05092022_ANNEX A SELF DECLARATION FORM FOR KYC UPDATION.pdf

KYC ANNEXURE ‘A’ STATE BANK OF INDIA___________________ BRANCH SELF DECLARATION FORM FOR KYC UPDATION...

KYC ANNEXURE ‘A’ STATE BANK OF INDIA___________________ BRANCH SELF DECLARATION FORM FOR KYC UPDATION (INDIVIDUALS: NO CHANGE IN KYC INFORMATION) Account Number* CKYCR No * OVDs submitted to Bank YES NO Date of Expiry of OVD are valid/not expired (as (If applicable) on date) * Name* PAN Number (If available) Current Address* Line 1: ________________________________________________________________ Line 2: ________________________________________________________________ City/Town/Village: _______________ District: ____________________________ State: _____________________ PIN: _____________________________________ Country: _______________ Occupation* Annual Income* Sources of Income (Please tick all that are Salary Business Income Agriculture Investment Income Pension Others applicable) * Mobile Number Email ID CUSTOMER’S DECLARATION I hereby declare that there is no change in existing status of my KYC Information which was provided at the time of opening the account / last KYC updation. I undertake the responsibility to declare, disclose and provide immediately and in no case beyond 30 days from the date of change, any changes that may take place in the information provided herein/or otherwise, as well as in the documentary evidence provided by me or if any certification becomes incorrect or undergoes a change. In case 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. Date:………………………. Signature/Thumb Impression of Customer Place:……………………… Name …………………………………………………….. For Office Use only 1. Certified that KYC Documents of the Customer available with the Bank are as per current Customer Due Diligence (CDD) Standards. 2. CKYCR Number of the customer is available in Bank records. 3. PAN details (if available) have been verified from database issuing authority. 4. Information submitted by the customer verified & KYC updation date entered in CBS. Maker……………………….. Checker…………………………… PF No.......................... (S.S. No______________) (This form is to be sent to LCPC for digitisation and storage)