DECLARATION FOR INDIVIDUALS - ANNUAL KYC DOCUMENTS

To, Citibank NA Mail room, Shakti Tower III, Basement 766, Anna Salai Chennai 600002 Dear Sir, Re : Savings / Current Bank Account Number : Account Title <Names of all holders to be included >. I / We hereby declare that the below mentioned information with respect to my/our above mentioned Bank Account is/are true and correct I / we also hereby confirm that the attached photographs and copies of identification documents are the present true identities of myself/ourselves and the identity document is/are valid as on date. Mailing Address : <(pre-populated)>

I/We confirm that the above mentioned address is my/our

Residence

Office

(Please tick as appropriate)

The Income Tax Permanent Account Number as recorded for each holder on the above mentioned accounts is/are as follows :

Name of First Holder

st

PAN No.

Name of 1

Joint Holder

PAN No.

Name of 2 Joint Holder

rd

nd

PAN No.

Name of 3

Joint Holder

PAN No.

Mandatory where PAN Number is not provided for the specific account holder :

I / We confirm having enclosed a self attested copy of ANY ONE the following documents for each of the holders to the above mentioned Account :

Name of First Holder Name of 1 Joint Holder Name of 2 Joint Holder Name of 3 Joint Holder
rd nd st

: : : :

Passport Passport Passport Passport

PAN Card PAN Card PAN Card PAN Card

Voters ID Card Voters ID Card Voters ID Card Voters ID Card

Driving License (Please tick as appropriate) Driving License (Please tick as appropriate) Driving License (Please tick as appropriate) Driving License (Please tick as appropriate)

Mandatory for all holders : I /We am/are enclosing a recent pass port size photograph for all holders on the above Account which is/are duly signed on the reverse by the Account holder . Name and Signature as per signature rule in the account Name of First Holder Name of 2 Joint Holder
nd

..

Name of 1 Joint Holder ...

st

Name of 3 Joint Holder .

rd