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SEBI Innovation Initiatives - Please visit Innovation Sandbox at https://innovation-sandbox.in/
REGISTRATION
* Please read instructions carefully before filling the form.
Step 1
Step 2
Step 3
Step 4
Personal Details
Title
Mr.
Mrs.
Ms.
Dr.
First Name
Middle Name
Last Name
Date of Birth
Day
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1952
1951
1950
1949
Sex
Male
Female
Nationality
Marital Status
Married
Unmarried
PAN No.
Email Id (Username)
Email Id (Alternate)
Enter Verification Code
Academic Qualifications
Qualification
Degree/Diploma ? Specialisation
Year of Passing
University / Institute
Overall (%) of Marks
Class / Division
Graduation
-- Select --
B.A
B.Com
B.Ed
B.Sc
B.Tech
Bachelor of Engineering
Bachelors in Medicine
BBA
BCA
LLB
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
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1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
Post Graduation
-- Select --
Account and Finance
Doctorate
M.Tech
Masters in commerce
Masters in Education
Masters in Law
Masters in Science
MBA
MCA
PG Diploma
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
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1991
1990
1989
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1987
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1981
1980
1979
1978
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1972
1971
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1968
1967
1966
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1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
Professional Qualification
-- Select --
CA
CS
CWA
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
Any Other
-- Select --
Account and Finance
B.A
B.Com
B.Ed
B.Sc
B.Tech
Bachelor of Engineering
Bachelors in Medicine
BBA
BCA
CA
CS
CWA
Doctorate
LLB
M.Tech
Masters in commerce
Masters in Education
Masters in Law
Masters in Science
MBA
MCA
PG Diploma
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
Working Experience
Employers Name
Employment Type
Profile Details
Period Duration
From
To
-- Select --
Employee
lecturer
Principal
Professor
Teacher
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
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1995
1994
1993
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1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
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1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
-- Select --
Employee
lecturer
Principal
Professor
Teacher
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
-- Select --
Employee
lecturer
Principal
Professor
Teacher
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
-- Select --
Employee
lecturer
Principal
Professor
Teacher
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
Total Experience
:
Months
Years
Submit and go to step 2 »
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Contact Details
Address Line 1
Address Line 2
State
-- Select --
Andhra Pradesh
Andman and Nicobar
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Minicoy Island
Mizoram
Nagaland
Odisha
Pondicherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telengana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
District
-- Select --
Pincode
-- Select --
Location
-- Select --
Pincode
Location
Mobile 1 (+91)
Landline 1
Mobile 2 (+91)
Landline 2
Languages Known: (Please mark ? at appropriate boxes)
Sr. No.
Language
Read
Write
Speak
+ Add
1.
-- Select --
Assamese
Bengali
English
Gujarati
Hindi
Kannada
Kashmiri
Malayalam
Marathi
Oriya
Punjabi
Tamil
Telugu
Urdu
Bank Details
Bank Name
Branch Name
Account No.
IFSC Code
MICR No.
« Previous
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Questionaries
Have you been associated with any intermediary before? If yes, give details:
Yes
No
Are you currently associated with any intermediary? If yes, give details:
Yes
No
Do you own or work for any other business? If yes, give details:
Yes
No
Have you conducted any training and education trainings of interest to retail investors? If yes, give details:
Yes
No
Do you own a laptop?
Yes
No
Any other information that you wish to provide
References (Two):
Name
Designation
Address Line 1
Address Line 2
State
-- Select --
Andhra Pradesh
Andman and Nicobar
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Minicoy Island
Mizoram
Nagaland
Odisha
Pondicherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telengana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
District
-- Select --
Pincode
-- Select --
Location
-- Select --
Pincode
Area
Contact No.
Email
Name
Designation
Address Line 1
Address Line 2
State
-- Select --
Andhra Pradesh
Andman and Nicobar
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Minicoy Island
Mizoram
Nagaland
Odisha
Pondicherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telengana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
District
-- Select --
Pincode
-- Select --
Location
-- Select --
Pincode
Location
Contact No.
Email
« Previous
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