KNOW YOUR CLIENT (KYC) APPLICATION FORM
Please fill this form in ENGLISH and in BLOCK LETTERS.
For Individuals
- IDENTITY DETAILS
- Name of the Applicant:
- Father’s/ Spouse Name:
- a. Gender: Male/ Female b. Marital status: Single/ Married c. Date of birth: (dd/mm/yyyy)
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- Nationality: b. Status: Resident Individual/ Non Resident/ Foreign National
5. a. PAN: b. Aadhaar Number, if any:
- Specify the proof of Identity submitted:
- ADDRESS DETAILS
- Residence Address:
City/town/village: Pin Code: State: Country:
- Contact Details: (Off.) Tel. (Res.) Mobile No.: Fax: Email id:
3. Specify the proof of address submitted for residence address:
- Permanent Address (if different from above or overseas address, mandatory for Non-Resident Applicant):
City/town/village: Pin Code: State: Country:
DECLARATION
I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.
Signature of the Applicant Date: (dd/mm/yyyy)
FOR OFFICE USE ONLY
Originals verified and Self-Attested Document copies received
(………………………………………..)
Name & Signature of the Authorised Signatory
Date …………………. Seal/Stamp of the intermediary
KNOW YOUR CLIENT (KYC) APPLICATION FORM
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For Non-Individuals
Please fill this form in ENGLISH and in BLOCK LETTERS.
- IDENTITY DETAILS
- Name of the Applicant:
- Date of incorporation: (dd/mm/yyyy) & Place of incorporation:
- Date of commencement of business: (dd/mm/yyyy)
4. a. PAN: b. Registration No. (e.g. CIN):
- Status (please tick any one):
Private Limited Co./Public Ltd. Co./Body Corporate/Partnership/Trust/Charities/NGO’s/FI/ FII/HUF/AOP/ Bank/Government Body/Non-Government Organization/Defense Establishment/BOI/Society/LLP/ Others (please specify)
1. Address for correspondence:
City/town/village: Pin Code: State: Country:
- Contact Details: (Off.) Tel. (Res.) Mobile No.: Fax: Email id:
3. Specify the proof of address submitted for correspondence address:
- Registered Address (if different from above):
City/town/village: Pin Code: State: Country:
1. Name, PAN, residential address and photographs of Promoters/Partners/Karta/Trustees and whole time directors:
- a) DIN of whole time directors:
- b) Aadhaar number of Promoters/Partners/Karta:
I/We hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I/we undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am/we are aware that I/we may be held liable for it.
Name & Signature of the Authorised Signatory Date: (dd/mm/yyyy)
FOR OFFICE USE ONLY
Originals verified and Self-Attested Document copies received
(………………………………………..)
Name & Signature of the Authorised Signatory
Date …………………. Seal/Stamp of the intermediary