FORM A Application for grant of certificate for POP. The information contained herein is updated as on: dd/mm/yy

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1 1 FORM A Application for grant of certificate for POP The information contained herein is updated as on: dd/mm/yy INSTRUCTIONS FOR FILLING UP FORM 1. It is important that before filling up this application form, the regulations made by the Authority are studied carefully. 2. Applicants must submit to the PFRDA a completed application form together with appropriate supporting documents and applicable application fee. 3. Application for registration will be considered, only if it is complete in all respects. 4. All information provided must be typed (in capital letter, if hand-written) 5. Information which needs to be supplied in more detail may be given on separate sheets which should be attached to the application form. 6. All signatures on the application must be original. 7. Every page of the form as well as every additional sheet must be initialed by the person authorised by the applicant. ] Part I 1. General details of the applicant (organization): 1.1. Name of the applicant: 1.2. Address of the registered/corporate office, address for communication, Phone/Mobile numbers, fax numbers, , website of the applicant: Registered Office Corporate Office Address for Communication Address: Address: Address: Phone /Mobile no. Phone /Mobile no. Phone /Mobile no. Fax No. Fax No. Fax No. Address Address Address Website Website Website

2 Date and place of incorporation/establishment and registration number given by the Registrar of Companies or any other authority (copy of the same) & constitution of the applicant (e.g. Limited Company-Private/Public, Partnership & Sole- Proprietorship. The Act, under which it is incorporated, established or registered. Date of Incorporation/ Establishment and Corresponding Act CIN No./Registration No. Constitution 1.4. Brief description of the principal activity of the applicant: (along with copies of the Memorandum and Articles of Association or Partnership Deed) 1.5. Capital Structure of the applicant ( last 3 financial years) (Rs. in lakhs) Capital Structure a) Authorised Capital and issued capital b) Paid-up capital c) Free reserves (excluding revaluation reserves) d) Total (b) + (c) Financial year Financial year Last financial year Note: - 1. In case of partnership or proprietorship concern, please indicate capital minus drawings and/or loans to partners/owners. 2. In case of partnership or proprietorship concern, please indicate the financial position, means and net worth of the partners Details of registration / recognition of the applicant with the Board and with financial regulatory authorities (RBI, SEBI, IRDA, PFRDA or National Housing Bank). Please attach a certified copy of the registration certificate(s) along with this application. Financial authority regulatory Details of Registration Registration No. Period Of Validity

3 Shareholding pattern of the applicant (please set out the names of all such persons who hold whether directly or indirectly more than 5% of the shareholding or voting rights in the company): Name of the Shareholder No. of Shares % of shareholding 1.8. Name and address of the statutory auditor/s: 1.9. Name and Address of the Principal banker of the applicant: Details of the Authorised Person as authorised by the applicant by way of resolution for making application to PFRDA and executing agreements with CRA & NPS Trust, etc. (Copy of resolution to be enclosed): Name Designation Correspondence Address Phone No. /Mobile no. Fax No. Address Details of the existing Compliance Officer (if any), otherwise give details of person who will perform this function in case of registration: Name Designation Correspondence Address Phone No. /Mobile No. Fax No. Address Details about branches: Total no. of branches Name of the States& UTs covered

4 Details of actions taken against the applicant or its associates by any regulatory authorities during the last 5 years from the date of application. S. No. Authority Description of default Action Taken Current Status Details of application refused for applicant or its associates by any regulatory authorities during the last 5 years from the date of application. S. No. Authority Reasons of refusal Action Taken Current Status 2. Details of Court cases / any similar litigation which could have a material adverse effect on the functioning of the applicant, for the last 5 years from the date of application. Forum Name of the Petitioner Short description of issue Current stage of proceedings Details of interim orders passed Details of final award / order 3. Brief description of the group of the applicant (if any) Name of the Group: Activities of the Group: 4. Profitability (audited- last 5 financial years) Financial Year Financial Year Financial Year Net Profit/loss Cash Profit/loss* *. Cash profit= Net Profit+ Depreciation. 5. Fee & Charges (non-refundable) At the time of Application INR 10000/- At the time of Registration INR 25000/- Financial Year Last Financial Year At the time of renewal of registration 0.50% of remuneration earned in the preceding financial year subject to minimum of Rs.25,000 and maximum of Rs.100,000 on every renewal

5 Application fee shall be sent along with application The Registration fee as prescribed above shall be paid within 15 days from the date of receipt of intimation of acceptance of application by the authority The fee for renewal of registration shall be paid before the expiry of 15 days of the registration granted The fees shall be payable by an Account Payee demand draft in favour of Pension Fund Regulatory & Development Authority payable at New Delhi or by electronic mode, the details of beneficiary account may be obtained by PFRDA separately. PART II Proposal Submission, Financial Reporting and Disclosures 6. The proposal submitted by the applicant shall comprise the following documents: 6.1. The application form submitted with all information asked dully filled and signed by the competent authority Application Fee of INR 10,000 though Demand Draft or by electronic mode as detailed in section 5 of form A Any other information sought by the Authority during the course of the registration process. The attested copy of the following documents should be submitted along with the proposal with required details in a forwarding sheet as per the order given below: 6.4. Registration certificate issued by the financial regulatory Authority. Yes/No 6.5. Certificate by External Auditor on Audited Profit and loss account summary for last Yes/No Five financial years Audited Balance sheet of the institution for the last five financial years. Yes/No 6.7. Self-declaration regarding any current on-going matter of regulatory investigation/ proceedings with details thereof. Yes/No 6.8. Experience in retail financial services as per the format given in Annexure I. Yes/No 6.9. Business Plan for distribution of National Pension System as per Annexure II. Yes/No Certificate from Chief Financial officer or an officer of similar cadre handling the Yes/No finance function, in support of the fact that the organisation has capability to electronically transmit clear NPS subscriber contribution and information on at least T+1 basis Any other information that the applicant considers would be worth mentioning in the Yes/No proposal and/or any other information as specified by POP Regulations, 2015 All pages and paragraphs of the proposal should be numbered and all the papers should be properly bound together. A proper index should be prepared giving the details of page numbers etc in respect of the different sections of the proposal.

6 6 7. Undertaking and Declarations: We hereby represent, warrant and declare that: UNDERTAKING 7.1. The information supplied in the application, including the attachment sheets thereto, is complete, true and accurate in all respects; 7.2. We are in compliance with, and have adhered to and fulfilled, all the criteria and conditions applicable for grant of certificate of POP under NPS; 7.3. We shall abide by the Fees and Charges structure mentioned under Section 5 of Part I, Annexure III and as may be prescribed by PFRDA from time to time and shall not charge more than the specified amount from the subscribers We further undertake that we shall immediately notify the PFRDA of any change in the information provided in the application in the manner as set out under the regulations; 7.5. We further undertake that we shall comply with the provisions of the PFRDA Act 2013 and the rules, regulations, guidelines, notifications, circulars, and any other directions as may be passed by the PFRDA from time to time, issued thereunder and applicable to us, and all other relevant laws including guidelines issued by the other governing regulatory bodies and the Government of India We further understand PFRDA may take suitable action against us in case we are unable to show progress as per the Business Plan submitted by us while evaluating performance review We further undertake that as a condition of grant of certificate, we shall abide by such operational instructions/ directives as may be issued by PFRDA from time to time under provisions of the Act or any other law for the time being in force. For and on behalf of (Name of the applicant) Name of the Applicant Signature of the Authorised Person Name of the Authorised Person Designation Seal/Stamp of the Applicant Date (dd/mm/yyyy)

7 7 DECLARATION THIS DECLARATION IS TO BE SIGNED BY AUTHORISED SIGNATORY OF THE APPLICANT : I hereby apply for registration. I have gone through the Pension Fund Regulatory and Development Authority (Point of Presence) Regulations, 2015 and am satisfied that I am eligible to apply for the Point of Presence registration. I state that I have truthfully and fully answered the questions above and provided all the information which might reasonably be considered relevant for the purposes of my/our registration. I declare that PoP shall abide by the Fees and Charges as specified under Section 5 of Form A & annexure VI (Subscriber fee & charges) of this form. I declare that the information supplied in the application form is complete and correct. For and on behalf of ( Name of Applicant) ( Signature of the authorised person) ( Name of the authorised person) Place: Date: Annexure I: Experience of Selling/Marketing of Financial Products Products Information Tie up with Companies for sale Experience of selling (No. of years) No. of customers a. Insurance Products b. Mutual Funds c. Other financial products (Provide details)

8 8 Annexure II: Business Plan Business plan to be submitted on a separate document and must contain the following: 1. Business Plan in terms of number of new NPS subscriber registrations for next 5 years with short term strategy for the current financial year. 2. Specific plan with timelines to activate all POP-SPs with periodic targets and year wise plan to enhance subscriber coverage. 3. Specific plan with timelines to make the existing client-base aware of the NPS through use of cost effective communication like targeted s, the periodical statements, SMS, etc. 4. Strategy for promotional measures to be adopted e.g. displays at ATMs, banners at branches, PoP specific leaflets, Flyers etc and ensure their availability at all POP-SPs. 5. Strategy with timelines for making NPS functionalities available on internet portals of the PoP. 6. Strategy to bring onboard their own employees and associated vendor/clients. 7. Strategy to enhance the awareness level and capacity building of ground level functionaries of PoP specific training programme. 8. Plan for making & assigning functions to POP-Sub Entities (if decided by PoP) as per the Regulation. 9. Strategy to ensure persistency of the accounts. 10. Plan for setting up a functional monitoring system within PoP, to oversee the achievement of NPS targets periodically w.r.t all the above activatables. Fee and charge structure by PoPs to Subscriber *: Annexure III: Subscriber fee & charges Type of Transaction Maximum permissible charges (INR) for each subscriber (exclusive of applicable taxes) Subscriber registration Rs.125/- and an ad valorem transaction charge of 0.25% of the initial contribution amount from subscriber subject to a minimum of Rs.20 and a maximum of Rs. Any subsequent transactions involving contribution upload Any other transaction not involving a contribution from subscriber 25,000/ % of the amount subscribed by the NPS subscriber, subject to minimum of Rs.20/- and a maximum of Rs /-. Rs 20/- The PoPs have the option to negotiate on the above charges with the subscribers, but within the prescribed charge structure. * Subject to change from time to time decided by PFRDA.

9 9 CHECK LIST FOR FIT & PROPER APPLICANT CRITERIA Sr. no Check Point YES NO A Regulated by Reserve Bank of India (RBI) or Securities and Exchange Board of India (SEBI) or Insurance Regulatory and Development Authority (IRDA), Pension Fund Regulatory, Development Authority (PFRDA) or any Indian Regulatory Authority and National Housing Bank (NHB). Having a minimum of 15 branches with each branch conforming to Information Technology infrastructure and capacity to electronically link to the Central Record Keeping Agency (CRA) approved by the Authority. Each of these branches of the Point of Presence should have demonstrated capability to electronically transmit in an efficient and secured manner clear NPS subscriber contribution and subscriber information on at least T+1 basis where T stands for the day on which clear funds are available with the Point of Presence. Minimum net worth (paid-up capital + free reserves ) of Indian Rupees (INR) 2.00(two) crores which would include a minimum capital of Rupees fifty lakhs (Rs.50 lakhs) as of the last day of the immediately preceding financial year. Shall possess a three year track record of profitability (Profit after tax) out of the last 5 financial years as of the last day of the immediately preceding financial year and not having any cash losses in the last two Financial Years. The institution must be in the business of marketing/selling of retail financial services/products. Absence of convictions and restraint orders by any financial sector regulator or by the court of the law in any of the preceding 5 years for any offence involving moral turpitude, economic offences, violation of any securities or banking law or fraud. In case of any doubt or conflict on this count and pertaining to the application of registration, the decision of PFRDA is final in this regard. Any other criteria as may be specified by the Authority from time to time in the form of resolutions, notifications, circulars, guidelines, norms, memorandums etc. Business Plan containing the required information in the form and manner, received 7B Registration fee received

Name of the applicant: Address of the Registered Office. Address for Communication. Telephone No. Mobile No. Fax No. .

Name of the applicant: Address of the Registered Office. Address for Communication. Telephone No. Mobile No. Fax No. . FORM A [See regulation 4] Insurance Regulatory and Development Authority of India (Registration of Insurance Marketing Firm) Regulations, 2015 Application for Insurance Marketing Firm Registration Application