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Paytm Wallet KYC upgrade form Paytm ‘Allfelds marked by* are mandatory. Form should be filled in English and n capita eters only. Wallet details 1. Wallet inked mobile ruber* Identity details 1.Name* 2.Gender* [|aale [~ |remaie [~ ]thicd Gender 3, Date of arth m 4.Nationality* [—Jindian [J others 5, PAN Number 6, Aadhaar Number 7, Satt-atesed copy of any one ofthe following pachoar [] Driving ucense [T] Passport [~]voteri> [7] nasa job cara 8. Bank A/C Number* 9. 1FSC Code™ 10, Cancelled Cheque Number ‘Address details 1. Correspondence Address* Giy/Townnal state Pincode Declaration {tere consent One7 fr etaig ae autentatg y ne Your Customer KY) fran wh rent cuore, NSDL, UDA, Sate Transp Dee fr ling HVC segueer es fo Pam Wet rbot mey Ore. Fater for tomer authenteato,|undeatandthat my bom ormatin wl narbe ore shared anil be submatad a Coal fetes Oat eposory fr autentiaton 2, Permanent cunt Number PAN) requ or undertaking etn ranean Under Ince TX estos. y NE Powdn PAN bone, erty dele at am roan esti PAN older 3. Promoter of 757 Communications Linked has rece rincle apron (NSP oTgSeipl PressRelaseDspayasplpie3A7A) om Alin Aug 2o1Sto opens payers take Icarsen to mire my Paym Wl acai lca the KYC fora) oh Pay Famers Bank pan ay Parents Ban rea ral appv rom “4 1nereny concen Payments Sank alates and/or parers to aactters forbs ccna nal produ My acceptance ot uote sabe commune rough scetance ot ‘Sede terms and cantar eer slo yey My aceptnc fue prods wl consent share KY Ifmaton Wh he psi serve rove ofthe prod pe the uel acu by under Know Your Catomar (KY) Master Deco, 2016 f/au og lnSenpematesonUer aeptse102S2BNoe20, 5, Idea tht lam aninasn recent. 6 herby ecarethat me cetalstamened sve ae Yue and core othe tet of myknowedge an copes of Poo ot erty and Prot ot Ades ae Tus cny a Org 7, LaeCE that Me NaN account Provided above or authencton, a pe th of Rts RC Mtr ieton, 2016 or Nene 1 Face cst coum bank ac. Place Date For office use only g ‘Agent 10* COU_10000 Name of the Agent Courier the following documents to Post Box No. 02,Nolda HO, 201301 1 Any ONE ofthe below documents(selF-atested copy) + Aadhaar Card + Passport + VoterID + DrivingLicense » NREGAJob Card 2. Cancelled Cheque of your bank 3. KYC Form duly filed and signed