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Attested Kyc Form

Attested kyc form and copy of proof id

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MANJU MANI
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266 views

Attested Kyc Form

Attested kyc form and copy of proof id

Uploaded by

MANJU MANI
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
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Central KYC Form for Individual Please fll this form in ENGLISH and in BLOCK LETTERS. All fields marked (*) are mandatory. [i PERSONALDETANS (NAME (same as in ID proof)" MANJU MANL Father's / Spouse’ Name* PRADEEP MANE Mother's Name* LSSANAA KURIAN Date of Birth™ : 75/1980 Gender? : M/W/T Citienship* : [nfan/Others Marltal Status* ; Maefied/Unmarried/Others Residential Status* : Residen#Individual/ WAL/Foreign national/Person of Indian origin Occupation type® (Tick Genter code): 22 [2_PROOF OF IDENTITY [Pal]* (Certified copy of any one is required) Scounation __| Code Proofontbsubmiteed Number [Beir date ] pease: —_ a = | =F srosiona [Loos | ter 1D sett umpiond | af | ban | exnewacssn = |[reees [oes | ‘Driving Weenee F Hovente | 0-8 fio [ | Psteden, Toa INREGA Job Care Puttieseersr | sor || Simpified Messures Account [iD no ~ Code = roaieseanr | 5-02 | [others (noted by Central Gove) 1D no. ode cma | ot [ 3. PROOF OF ADDRESS [PoA]* (Certified copy of any ones required) _————+ds Esteperied root oF i> Submitted Number Expley date passport Uss50881 xznzz031 | Voter 10. | a a Driving cence F | uo i 7 NAEGA lob card | mi Simplified Measures Agezunt _|1D1n@ lcoae [Others (notified by Central Gow) fo ne. Z ode al 3.1 Permanent Address Address Detai PUTHUPARAIMBIL HOUSE, THIRUUANCHOOR P.O, KOTTAYAM, KERALA, LPincode « S9801s) 3.2 Correspondence Address/Local Address details - ‘Address Details; PUTHUPARAMEIL HOUSE, THIRUUANCHOOR FO, KOTTAYAM, KERALA ] Pincode - 6509 Contact Betatls Fax: [Tet (orm: Mobile®: 9856252875, lemail:atb7edd8e8ft gmail.com 5. Applicant Declaration® ‘hereby decors thatthe details Frshed above are true and conect tothe best ofrayknowoap ‘anges therein, immediatly. Ih kis an} of he above informatin ts loud to be false or unto or miisuding be misrepresenting, tam suse ‘hat may ba nad ale fr hereby consant to receieng startin fren Central ONC Registry threugh SAAS/EmSi on the oboe eeiotered pumberFemal address. Bate: oznanea? Place: KO TIANA €._Attestation/Far office use only KYC Verification carried out by Recelved self attested copies sd bak ond I underaie te inform you aay hiding Ady Officer's Name/SR No/Designation/Branch

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