PRIME : THE PRIME DIRECTORY

FILL SEPARATE FORM FOR EACH SECTION
(Please fill information only relating to the primary capital market)
(Fields with * are must.)

FOR INCLUSION IN SECTION*
NAME OF ORGANISATION*
YEAR OF COMMENCEMENT
NO.OF EMPLOYEES
SEBI REGISTRATION NO
VALID FROM	VALID TILL
	(dd) (mm) (yyyy) (dd) (mm) (yyyy)
CATEGORY
FOR BROKERS,CLEARING CODE (example 01/0527-1)
CHAIRMAN
MANAGING DIRECTOR

HEAD OFFICE ADDRESS:(Is this also Regd.Office?

	Phone1
	Phone2
	Phone3	Fax
City	PIN
Email
Website

KEY EXECUTIVES (INCLUDE ALL OFFICERS IN PRIMARY MARKET DEPARTMENT)

1.Name Designation

   E-mail Mobile Phone Ext.

2.Name Designation

   E-mail Mobile Phone Ext.

3.Name Designation

   E-mail Mobile Phone Ext.

4.Name Designation

   E-mail Mobile Phone Ext.

5.Name Designation

   E-mail Mobile Phone Ext.

6.Name Designation

   E-mail Mobile Phone Ext.

7.Name Designation

   E-mail Mobile Phone Ext.

8.Name Designation

   E-mail Mobile Phone Ext.

9.Name Designation

   E-mail Mobile Phone Ext.

10.Name Designation

   E-mail Mobile Phone Ext.

Click here if you wish to provide data on your branch office/s.

NOTES

1. If your organisation is in more than one activity or you have more than one company working in the primary market, please submit necessary number of this form.
2. If you are a member of more than 1 stock exchange, please submit this form for each membership separately.