CKYC & KRA KYC Form

Know Your Client

New
Application Form (For Individuals only) Application
Type* Update KYC Number*
(Please fill the form in English and in BLOCK Letters) Fields
marked with ‘*’ are mandatory fields
KYC Type* ■ Normal (PAN is mandatory) PAN Exempt Investors (Refer instruction K)

1. Identity Details (Please refer instruction A at the end)

PAN C Z P P G 7 6 6 8 J Please enclose a duly attested copy of your PAN Card

Name* (same as ID proof) M R S S H I T A L S H I V A J I G H O L A P

Maiden Name (If any*)

Father / Spouse Name* M R . H A N U M A N T K A L E

M R S N I R M A L A
Mother Name*
Date of Birth* 1 3 0 3 1 9 8 6 Photo

Gender* M- Male ■
F- Female T-Transgender

Marital Status* Married Unmarried Others

I N
Citizenship* ■
IN- Indian Others – Country Country Code
Residential Status* ■ Resident Individual Non Resident Indian
Foreign National Person of Indian Origin
Occupation Type* S-Service Private Sector Public Sector Government Sector
O-Others Professional Self Employed Retired Housewife
B-Business X-Not Categorised

2. Proof of Identity (PoI)* (for PAN exempt Investor or if PAN card copy not provided) (Please refer instruction C & K at the end)
(Certified copy of any one of the following Proof of Identity [PoI] needs to be submitted)
A- Passport Number Passport Expiry Date D D M M Y Y Y Y

B- Voter ID Card
D- Driving Licence Driving Licence Expiry Date D D M M Y Y Y Y

E- Aadhaar Card
F- NREGA Job Card
Z- Others (any document notified by the central government) Identification Number

3. Proof of Address (PoA)*

■ 3.1 Current / Permanent / Overseas Address Details (Please see instruction D at the end)

Line 1* M U P O S T D A D S H I N G E

Line 2 T A L U K A

Line 3 B A R S H I City / Town / Village* D A D S H I N G E

District* D A D S H I N G E Zip/Post Code* 4 1 3 4 0 1 State/UT Code M H as per Indian Motor Vehicle Act, 1988

State/UT* M A H A R A S H T R A

Country* I N D I A Country Code I N as per ISO 3166

Address Type Residential / Business Residential Business Registered Office Unspecified

(Certified copy of any one of the following Proof of Address [PoA] needs to be submitted)
Proof of Address
Passport Number Passport Expiry Date D D M M Y Y Y Y

Voter ID Card
Driving Licence Driving Licence Expiry Date D D M M Y Y Y Y
■ Aadhaar Card X X X X X X X X 7 4 1 0

NREGA Job Card

Others (any document notified by the central government) Identification Number

3.2 Correspondence / Local Address Details* (Please see instruction E at the end)
✔ Same as Current / Permanent / Overseas Address details
Line 1*
Line 2
Line 3 City / Town / Village*
District* Zip / Post Code* State/UT Code as per Indian Motor Vehicle Act, 1988

State/UT*
Country* Country Code as per ISO 3166
4. Contact Details (All communications will be sent on provided Mobile no. / Email-ID) (Please refer instruction F at the end)

Email ID a n i k e t g h o l a p 3 5 3 @ g m a i l . c o m
Mobile Tel. (Off)
9 1 9 6 9 9 1 8 4 4 4 3 Tel. (Res)

5. FATCA/CRS Information (Tick if Applicable) Residence for Tax Purposes in Jurisdiction(s) Outside India (Please refer instruction B at the end)
Additional Details Required* (Mandatory only if above option (5) is ticked)
Country of Jurisdiction of Residence* Country Code of Jurisdiction of Residence as per ISO 3166

Tax Identification Number or equivalent (If issued by jurisdiction)*

Place / City of Birth* Country of Birth* Country Code as per ISO 3166

Line 1*
Line 2
Line 3 City/Village*
District* Zip/Post Code* State/UT Code as per Indian Motor Vehicle Act, 1988

State/UT*

Country* Country Code as per ISO 3166

6. Details of Related Person (Optional) (please refer instruction G at the end) (in case of additional related persons, please fill ‘Annexure B1’)
Related Person Deletion of Related Person KYC Number of Related Person (if available*)
Related Person Type* Guardian of Minor Assignee Authorized Representative
Prefix First Name Middle Name Last Name
Name*
(If KYC number and name are provided, below details of section 6 are optional)
Proof of Identity [PoI] of Related Person* (Please see instruction (H) at the end)
(Certified copy of any one of the following Proof of Identity[PoI] needs to be submitted)
A- Passport Number Passport Expiry Date
B- Voter ID Card
C- PAN Card
D- Driving Licence Driving Licence Expiry Date D D M M Y Y Y Y

E- Aadhaar Card
F- NREGA Job Card
Z- Others (any document notified by the central government) Identification Number

7. Remarks (If any)

8. Applicant 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. I hereby declare that I am not making this application for the purpose of contravention of any Act, Rules, Regulations or any
statute of legislation or any notifications/directions issued by any governmental or statutory authority from time to time.
• I hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/email address
• I hereby consent to MF/AMC/KRA to share this KYC data / applicable Aadhaar XML data with CKYCR, download the information from CKYCR and
share the data to other participating intermediaries as mandated by PMLA Act/Rules/SEBI guidelines.

Date: 2 4 0 8 2 0 2 3 Place : G U R G A O N Signature / Thumb Impression of Applicant

D D M M Y Y Y Y
9. Attestation / For Office Use Only
Documents Received Certified Copies
KYC Verification Carried Out by (Refer Instruction I) Institution Details

Date 2 D4
D 0 M8
M 2
Y Y0 Y 2Y 3 Name B A N A Y A N T R E E S E R V L T D

Emp. Name S U D H A V E R M A Code I N 8 9 9 3

Emp. Code 1 5 1 7 0 0 9 3 Emp. Branch G U R G A O N

Emp. Designation V E R I F Y I N G O F F I C E R

In-Person Verification (IPV) Carried Out by (Refer Instruction J) Institution Details

Date D2 D4 M0 M8 2 Y0Y 2Y 3
Y Name B A N A Y A N T R E E S E R V L T D

Emp. Name S U D H A V E R M A Code I N 8 9 9 3

Emp. Code 1 5 1 7 0 0 9 3 Emp. Branch G U R G A O N

Emp.
nationDesignation V E R I F Y I N G O F F I C E R