FIMMDA

General

Name of the Institution*

Address of Registered Office*

Address 1*

Address 2*

City*

State*

Pincode*

Country *

Telephone *

Fax *

Email *

Authorized Capital

Paid-up Capital

Share Holding Pattern

Name of the CEO *

Names & Designation of Directors on the Board:

1.		6.
2.		7.
3.		8.
4.		9.
5.		10.

Particulars of Licenses issued by the Regulatory bodies (RBI/IRDA/SEBI etc):

Banking / Insurance	Authorization to Commence Business	License to Deal in Foreign Exchange

Organization Type (Tick)

Academic Institution

Association

News Organization

Insurance Company

Financial Institution

Foreign Bank

Public Sector Bank

Private Sector Bank

Primary Dealer

Payment Bank

Small Finance Bank

Others

Name of the Treasury Officials with Designation

Head of Treasury

Name:

Designation:

Telephone No.

Fax No.

E-Mail Id

Alternate Official