CONVERTIBLE NOTES APPLICATION FORM Company Name whose shares are being transacted: PAN number of the Company: Company Name whose shares are being transacted: PAN number of the Company: Phone Number: Email ID: Is this your first FDI filing? YesNo Name: Email ID: Phone No: Designation: Have you created a Business User (BU) on FIRMS? YesNo Our Team Will Contact You Do you want us to create BU? YesNo Our Team Will Contact You Download Authorization Letter Click Choose File To Upload Select Entry Route: AutomaticGovernment Select Sectoral Cap: 20%26%49%51%74%100%Others Sectoral Cap section Whether FDI received for a particular project? YesNo Pin code: District: State: Brownfield/Greenfield: BrownfieldGreenfield Initial FCGPR Reference Number if any: AD bank details: IFSC Code: Bank Name: Branch Address: State: CN Specific the type of filing: FIRC/ Debit Statement and KYC of Non Resident: Document evidencing date of issue of Convertible Note: Registration certificate for being a start-up: Board resolution: CS certificate: Declaration to be filed by the authorised representative of the Indian Company:
