INDIVIDUAL CUSTOMER INFORMATION FORM

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AML Screening No.
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(FOR BANK'S USE ONLY)

Branch : Customer No.
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Account No.
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Date : Account Class
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Please complete the details in capital letters and strike out the non-applicable fields/boxes. -s[kof ljj/0fx¿ 7"nf cIf/x¿df k"/f ug{'xf]; / nfu" gx'g] If]qx¿/ aS;x¿ :6«fOs ug{'xf];_

Social Media ID

Issued District/Place Passport Expiry Date (A.D.) Visa Expiry Date (A.D.)
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Expiry Date
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SEE +2
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(*Mandatory Details clgjfo{ ljj/0f )

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SBIL-PRT-0105
 Note: 1. Please provide the self declaration or valid documents verifying the annual income -s[kof tkfO{sf] jflif{s cfo>f]t k'lit ug{ :j3f]if0ff cyjf sfuhft k|bfg ug{'xf]nf_
2. Please submit sepearate sheet if required -cfjZos ePdf 5'§} ljj/0f k]z ug{'xf]nf_

Anticipated Annual Volume of Transaction -cg'dflgt jflif{s sf/]af/_

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Do you hold Residence/Citizenship/Green card of foreign country?

Residence/Citizenship/Green card (Individual & FATCA Form W9 to be filled)

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Politically Exposed Person Declaration -/fhlglts÷pRr kb:y JolQm :jf]3f]if0ff_
Are you a Politically Exposed Person (PEP or Family member of PEP or Associated with any PEPs) Yes No
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If Yes, please specify the Name of PEP Relationship with you Position of PEP
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Beneficial Owner Declaration -lxtlwsf/Lsf] :j3f]if0ff_
Do you have any beneficial owner? Yes No Please specify the name of beneficial owner Relationship with you
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Google Plus Code

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I hereby declare that all the information contained in this form and documents supplied herewith are true and correct in all respect. If found otherwise,
I will be fully responsible as per the prevailing law. The Bank is authorized to share my information to the parties authorised by the Bank for various
banking services or to any entity allowed to collect such information lawfully. The Bank is allowed to contact me on above given details by any means of
communication and the Bank will not be responsible for any consequences thereon. I hereby agree to notify the Bank in case of any changes in the details
provided. The Bank will not be held responsible for any consequences arising in future in case I failed or delayed to inform the change in the details provided.
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AML Risk Category Low Medium High* Reason for High Risk

*Need separate approval to be attached including citizenship detail of unseparated family members. Next KYC Review Date (A.D.)

Form Checked/Customer's Sign. Confirmed/Attested by Date : Reviewed/Re verified by Approved by

Employee Code No. Date : Date :
Employee Code No. Employee Code No.

SBIL-PRT-0106