the Stock Exchange shall duly discharge OTCEI of all the liabilities due to me/us and I/We shall have no further claim against the Company and its officers and Directors.

I/We further understand and accept that OTCEI will not refund any amount paid by us towards Admission fees, Technology fees, Fees for trading in permitted securities segment, the annual dealership/membership fees or any other fees/costs paid to OTCEI, which are all non-refundable in nature.

I/we understand that I/we no longer have any membership rights with the OTC Exchange of India (erstwhile) and our rights as Member / Dealer of OTC Exchange of India ceased to exist. I give below my present contact details:

Present Address :

Contact No. : Mobile No. : Email Address :

Permanent Account No. : (Attach a copy of PAN)

Thanking you.

Name of Trading Member: ______(as mentioned in the SEBI Certificate)

Trade Name: ______

______

Signature of Proprietor/ Signature of Designated Director2 Designated Director1 (in case of Body Corporate) (in case of Body Corporate)

Date: ______

Encl.: a) SEBI Original registration certificate Or Indemnity-cum-affidavit. b) Copy of PAN (In case of corporate body Pan of company & all directors PAN required duly self attested) c) Cancelled Original Cheque d) Board Resolution with Specimen Signatures (in case of body corporate all directors should be signed) e) Each page should be signed and filled.

Affidavit in case of lost/misplacement of SEBI Certificate

DEED OF INDEMNITY cum AFFIDAVIT (on stamp paper of Rs. 200/-)

THIS DEED of INDEMNITY cum AFFIDAVIT made on this _____ day of ______2015 by M/s. ______(name of Trading Member) having registration no.______as a Trading Member of the OTC Exchange of India IN FAVOUR of OTC Exchange of India and Securities and Exchange Board of India, (hereinafter called as OTC Exchange of India and “SEBI” respectively, which expression shall unless repugnant to the context or meaning thereof include their successors, assigns and legal representatives)

WHEREAS

1. I / we are required to submit the original SEBI Registration Certificate(s) to the Company as consequent upon de-recognition of OTC Exchange of India as an Exchange, the trading members of OTC Exchange of India shall cease to be trading members and therefore liable to be de-registered as stock brokers, and their certificate of registration granted by SEBI shall accordingly stand automatically cancelled.

2. I / we have misplaced / lost my / our SEBI Registration Certificate as aforesaid.

3. I / we undertake not to utilize the SEBI Registration Number or the certificate issued to me / us as a Member Broker of the OTC Exchange of India.

4. I/we therefore am/are willing to execute this Indemnity cum Affidavit for the purpose of cancellation of broker registration without the original certificate of registration.

NOW IN CONSIDERATION OF OTC Exchange of India and SEBI permitting us cancellation of SEBI registration as a Trading Member as per the registration number mentioned above without the original certificate of registration, I/WE UNCONDITIONALLY AND IRREVOCABLY UNDERTAKE AND AGREE a) To deliver the original SEBI Registration Certificate to OTC Exchange of India as soon as the same is found, recovered or possessed by us.

b) That I / we agree to protect, indemnify and keep indemnified OTC Exchange of India and SEBI harmless from and against all claims, demands, actions, proceedings, losses, damages, liabilities, costs, charges, expenses or obligations which may be brought or commenced against them or which they may or may have to bear, pay or suffer directly or indirectly as a result of such loss or damage arising as a result of any other person claiming to be the holder of the aforesaid SEBI Registration Certificate and / or misuse of SEBI Registration Certificate by me / us in any respect. c) That this Undertaking shall be binding upon our successors, legal representatives and assigns. d) That I/we shall execute, sign, and subscribe, to such other documents, papers, agreements, covenants, bonds, and / or undertakings as may be prescribed or required by OTC Exchange of India and or SEBI from time to time.

IN WITNESS WHEREOF, this Deed of Indemnity cum Affidavit is executed on this the ______day of ______2015.

Signed and delivered For M/s. (name of broker)

Name and Designation

in the presence of WITNESSES

Signature