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Know Your Client (Kyc) Application Form: Declaration

This document is a KYC (Know Your Client) application form for individuals. It requests identity details like name, father/spouse's name, gender, date of birth, nationality, and residency status. It also asks for contact details like address, phone numbers, and email. The applicant must declare that the information provided is true and correct, and agree to inform the institution of any changes. They acknowledge that providing false information could make them liable. The form is to be filled in English and block letters, and the applicant must submit proof of identity and address.

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porkovan
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© © All Rights Reserved
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Download as XLSX, PDF, TXT or read online on Scribd
82 views

Know Your Client (Kyc) Application Form: Declaration

This document is a KYC (Know Your Client) application form for individuals. It requests identity details like name, father/spouse's name, gender, date of birth, nationality, and residency status. It also asks for contact details like address, phone numbers, and email. The applicant must declare that the information provided is true and correct, and agree to inform the institution of any changes. They acknowledge that providing false information could make them liable. The form is to be filled in English and block letters, and the applicant must submit proof of identity and address.

Uploaded by

porkovan
Copyright
© © All Rights Reserved
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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KNOW YOUR CLIENT (KYC) APPLICATION FORM

For Individuals
Please fill this form in ENGLISH and in BLOCK LETTERS
A. IDENTITY DETAILS
1. Name of the Applicant:

_________________________________________________________

2. Fathers/ Spouse Name

_________________________________________________________

3. a. Gender:

Male/ Female

c. Date of birth: ____________

(DD/MM/YY)

4. a. Nationality: ___________________________
c. US Residency

b. Marital status:

b. Status: Resident Individual/ No

Yes / No

6. Specify the proof of Identity submitted: _________________________________________________


ADDRESS DETAILS

1. Residence Address: _____________________________________________________________________

________ City/town/village: ___________ P.O Box: __________ State: ______________ Country: ___
2. Contact Details: Tel. (Off.) _______ Tel. (Res.) ________ Mobile No.: _________ Fax: _________

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

4. Permanent Address _____________________________________________________________________

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
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 _________________________
For Office Use
Original Verified Documents received

Name and Signature of the Authorized Signatory


Date _______________________________

List of Document Requested


1. Valid ID or Passport Copy

T (KYC) APPLICATION FORM


Individuals

_______________________________________________

_______________________________________________
Marital status:

Single/ Married

Status: Resident Individual/ Non Resident/ Foreign National

_____________________________________________

_______________________________________

ate: ______________ Country: _________________

ile No.: _________ Fax: _________ Email id: __________

dress:_______________________________________

_________________________________________

wledge and belief and I undertake to inform you of any changes therein, immediately. In case any of the

re that I may be held liable for it.

Date __________________________

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