PAYMENT OPTIONS

KNOW YOUR CLIENT (KYC) APPLICATION FORM

 

Please fill this form in ENGLISH and in BLOCK LETTERS.

For Individuals

 

  1. IDENTITY  DETAILS
  2. Name of the Applicant:                                                                                                                                                                    
  3. Father’s/ Spouse Name:                                                                                                                                                                    
  4. a. Gender: Male/ Female b. Marital status: Single/ Married                   c. Date of birth:                                                   (dd/mm/yyyy)
PHOTOGRAPH

 

Please affix your recent passport size photograph and sign across it

  1. Nationality: b. Status: Resident Individual/  Non Resident/  Foreign National

5.         a. PAN:                                         b. Aadhaar Number, if any:                                                       

  1. Specify the proof of Identity submitted:                                                                                                                                                                    

 

  1. ADDRESS DETAILS
  2. Residence Address:                                                                                                                                                                    

                 City/town/village:                       Pin Code:                      State:                             Country:                  

  1. Contact Details: (Off.) Tel. (Res.)                  Mobile No.:                   Fax:                                                            Email id:                    

3.        Specify the proof of address submitted for residence address:                                                                                                                                                                    

  1. 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

PHOTOGRAPH

 

Please affix the recent passport size photographs and sign across it

For Non-Individuals

Please fill this form in ENGLISH and in BLOCK LETTERS.

  1. IDENTITY DETAILS
  2. Name of the Applicant:                                                                                                                                                                    
  3. Date of incorporation: (dd/mm/yyyy) & Place of incorporation:                                                                    
  4. Date of commencement of business: (dd/mm/yyyy)

4.        a. PAN:                                                              b. Registration No. (e.g. CIN):                                                                             

  1. 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:                    

  1. Contact Details: (Off.) Tel. (Res.)                Mobile No.:                 Fax:                                                         Email id:                  

3.        Specify the proof of address submitted for correspondence address:                                                                                                                                                                

  1. 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:

  1. a) DIN of whole time directors:                                                                                                                                                                    
  2. 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