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upstoxKYC Page

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Ramkumar Srinivasan
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21 views

upstoxKYC Page

Uploaded by

Ramkumar Srinivasan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Know Your Client (KYC) PLEASE AFFIX A

Application Form (For Individuals Only) RECENT PASSPORT


PHOTOGRAPH AND
Please fill type the form in English and BLOCK letters. Sign all areas marked with SIGN ACROSS IT
‘x’. Once completed, please mail the completed form along with the necessary
proofs to our corporate office in Mumbai.
CLIENTʼS SIGNATURE [1]

A. Identity Details (please see guidelines)


FULL NAME (As appearing in supporting identification document):

FATHER / SPOUSE’S NAME: MAIDEN NAME: (If any)

MOTHER NAME:
GENDER MALE FEMALE T - TRANSGENDER MARITAL STATUS MARRIED UNMARRIED OTHERS

CITIZENSHIP IN - INDIAN OTHERS (ISO 3166 COUNTRY CODE ) DATE OF BIRTH (dd/mm/yyyy)

RESIDENTIAL STATUS RESIDENT INDIVIDUAL NON RESIDENT INDIAN FOREIGN NATIONAL PERSON OF INDIAN ORIGIN

PAN (Please enclose a duly attested copy) AADHAAR NUMBER (if any)

PROOF OF IDENTITY SUBMITTED FOR PAN EXEMPT CASES (Please Tick )


UID (AADHAAR) PASSPORT VOTER ID DRIVING LICENCE OTHERS (Please see guideline ‘D’)

NREGA JOB

B. Address Details (Please see guidelines)


Address Type Residential / Business Residential Business Registered Office Unspecified
ADDRESS FOR RESIDENCE/CORRESPONDENCE:

CITY/TOWN/VILLAGE: STATE:
PIN CODE
COUNTRY:
TEL (OFF) : TEL (RES):

MOBILE: FAX:

EMAIL ADDRESS:

PERMANENT ADDRESS OF RESIDENT APPLICANT IF DIFFERENT FROM ABOVE B1 OR OVERSEAS ADDRESS(MANDATORY) FOR NON RESIDENT APPLICANT:

CITY/TOWN/VILLAGE: STATE:
PIN CODE
COUNTRY:
PROOF OF ADDRESS TO BE PROVIDED BY APPLICANT. PLEASE SUBMIT ANY ONE OF THE FOLLOWING VALID DOCUMENTS & CHOOSE THE DOCUMENT ATTACHED
PASSPORT RATION CARD REGISTERED LEASE/SALE AGREEMENT OF RESIDENCE DRIVING LICENCE VOTER IDENTITY CARD
*LATEST BANK A/c STATEMENT/PASSBOOK *LATEST TELEPHONE BILL (Only landline) *LATEST ELECTRICITY BILL *LATEST GAS BILL
OTHERS (Please Specify)
*Not more than 3 months old. Validity/Expiry date of proof of address submitted (dd/mm/yyyy)

ANY OTHER INFORMATION:

DECLARATION
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 may
be held liable for it.

PLACE:
CLIENTʼS
SIGNATURE [2] X DATE (DD/MM/YYYY)

FOR OFFICE USE ONLY IPV Done on (dd/mm/yyyy)

AMC/Intermediary name OR code Application Typ


e eN w Update Seal/Stamp of the intermediary should contain
Staff Name
(Originals verified) True copies of KYC Number (Mandatory for KYC update request)
Designation
Name of the Organization
documents received Signature
(Attested) True copies of documents Date
received Main Intermediary Account Type Normal Small Place

Simplified ( or low risk customers)


PAGE 4
V 3.1.1

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