|
1
|
Client Information
|
|
|
(a)
|
Name of Entity
|
|
|
(b)
|
CIN / Registration No.
|
|
|
(c)
|
Date of Incorporation / Registration No.
|
|
|
(d)
|
Type of Entity
|
|
|
(e)
|
Business Description
|
|
|
(f)
|
Address of Registered Office
|
|
|
(g)
|
Address of Corporate Office
|
|
|
(h)
|
Address(es) of Branch Office(s)
|
|
|
(i)
|
PAN No. and Name & Address of Income Tax Circle
|
|
|
(j)
|
Email id
|
|
|
(k)
|
Telephone No (s)
|
|
|
(l)
|
Fax No (s)
|
|
|
(m)
|
Banker(s) of the Entity
|
|
|
(n)
|
Major Client customers information
|
|
|
|
|
|
|
2
|
Corporate Structure
|
|
|
(a)
|
Shareholding pattern (with details of holding of more than 25%)
|
|
|
(b)
|
Name of parent company
|
|
|
(c)
|
Name of subsidiaries
|
|
|
(d)
|
Details of Chain holding , if any
|
|
|
(e)
|
Details of associate / JVs
|
|
|
|
|
|
|
3.
|
Permissible Business information as per Memorandum of Association
|
|
|
4.
|
Board Structure/ Organization Structure
|
|
|
5.
|
Transaction with Business entities in which Directors are interested
|
|
|
6.
|
Details of Loans and Guarantees
|
|
|
Details of Loans and Guarantees in which director(s) are interested
|
|
|
7.
|
Creation, modification and satisfaction of charges
|
|
|
8.
|
FOREX Exposure and overseas borrowings
|
|
|
9.
|
Payment status of statutory dues and arrears
|
|
|
10.
|
Name of the CEO ,CFO & Company Secretary
|
|
|
11.
|
Engagement Information
|
|
|
(a)
|
Details of assignment proposed by the Entity
|
|
|
|
|
|
|
12.
|
Proceedings against the company or any of its director
|
|
|
(a)
|
Details of proceedings pending or commenced, etc.
|
|
|
(b)
|
Details of prosecution, if any, pending or commenced or resulting in conviction in the past against the director and /or the company or its parent company or any of its subsidiaries
|
|
|
(c)
|
Details of criminal prosecution, if any, pending or commenced or resulting in conviction in the past against the director
|
|
|
(d)
|
Whether any of the director(s) of the company attracts any of the disqualifications envisaged under Section 274 of the Companies Act, 1956?
|
|
|
(e)
|
Has any director and /or the company or its parent company or any of its subsidiaries at any time been found guilty of violation of rules / regulations / legislative requirements by customs / excise / income tax / foreign exchange / other revenue authorities, if so give particulars
|
|
|
(f)
|
Whether any director at any time has come to adverse notice of a regulator such as SEBI, RBI, IRDA, MCA
|
|
|
( g)
|
Default in repayment of Public Deposits and unsecured loans debentures, loans from banks , financial institution
|
|
|
|
|
|
|
6
|
Other Information
|
|
|
(a)
|
Details of last IPO/FPO/Rights Issue
|
|
|
(b)
|
Name, address and CoP No. of Statutory Auditor
|
|
|
(c)
|
Name, address and CoP No. of Secretarial Auditor
|
|
|
|
|
|
|
7
|
Undertaking to be obtained from the client
|
|
|
I confirm that the above information is to the best of our knowledge and belief true and complete. I undertake to keep the PCS informed, as soon as possible, of all event which take place subsequent to his engagement which are relevant to the information provided above.
|
|
|
Place:
|
|
|
|
Date:
|
|
For…………
Signature of client
|
|
8
|
Remarks (if any)
|
|