Form for giving intimation under Rule 18(4) for transactions in shares, securities, debentures and investment in mutual fund schemes, etc.
1.	Name and designation		…..		….. 		…..
2.	Scale of pay and present pay 	…..		…..		…..
3.	Details of each transaction made in shares, securities, debentures, mutual fund scheme, etc., during the calendar year………………………………................
	…………………………………………………………………………………
	…………………………………………………………………………………
4.	Particulars of the party, firm with whom transaction is made –
	(a)	Is party related to the applicant?	…..		…..
	(b)	Did the applicant have any dealings with the party in his official capacity at any time or is the applicant likely to have any dealings with him in the near future?
5.	Source or sources from which financed –
	(a)	Personal savings	…..		…..		…..
	(b)	Other sources giving details		…...		…..
6.	Any other relevant fact which applicant may like to mention

DECLARATION
	I hereby declare that the particulars given above are true.

Station:									Signature:
Date:										Designation:

Please provide the DEMAT No., Bank Account No. and the source of funds alongwith the form.