Distributor Form | Venkatesh Capital Management

1

Distributor Details

Name of Distributor / Firm*

Entity Type

Address

Contact Person*

Mobile No.*

Email ID*

Nature of Business

AIF Distribution Mutual Fund Distribution Insurance Distribution Wealth Management Financial Advisory Stock Broking Investment Advisory Other

2

KYC Details

PAN*

Aadhaar No. / Valid KYC ID*

Registration Number (if applicable)

Yes No

3

Bank Details

Bank Name

Branch Name

Account Holder Name

Account Type

Account No.

IFSC Code

4

AIF Distribution Experience and Existing AIF Relationships

Do you have prior experience distributing AIFs or alternate investment funds?*

Yes No

5

Investor Network and Distribution Capability

Investor Network

HNI Family Office Institutional Corporate Other

Best time to contact*

6

Document Upload

PAN Card

GST Registration Certificate or Entity Registration Proof*

ARN or Other Registration Proof*

7

Terms & Conditions

By submitting this form, the Distributor agrees to comply with applicable SEBI regulations, the Fund's PPM and KYC/AML requirements. Any information provided is subject to verification, and empanelment is at the sole discretion of the Investment Manager.

8

Declarations, Consent, and Digital Signature

Declarations and Consents*

Authorized Signatory Name*

First Name

Middle Name

Last Name

Designation*

Date of Declaration*

Digital Signature*

Draw your signature above using mouse or touch, or switch to Upload to add a scanned / photographed signature (PNG or JPG).

Declaration Note