KYC_ApplForm_p.pdf

KNOW YOUR CLIENT (KYC) APPLICATION FORM For Individuals PHOTOGRAPH Please fill this form in ENGLISH and in BLOCK LETTERS....

KNOW YOUR CLIENT (KYC) APPLICATION FORM For Individuals PHOTOGRAPH Please fill this form in ENGLISH and in BLOCK LETTERS. Please affix your recent passport A. IDENTITY DETAILS size photograph and sign across it 1. Name of the Applicant: ________________________________________________________________ 2. Father’s/ Spouse Name: _______________________________________________________________ 3. a. Gender: Male/ Female b. Marital status: Single/ Married c. Date of birth: ____________(dd/mm/yyyy) 4. a. Nationality: ___________________________ b. Status: Resident Individual/ Non Resident/ Foreign National 5. a. PAN: ____________________ b. Aadhaar Number, if any: ______________________________________________ 6. Specify the proof of Identity submitted: _______________________________________________________________ B. ADDRESS DETAILS 1. Residence Address: ________________________________________________________________________________ ________ City/town/village: ___________ Pin Code: __________ State: ______________ Country: _________________ 2. Contact Details: Tel. (Off.) _______ Tel. (Res.) ________ Mobile No.: _________ Fax: _________ Email id: __________ 3. Specify the proof of address submitted for residence address:_______________________________________ 4. Permanent Address (if different from above or overseas address, mandatory for Non-Resident Applicant): ____________ ________ City/town/village: ___________ Pin Code: _________ State: ______________ Country: __________________ 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. __________________ Signature of the Applicant Date: ___________ (dd/mm/yyyy) FOR OFFICE USE ONLY Originals verified and Self-Attested Document copies received (………………………………………..) Name & Signature of the Authorised Signatory Date …………………. Seal/Stamp of the intermediary  KNOW YOUR CLIENT (KYC) APPLICATION FORM For Non-Individuals PHOTOGRAPH Please fill this form in ENGLISH and in BLOCK LETTERS. Please affix the A. IDENTITY DETAILS recent passport size photographs 1. Name of the Applicant: ________________________________________________________________ and sign across it 2. Date of incorporation: _______________(dd/mm/yyyy) & Place of incorporation: ________________ 3. Date of commencement of business: ______________________________________________________ (dd/mm/yyyy) 4. a. PAN: _______________________________ b. Registration No. (e.g. CIN): _________________________________ 5. Status (please tick any one): Private Limited Co./Public Ltd. Co./Body Corporate/Partnership/Trust/Charities/NGO’s/FI/ FII/HUF/AOP/ Bank/Government Body/Non-Government Organization/Defense Establishment/BOI/Society/LLP/ Others (please specify) _______________ B. ADDRESS DETAILS 1. Address for correspondence: ________________________________________________________________________ _________ City/town/village: _____________ Pin Code: _________ State: ______________ Country: _______________ 2. Contact Details: Tel. (Off.) _______ Tel. (Res.) _______ Mobile No.: ________ Fax: ___________ 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: ________________ C. OTHER DETAILS 1. Name, PAN, residential address and photographs of Promoters/Partners/Karta/Trustees and whole time directors: _________________________________________________________________________________________________ 2. a) DIN of whole time directors: _______________________________________________________________________ b) Aadhaar number of Promoters/Partners/Karta:______________________________________________ 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/we may be held liable for it. _____________________________________ Name & Signature of the Authorised Signatory Date: ___________ (dd/mm/yyyy) FOR OFFICE USE ONLY Originals verified and Self-Attested Document copies received (………………………………………..) Name & Signature of the Authorised Signatory Date …………………. Seal/Stamp of the intermediary