Know Your Customer (KYC) Form for CHA - Individual Profile

Name : ____________________________________________________

**

Mr/ Mrs/ Ms _______________________________________________

___________________________________________________________
Date of Birth _________________ Sex _________________________
___________________________________________________________
Present Address:
___________________________________________________________
___________________________________________________________
___________________________________________________________
__________________________________
PAN Number ________________ IEC Number _________________ _____
Telephone
________________ Mobile
_________________
Fax
_ Email
_________________
___________________________________________________________
Permanent Address : _________________________________________
____________________________________________________________
____________________________________________________________
_________________________________________________________
Telephone
Fax

Mobile ______________________
Email
______________________

__

__________________________________
___________________________________________________________ ______
Documents Required ( Minimum 2 )
Passport

PAN Card

Voters Identity Card

Driving License

Bank Statement

Ration Card

Note: Any two of the documents listed above, which provides client/ customer information to the
satisfaction of the CHA will suffice.
Documents Required (* Mandatory )
Copy of IEC duly attested by Imp (cert with Photo)

Checked by
Customer Exc
Document Dept
Account Dept

___________
___________
___________

Authority Letter

Filing
A/c Code
Filed On
Scan & Uploaded by
Scan & Uploaded on

Photo of Authorized Signatory

_____________
_____________
_____________
____________

Signature & seal with name of signatory