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Kotak Mahindra Bank

Kotak Mahindra Bank
I

Jl-JAF/ Jan 15/ 14-1.0

THIS FORM WILL PASS THROUGH A SCANNER, PLEASE FILLIN BLOCK LETTERS E.G. A N I T A K U M A R

I CUSTOMER RELATION FORM BARCO DE I

(For Non-Individual Only)
(To be filled in by Joint Applicant I Mandate separately)

Bank Use: Preferred Home Banch -······- ···········--·······- Branch Code licket ID

-----DETAILS OF ORGANISATION
*Name N· E E R C A R E H 0 ME S PR 1. VA . T E Ll.Ml .TE . D

Name should be
PERSONAL DETAILS - AUS Mandate * Beneficiary Owner • Fields are Mandatory
in First Name
Middle Name
& Last Name
*CKYCR New i Exisiting - No Change · Exisiting - Update Change format & upto 4C
,y "\characters only
',\j .
Existing CRN Yes (In case you have an existing relationship with the Bank) V' . No (Please fill the details below)

*Name MR S HA I L ENDRA K UMA R S R .I__ \!__ A_ S T A V

* DOB 0 1 0 7 1. 9 8 6 * Mother's Maiden Name p R_ ]: _IY.l__L _f\ _T_A S R I VAS T A _y

· *Father I v *Spouse Name S R_ I V A S T A ,V A Citizenship v Indian Other

(lfpan not<Miilabltfathtr'sNameM.in:fatory)

*Gender v Male Female Third *Marital Status Single v Married Others - - - -

*Annual Income D 0- 2 lakhs !---j > 2 - 5 lakhs ~J > 5 -10 lakhs

r-·--1
~j > 1O- 25 lakhs > 25 lakhs Designation

* Identity & Address documents of all shareholders holding more than 25% share capital in the company and more than 15% in a partnership will be mandatorily required.

Permanent Address I Residence Address (Upto go <h"actm onlyi

Line 1 L_?~ - F L 0 Q_L~_J___J_J_j __; ____ L___j __J __J_____ L__L___L_L_i____J

Line 2 ..l . !S...!.. ~.J - --- -- ----·· ·'······ ········ ·····-··-·····-'···· ······----····-·· ·-········ ··~

Line 3 /Landmark Ll _l_L_l_LL._J '. _j_J___J___j__J_~.--- - -· _l __ L__J___ J__ !____J_J_l_J

*City *PIN Code Ll_Ll_[_Qj_Q__! 4 I8 I
*State I NIE 11_W! _i _ _ li_____
L----··-·-- : E i _..L_L__
D l____L ! H
1
I i
L--···L-.J..
1
........L: i i_____..!Telephone
__J.I __ j___j : No . .:..-\'9
1
1. ... _lo___
_.J_-i_·.1_-....•:_0_1.7_____ s._.. - i_. .3_._l ___8..____i 4 l ..s......
- 1 o 1 s

NOTE: Account Statement/Cheque book of the Corporate and Debit card/PIN/Password mailers for each authorised signatories will be sent to the Company's mailing address only. 'Mobile No &
•Email Id as
provided wi ll be
*Preferred Mobile No. 7 5 0 3 8 ~ 5 i1 :OJS .;··
considered as
~~ Preferred'
(All alerts will be sent to the preferred Mobile No. & Email ID) '1JF-
." - --

* Preferred Email ID S H Ai I L' E ND RA@; E Ej S P L j . ~ - 0

v I do not wish to update my mobile number/e-mail ID (or) both. I am aware that for availing Channel access -Net Banking/CMS NetlT/Mobile Banking/Debit Card -POS etc.,
mobile number and e-mail ID is to be mandatorily updated in Bank's records.

....
CHANNEL ACCESS REQUEST (Not applicable for Co-operative Bank Customers)
I wish to apply for access to the following channels
Access to
1-;tAPPLICANTf AUS-I Channel Access will be granted only to the person specifica lly authorised for the purpose. PG will be activated by default for curtomers registered for Net
banking with unconditional transaction rights.
online tax
payment will
- NB DC# ---1 Mobile Banking & Mobile Payment services will be activated by default for custom ers who opt for Net Ba nking I Debit Card be activated by
f-·--------t---=~--===---1
Transaction Rights 0 El I :# Default Debit Card will be EMV Chip & PIN enabled for Domestic PoS (retail outlet} I ATM usage only. Please visit Mobile I Net Banking or nearest Branch to put
up a request to activate other transaction types like domestic e-commerce (online payment), Contactless {Tap & Pay) and International transaction on your Debit
default for
Authorised
Signatories
View Rights L~J Card. For Privy League Customers default Debit Card will be Privy league Platinum I Signature Chip Card depending on the program chosen. opting for Net
,Banking Access
PB - Phone Banking; NB - Net Banking; DC - Debit Card (Not applicable for Co-operative Banks); PG - Payment Gateway (Onli ne Shopping I Trading)

SMS BANKING & ALERT FACILITY

Alert Facility enables you to receive alerts on your Email and I or Mobil e rega rding account transactions and mai ntenances. New alerts may be added from time to time. By tick ing on any of the o ptions below
I expressly consent and authorise the Bank to make Telephone Calls and Send SMS. and/ or Emails to inform me/ us on any informatipn or updates relating to Bank's existing/ new Pro.duct/ Services. The said consent
is valid till such time I withdraw the same in writing.

Bank will send all alerts to a uthorized signatories preferred mobile number an d E-Mai l address mentioned in this form, irrespective of the mode of
operation. Regulatory and Risk a lerts will be sent by the Bank by default.
 D a .
Kotak Mahindra Bank
Kotak Mahindra Bank

TERMS & CONDITIONS

1) The form should be accompanied by the Resolution of the Board/Managing Committee in case of limited Companies, Trusts, Societies, Associations and Clubs, partnership letter in case of partners hips. Distinct
Board/ Managing Committee Resolution and Partnership Letter is to be provided for each Deposit and/or Demat Account as applicable.
2) In case of Partnerships, limited Companies, Trusts, Societies, Associations and Clubs, person(s) with conditional mode of operation/authority will get only non-financial transactions on Net Banking and Phone
Banking and will not get Payment Gateway access.
3) In case of Partnerships, limited Companies, Trusts, Societies, Associations and Clubs all signatures should be accompanied by stamp of the organisation, as applicable.
4) The Channel Access for investment Account(s) is restricted to enquiry rights on Phone Banking and view and transaction rights Net Banking.
5) For transaction on rights on these account(s), a Power of Attorney in favour of Bank has to be duly executed and authorized person should have an unconditional operating authority.
6) In case of Partnerships, limited Companies, Trusts, Societies. Associations and Clubs, Investment Account(s), transaction rights on Net Banking will be granted/Debit Cards will be issues only
to person(s) with unconditional mode of operations/authority. ·
7) In case of Partnership, Limited Companies. Trusts, Societies, Associations and Clubs Debit Cards will be issued only to person(s) with unconditional mode of operation/authority.
8) Proprietor of a Proprietorship concern and karta of an HUF will get both financial and non-financial tra nsaction rights on et Banking and Phone Banking. They are also eligible for Debit
Cards and Payment Gateway access.
9) Net Banking and Phone Banking access to applicable for all Investments Account(s) existing or to be opened in future for the Organisation.
1O) The channel access for Demat Account is restricted to view or enquiry rights on Net Baking and Phone Banking.
11) The Net Banking, Phone Banking and Payment Gateway access is applicable for all Deposit Accounts existing or to be opened in future for the Organisation.
12) Payment Gateway facility is provided as per the terms and conditions of the Bank and regulatory rules as applicable from time to time.
13) The customer reiterates that he shall be continued to be governed by the terms and conditions of the Bank.

CUSTOMER DECLARATION
The particulars contained herein shall be valid for all accounts opened by me/us or to be opened by me/us hereafter either singly or with other(s) and/or by me/us in any representative capacity with the Bank unless informed to you
otherwise. I/We have read/obtained/understood and agree to the terms and condition and citizen charter governing the opening of an account with Kotak Mahindra Bank Ltd. {the Bank) and those relating to various Services including
but not limited to (a) ATMs (b) Phone Banking (c) Debit Card (d) Net Banking (e) Mobile Banking (fj Payment Gateway (g) Kotak Bill Pay (h) SMS Banking (i) Alerts Service Gl Opening of an Investment Account. I/We understand that the
Bank may at its absolute discretion, discontinue any of the Services completely or partially without any notice to me/us. I/We agree that the Bank may debit my/our account for service charges as applicable from time to time. I/We
understand that investment products are not Bank objects or other obligations of or guaranteed or insured by Kotak Mahindra Bank Ltd. or their affiliate>They are subject to risk and possible loss of principal. Past Performance is not
indicative of future performance. I/We hereby dedare the above information is true and correct to my/our Knowledge. I/We shall advice the Bank immediately in the manner as agreed by me/us and acceptable to the Bank, in case of
any change in the above details and information given by me/us. I/We have read and understood the terms and conditions available at Bank's web-site wwv1.kotak.com.
For Corporate: I/We have read and understood the Kotak Mahindra Bank account terms and condition> I/We accept and agree to be bound by the said terms and conditions including those excluding/limiting your liability. I/We
agree that the Bank may debit my/our account for service charges as applicable from time to time. I/We do hereby authorize the bank to conduct my/our credit history verification with CIBIL or any otl1er credit rating agency.
In Case CRF used for New ale opening: I have read and understood the details of all features and charges available in General Charges (GSFC) as applicable to the Product subscribed by us in the AOF attached. I have also
read and understood other conditions of Most Important Document.
I/We have voluntarily supplied the above information obtained from me while account opening which I acknowlede that the Bank is required to obtain in pursuance of periodidAd-hoc reporting to regulatory authoriti~> I/We have
gone through the Privacy Notice published by the Bank on its website www.kotak.com and having agreed to the same. I/We hereby give my consent in favour of the Bank to process my personal information for the purpose and in the
manner provided in the Privacy Notice while II We avail the product and /or service applied for.
I/We hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered mobile number/ email address. I/We submit my Aadhaar number & voluntarily give my/our consent to use my/our
I Aadhaar details (DOB/gender) to authenticate my/our details from UIDAI & link the Aadhaar number to all my/our existing/new/future accounts held under my/our Customer Relationship Number (CRN) with your bank
1
Preferably the
SIG NA.U!llL&..e.HQIPGRAP HS f,P1ease attach recent passport size photograph in the space provided below) Passport size
photograph
against the red
background
should be
For Neercare Hornes Private Limited atrached

<a
~t~
Authorised Signatory

Name : _ 5__ H A L E N D R A

Documents Section (BANK USE)

ID Address
Document Name Relation Code F NF
Proof Proof

Passport Number
i_LJ LJ ·····-·· L.LJ *Additional Info I
'--'--'--'---'---'---' ···-----··---·--···- ··----·----····-·-····-

Passport Expiiy Date !. ~:..Ld l~~ L!'_l::.lv I:'.J Approved By

I
!voter ID Card [ _J _] .J . J.J._J...L ....L
IIDriving License Sales Official Branch Official

! ' ·----···- ····''····-"·······'- -·'····--·'---····· ···-- ·-'·····-··"··········--- ··'-······'· ·-··'········'

I Driving License Expiiy Date KYC Verification Carried Out By (BANK USE)
Emp. Name l_J___J.._L_ I l_J__JJ_J._J_---l_L_l.__;__J__l__!_L__LJ
IE-UID (AAD HAAR) Emp. Designation ! I ,!. 1'_ i I I
'---'--'--'---'--'--'---'--'--'--''---'----'--'---'---'--"i.___l__J

JNREGAJob
Emp. Code '-- LLJ J__ J_L i Emp.CodeBranch
Date j ;:'. I
L t,; j t/ ! 'I I., i : I
I Letter issued by National Population Register '
! i DOCUMENTS COLLECTED

;~~~:'.'. ·----~~ __JJ __L._.L_l_lJ.___LJ_J_.LJ=~_j_ Cl AADHARENRL FORMSIXTY PANDWN PASSBOOK

I
' ~~~N is mandatory) J _J_L_j I NA_ ,__N_A__ [ ] SPBS

f-1 OTHERS
UTILITY [ ] VERDEC