Date: _________________

To,
Reliance Securities Limited
Dear Sir(s)

I/We am/are registered client with you. In reference to my/our dealings with you as your
client and pursuant to SEBI circular bearing reference number MIRSD/SE/Cir-19/2009 dated
Dec 3, 2009 read with NSE circular bearing reference number NSE/INSP/2010/91 dated Feb 3,
2010 and BSE circular bearing reference number 20100203-30 dated Feb 3, 2010, I/We hereby
undertake & confirm for the following and authorize you.

Authorization for Electronic Contract Notes and other communication

I/We hereby authorise & confirm to send Contract Note, Bills, DAS, Margin statement, Ledgers,
Transaction statement (Statement of Funds / Securities), report, Order/Trade confirmation slip,
letter, circulars, other documents & communication in electronic form at the email Id (
userid@reliancemoney.com) created for me/us, which would be hosted and managed by
Microsoft.
Authorization for Running Account
I/We hereby confirm and authorise you to maintain my/our account on running basis in order to
facilitate the transfer of funds across segments/exchange(s) and retain the payout received /
credit balance in my /our account for my/our future obligation / margin obligation or other
liabilities unless I/we instruct otherwise. This authorization shall be valid only for the financial
year 2010-2011. I/We also aware that the authorization can be revoked at any time at my/our
own discretion.
The actual settlement of funds shall be done at least once in the preference period selected
below: (Please Tick)
Once in a calendar Quarter
Once in a calendar month
Authorization to activate Market segments/ stock exchanges
I/We hereby authorise and request you to activate below segment / stock exchanges for my/our
account held with you.
Trading Preference (TO BE MANDATORILY SPECIFIED AND SIGNED):
BSE Capital Market
NSE Capital Market
NSE F&O

Ver 11.0 / Apr 2010

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Financial details
My/our Income Range p.a. is as below: (Please Tick)
Less than Rs. 1 Lacs
Rs. 1 - Rs. 5 Lacs
Rs. 5 - Rs. 10 Lacs
Rs. 10 - Rs. 25 Lacs

>Rs. 25 Lacs

For the trading in derivative segments, I/We furnish the following documents as financial
information:
List of documents
Copy of ITR Acknowledgement
Copy of Annual accounts
Copy of Form 16 in case of salary income
Net worth certificate
Salary Slip
Bank account statement for last 6 months reflecting Income
Self declaration along with relevant supporting
Other (please specify

(Please Tick)

Others
I/We hereby confirm that no action has been taken by SEBI or other authorities against me/us
during the last 3 years. I/We also confirm and agree to provide you the information of any action
taken by SEBI or other authorities against me/us.
I/We also confirm that I/we have read and understood the Policies & procedures of Reliance
Securities Ltd., made available on the Trading portal under the link Help>Misc.>RSL Policies &
Procedures (As per SEBI Cir Dec 03, 09).
I/We understand that only the documents mentioned as mandatory are mandatory. Any
additional clauses or documentation that are executed along with the Account opening form is
voluntary. I/We also understand that the documents mentioned as voluntary are voluntary and
I/we need not execute such documents if I /we do not wish to use the trading facility through
Reliance Securities Ltd.
I/We hereby agree to provide a written request to you for a copy of the AOF (Account opening
form) and Policies & procedures of Reliance Securities Ltd., if required.
Yours faithfully,
Name of Client: ________________________________________________

Signature:

#__________________________

Client Code: ___________________________

Personal Email ID: ______________________
Mobile No.: ____________________________
Ver 11.0 / Apr 2010

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