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kyc

Uploaded by

optionviewx
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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PHOTOGRAPH

KNOW YOUR CLIENT (KYC) APPLICATION FORM FOR INDIVIDUALS


Please affix the recent
Please fill this form in ENGLISH and in BLOCK LETTERS. passport size
photographs and sign
Note: All Fields Are Required. across it.

1. Name of the Applicant:_________________________________________________

2. Father / Spouse Name:_________________________________________________

3. a. Gender:_________________________________________________

b. Marital status:_________________________________________________

c. Date of birth:_________________________________________________

4. a. Nationality:_________________________________________________

b. Status:_________________________________________________

5. a. PAN:_________________________________________________

b. Unique Identification Number (UID)/ Aadhaar, if


any:_________________________________________________

6. Specify the proof of Identity submitted:__________________________________________

____________________________________________________________________________________

B. ADDRESS DETAILS .

1. Address for correspondence:____________________________________________

City/town/village:_________________________________________________

Pin Code:_________________________________________________

State:_________________________________________________

Country:_________________________________________________

2. Contact Details: Tel. (Off.) or Tel. (Res.):_____________________________________________

Mobile No.:_________________________________________________

Email id:_________________________________________________
3. Specify the proof of address submitted for correspondence
address:______________________________________

_____________________________________________________________________________

4. Registered Address (if different from above):_____________________________________________

City/town/village: _________________________________________________

Pin Code:_________________________________________________

State:_________________________________________________

Country:_________________________________________________

5. Specify the proof of address submitted for permanent


address:_____________________________________

____________________________________________________________________________________

C. OTHER DETAILS .

1.Gross Annual Income Details (please specify): Income Range per annum:______________or Net-worth as
on (date)_________________. ( __________________ ) (Net worth should not be older than 1 year).

2. Occupation (please tick any one and give brief details): Private Sector/ Public Sector/ Government
Service/Business/ Professional/ Agriculturist/ Retired/ Housewife/ Student/ Others.

3. Please tick, if applicable: Related to a Politically Exposed Person (PEP)/Politically Exposed Person (PEP).

4. Any other information:________________________________________________________________

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
accept all terms & condition of company.

_____________________________________

Name & Signature of the Authorized Signatory Date: ___________ (dd/mm/yyyy)


FOR OFFICE USE ONLY .

 (Originals verified) True copies of documents received


 (Self-Attested) Self Certified Document copies received

_____________________________________
Name & Signature of the Authorized Signatory

Date: ___________ (dd/mm/yyyy)

Sign of executive

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