Claim against Defaulter Member
Defaulter Member Detail
Member Name
*
Member ID
*
SEBI Registration ID
Contact detail of Member:
*
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Claimant Detail
Claimant Name:
*
Correspondence Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile:
*
Phone Number
Email
*
Confirmation Email
example@example.com
PAN:
*
Client Code:
*
Bank Name:
*
Branch Name:
*
Bank Account Number:
*
IFSC Code:
*
NeRL Account Details: CP Name:
CPID:
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Complaint Detail
Mode through which information received about declaration of member as defaulter/Expulsion
*
Please Select
Please Select
SMS
Email
Letter
Public Notice
Others
Mode of complaint taken up with member
Please Select
Please Select
Email
Letter
SEBI Scores
Other
Detail of Complaint taken up with the member
Date of Complaint:
-
Month
-
Day
Year
Date
Nature of Claim
*
Non-receipt of margin given to the Member
Non-receipt of credit balance as per the statement of account
Non receipt of commodity after purchase on settlement of contract
Non-receipt of funds after delivery of commodity, on settlement of contract
Others Claim
Details of the Complaint taken up with the SEBI
Status if Complaint (please tick wherever applicable)
Under Process
Closed
Date of Complaint
-
Month
-
Day
Year
Date
Details of the Complaint taken up with the Exchange
Status if Complaint (please tick wherever applicable)
Under Process
Closed
Date of Complaint
-
Month
-
Day
Year
Date
Date of GRC Meeting
-
Month
-
Day
Year
Date
GRC Order Status
Please Select
Under Process
Order Passed Against TM
Order Passed Against Client
Arbitration Matter No
Arbitration Application Date
-
Month
-
Day
Year
Date
Status of Arbitration Matter
Under Process
Arbitral Award in favor of Client
Arbitral Award in favor of TM
Arbitral Award Amount (in Rs.):
Whether the claim is filled within the specified period i.e. ninety days from the date of public notice
*
Yes
No
If no, then please specify the reason for delay in filing and kindly provide certified copies of documentary evidence in support of the reason. (However, please note that such claim(s) shall be eligible for being considered for compensation from the IPF, if IPF Trust is satisfied that such claim(s) could not have been filed during the specified period for reasons beyond the control of the claimant)
*
Any other information/additional detail of the case
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Document Upload
PAN card
*
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Account Opening Form, KYC Form
*
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NCDEX Ledger Statement as provided by the Member (Please specify the period and provide self-attested copy)
*
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Bank Statement/Pass Book
*
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Bank Cancelled cheque where name of the account holder(s), bank account no., branch name and IFS Code mentioned
*
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Details/communication from/by SEBI/other stock exchanges approving / rejecting claim
*
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Other Documents (if Any)-1
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Other Documents (if Any)-2
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Declaration
a. All the information provided by me in this form are true to the best of my knowledge, belief and understanding and no part of it has been false, concealed and/or misrepresented, intentionally or otherwise. I am aware that my claim is liable to be rejected if the information given by me in this form is found to be false and/or incorrect.
*
Accepted
Not Accepted
b. I understand that the information mentioned in the form will be processed in accordance with Rules, Bye laws, Regulations, guidelines etc. of the Exchange, SEBI circulars and Regulations
*
Accepted
Not Accepted
Date
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Place: _______________
*
Submit
Should be Empty: