APPLICATION FORM FOR REMISIERS

Name Of Remisier Applicant

Date Of Birth
Age
Male / Female
Fathers Name
Residential Address

City
Pin-code
State
Nationality
Mobile No
Resident Contact No
Mail ID
PAN No
Educational Qualification
Present Occupation
Name & Address Of The Current
Employer

Segments Required –
• Commodity
• Capital
Location of JRG Branch Office :
Address of JRG Branch Office
T.Nagar
G1-G2, Sree Sai Homes, 9/5
Sounderajan Street, Venkatnarayana
Road,
T.Nagar, Chennai-600017

Branch Telephone No 044-24332063/64/65

Name Of Branch Manager Senthil Kumar T.V
Branch Code- Capital CE
Branch Code- Commodity CE
Whether You Are A Sub-Broker
With Any Stock Broker
• YES
• NO
Whether You Are A Remisier
With Any Stock Broker
• YES
• NO
Whether case / claim /
arbitration pending against the
remisier in any court / exchange
(provide details)
BANK DETAILS OF REMISIER
Name Of The Bank
Bank Account No
Branch address & Tel. No

Date Of Opening Of A/C

Name of Branch Manager:Signature :

Name of Remisier:
Signature :

Note:
1. All the fields in Application form are mandatory and should be duly
filled.
2. This application form should be send to HO along with the
documents required for registration otherwise the application form
will be rejected.