Company Introductory Form Acuity Stockbrokers (Pvt) Ltd Level 05, Acuity House No.53, Dharmapala Mawatha, Colombo 03 Tel: 0112-206206 Fax: 0112-206298/73 1of 3 Note: This form should be completed and retained by the Member Firm in accordance with FIU regulations. This information is sought under the Prevention of Money Laundering Act No:6 of 2005,Financial Transaction Reporting Act No.6 of 2006 and the Rules for the Securities Industry issued by the Financial Intelligence Unit of the Central Bank Of Sri Lanka. All the information as applicable in sections A BC below is mandatory for the Applicant and Section D should be completed by the authorized person(s) if applicable. Name of the Applicant CDS A/c No. Date Section A - Basic Account Information 1. Nature of the entity : Please tick ( ) Limited Liability Company Global & Regional Fund Statutory Body A Body established under An Act of Parliament Public Limited Company Local Fund A Body established under An Act of Parliament Other :( Please specify). 2. Status: : Please tick ( ) Local Foreign 3. a) Whether Listed on CSE :Please Tick ( ) Yes No b) Whether Listed on other :Please Tick ( ) Yes No Stock Exchange If Listed please specify:. 4. Nature of business 5. Date & place of incorporation 6. Company registration No. Section B - Contact Details of the Applicant: Contact Details: a) Name of the Key Contact Person: b) Telephone no. (office) c) Telephone no. (res) d) Mobile number: e) Fax number: f) E-mail address:
Section C - Other Details 2of 3 1.Nature of business (Product / service provide): 2. Expected Value of Investment per annum :Please tick ( ) Less than Rs.100,000 Rs.100,000 to Rs.500,000 Rs.500,000 to Rs1,000,000 Rs.1,000,000 to Rs.2000,000 Rs.2,000,000 to Rs.3,000,000 Rs.3,000,00 to Rs.4,000,000 Rs.4,000,000 to Rs.5,000,000 Rs.5,000,000 to Rs10,000,000 Over Rs.10,000.000 3. Bank Account /s maintained Bank : Branch : Type of A/c A/c No. I. II. III. IV. 4. Source of funds: Please tick ( ) Business Ownership Sales and business turnover Sale of Property/Assets Commission income Investment Proceeds/savings Donations/Charities (Local/Foreign) Others (Specify) Investments Contract proceeds Gift Export proceeds Profits/Revenue 5. Other Connected Business/Professional activities & business interests... 6.Other Details/Remarks/Notes: (if any) ion Section D - Authorized Signatories Details 1. 2. 3. Name of the person Capacity Instructions for orders (Accepted at client s risk) Telephone: Yes /No Fax: Yes/No E-mail: Yes/No Instructions for contract notes (tick as appropriate) E-mail Post Fax Deliver Settlement cheques - Posted to client/ Collected by client /Deposit to HNB A/C No Investment objective..
3of 3 References Name 1. 2. 3. Tel. No. We abide by the terms and conditions of the client declaration form, which is annexed herewith and agreed to be bound by same. Company Seal...... This application is made by us in terms of our company board resolution, a certified copy of which is annexed. Date Secretary FOR OFFICIAL USE ONLY Advisor: Signature. Date.. Manager - Sales.. Signature. Date... ------------------------------------------------------------------------------------------------------------------------------------ Risk profiling Category Rating Total Overall rating Client type Business / trade Investment per annum Compliance Officer... Signature. Date.. Financial Controller Signature. Date.. System updated Signature (Data entry operator). Date..
Acuity Stockbrokers (Pvt) Ltd Level 05, Acuity House No.53, Dharmapala Mawatha, Colombo 03 COMPANY DECLARATION 4of 3 We undertake to deposit with Acuity Stockbrokers (Pvt) Ltd (hereinafter called and referred to as the Company which term or expression as herein used shall where the context so requires and admits of construction mean and include the said Acuity Stockbrokers (Pvt) Ltd. and its successors and assigns) along with any purchase order, a sum of not less than twenty five per centum (25%) of the estimated market value of such purchases as at the date of the purchase order, which said sum is to be set off against the total amount due from us on the date of settlement in respect of such purchase. We hereby authorize the Company at its sole and absolute discretion and at our risk to sell and transfer any or all of the shares or securities registered in our account to be opened and maintained with the Company for the purpose of compensating the said Company for any liabilities, loss, damage or claims of whatsoever nature that may incur as a result of our defaulting in making any payment lawfully due in terms of contract for the purchase of shares whether or not the contract notes have been received by us or any transaction pertaining to our account. We hereby agree to pay an interest of 0.1% per day, from the day after the settlement date up to the date of final settlement. We declare that we shall not hold the Company responsible nor liable in the event that we fail to make settlement in time for the purchase of any Right Issues. We accept that in the event of any Purchase / Sale order placed by us with the Company not being executed within a maximum period of 05 days from the date of such order, such order shall be deemed to be cancelled at that point of time and will not be acted upon, unless specific and express instructions to the contrary are given by us to the Company We agree and undertake not to engage directly or indirectly in any transactions (i) Which involves money, or other property, that is proceeds of crime or (ii) Which otherwise tantamount to a transaction prohibited by the Prevention of Money Laundering Act No.5 of 2006, Financial Transaction Reporting Act No 6 of 2006 and Suppression of Financing of Terrorism Act no 25 of 2005 We hereby request the Company to accept and to execute instructions and to give effect to requests to the Company to enter into contracts with or for us of any other nature whatsoever where such instructions and / or requests are given:- (a) by telephone, telegram or telex or electronic recording and purport to come from me / us and are honestly believed by the Company to come from me / us, even if not in fact coming from me / us and / or not followed by written confirmation; or (b) by telephone facsimile ( telefax ) and purport to come from me / us and are honestly believed by the Company to come from me / us provided that such instructions and / or requests bear a signature which appear to the Company to correspond to the signature or signatures of me / us or my / our duly authorise Attorney and I / We agree to mark clearly on any confirmation of any communication made by telefax the words Confirmation Only - Do Not Duplicate in the event any such confirmation is sent by us / me. We assume all risks involved in connection with any such instructions and / or requests and in particular ( but without prejudice to the generality of the foregoing ) risks due to errors on the part of the Company regarding the identity of us, errors in transmission or misunderstandings, and the Company is discharged from all responsibility / losses in respect thereof. We hereby agree to indemnify the Company and keep the Company indemnified against any loss arising in consequence of acting in reliance on any such instructions and / or requests, and any actions, proceedings, cost, claims and demands in respect thereof. We agree to perform and ratify any contracts entered into by the Company and / or any action taken by the Company as a result of any such instructions and / or requests given or made or purporting to be given or made by or on behalf of us and honestly believed by the Company to have been given or made by or on behalf of us. Such assumption of risk, discharge, indemnity and agreement to perform and ratify shall extend to communications made or purporting made or purporting to be made by any representative or attorneys now or hereafter from time to time appointed or believed by the Company to have been appointed by us and honestly believed to have been made on our behalf. Notwithstanding the foregoing, the Company may at any time at its absolute discretion decline to execute any instruction and / or request given or made by telephone, telegram, telex or telefax which is not followed by written confirmation, notwithstanding that at the time of such instruction, request or offer an employee of the Company receiving such instruction, request or offer may have indicated assent to such instruction, request or offer. We declare that we shall not hold the Company responsible for the non- execution of any order placed by us, if such orders could not be executed despite the exercise of due care and diligence by the Company.
5of 3 This CDS account is opened at our own risk and on the understanding that share trading can result in profits or losses to us and you are in any event not liable or accountable for any loss or damage arising from or occasioned by maintaining the said CDS account for our behalf. The giving of time to us or the neglect or forbearance or omission of the Company to require enforce performance of any term or condition or payment of any one or more of its claims against us or the granting of any other indulgence to us shall not affect the terms and conditions on our part contained herein. We shall keep the Company indemnified at all times against all claims demands actions proceedings losses damages costs and expenses which may be bought against or incurred by it and which arise directly out of or in connection with any transaction in which it acts as our stockbroker because of its waiver of any condition or terms to be complied with by us or due to any other reason whatsoever. No discretionary powers will be given by us to any employee /s of the Company without the written confirmation of same from the Company We also declare that the sole beneficiary of this CDS account is our company. We agree and undertake to examine and verify the entries in the contract notes, CDS Statements and Statement of Account tendered to us and make prompt payments due to the Company on the purchases made on our behalf or for us by or through the Company on the orders placed by us with the Company If there is any discrepancy in the entries shown on such Statements of Account we agree and accept as our responsibility to point out the same. We request and authorise you to obtain confirmation of orders through telephone / facsimile transmission, exchange of electronic messages or by person. In such event we agree and accept as our responsibility to point out any discrepancy of orders on the transaction date itself. In any event any discrepancy not so pointed out by us in writing to the Company within the stipulated time period as given in the relevant document, it shall be conclusively settled between us and the Company that all entries in the Statements of Account are correct and accordingly we will be bound by the same. It is our responsibility to check the status of our CDS account periodically and inform non-receipt of the contract notes, CDS statements and statements of account in writing, if any to the Company under registered post. In consideration of the Company agreeing to arrange for purchase of shares listed in the Colombo Stock Exchange (CSE) as per purchase orders placed by us we hereby covenant and undertake to settle the payments on due date as per CSE Rules. In case we fail to pay all such sums of monies on due date as aforesaid it is lawful but not obligatory for the Company to make such payments. In such events we unconditionally and irrevocably undertake to re-pay all such sums of monies together with the interest due or owing to the Company Any document, addressed to our last known address and sent by courier or by post shall deemed to be received by us on the day it would have been delivered in the normal course of business. Any amendment or modification in respect of this Agreement will be effective if notified by the Company in writing (including a writing evidenced by a facsimile transmission) to us and shall deem to have been accepted by us. This declaration shall be binding upon us and our successors and assigns. Company Seal............ Company Reg. No. Date Witnesses 1. 2 01/01/09 Company declaration-b-22.01.09 (Convey