9 hal 2 2 g : : z : gq 2 3 a i > Know Your Client (KYC) DP ID No: Application Form (For Individuals Only) Ca =| : TINEW [1] CHANGE REQUEST Fite ssoepa) Application No. : Floaso filin ENGLISH and in BLOCK LETTERS with black ink < ‘A, ldentity Details (please see guidelines overleaf) {Mame of Applicants apearng in sapaorngideticaton daar Name FothersSpouse Name Gender [Mole Clfemale 8 Marital status [isle CJMared —€ Date of Bith Nationality Clindian other 4. Status se tk) Cl Resien ual Non Resident Cofereign Natonal aspert Copy Manat for NR & Fron Nationa SPAN Please enchse a aul atesed coy of your PAN Cars Unique entiation Number (UDWAadhar, 2 6. Proot of Identity submitted for PAN exempt cases ase Tick) (CUD dada) CPaspar Cote BCDring cence Dots Pas see gue ve B, Address Details (please see guidelines overleaf) 1. Adress fr Correspondence ip enn ge Sa cory | 2. Contact Details exfoy| (80) | (70 eles] (50) | (ST) ati | (59) | (TD) Fx] 060) | (TO) eal 3. roof of address tobe provided by Applicant. Please submit ANY ONE ef the following valid documents & tick (v) against the document attached. Passport CORation Card CTRegsteed LeasesSale Aareerentof Residence C)Orng License ClvoterBentity Crd CIs.atest Bank Al StaterentPassbook Cites ephone ion and Une) tates ey Bl Cates as Bil IUD vata) Cob ‘et move an 3 Meth alii/piy date of proof ofaddes submited / 4. Permanent Address of Resident Applicant if different from above B1 OR Overseas Address (Mandatory) for Non-Resident Applicant ip enn ige in cade sat) Coury | 5. Poof af address to be provided by Applicant. Please submit ANY ONE of the fllowing valid documents & tick (v) against the document attached CoPassport ClRaion Card ClRegsteed LeasesSale Areerentof Residence C)Drvng License Clvoter Bentty Crd Cisatest Bank Ai StatementPassbook states ‘lephone Bil only Land Line) Latest Elect 8! C}-Latst Gas Bil IUD (achant) Comers ‘Pet mote an 3 Meth alty/xply date of proof of addres submited 1 . Other Details (please see guidelines overleaf) 1.Gross Annual Income Details (Please tk (vi: [Below 1 Lac 1S tac S10 Lae 10.25 Lae > 28 Lacs OR Networth in €("Net worth shoul! not be oer than 1 yee as on (date) 2. Occupation (Please tckiv) any one and give brie decal CiPriate Sector Service L) Pubic Sector] Government Service C) Business ClPrafesional ClAgricuturst etired Housewife [Student [Forex Dealer (thers (Please specity) 3. Please tick, if applicable: [Politically Exposed Person [Related to a Politally Exposed Person For definition of PER, please refer guideline overleaf 4. Any other information: DECLARATION SIGNATURE OF APPLICANT Thereby declare thatthe etal furnished above te rue anccorrect {othe best of myourknawledge nde anc |andertake to inform you of any changes there n,rmmecs ately. Incase any of the above informations found to be {albeor untrue ormslendingor misrepresenting, lamve ate awe hat he maybe hel ase rf Pe: ate FOR OFFICE USE ONLY PV Done() on Molt ‘Actieredan name OR cade Seal’tam of the intermediary SealStamp of the intermedi s Staff Nae Staff Name D (0raina verte) Set Coie Docuent copies reeves Designation Designation Name of the Organization of the Organization Signature Signature Date Date (0 tes te cops of docamens eed Main bereINSTRUCTIONS / CHECK LIST FOR FILLING KYC FORM ‘A. IMPORTANT POINT: 1. Sefattested copy of PAN cardis mandatory forallint, 2. Copies of ll the documents submited bythe applicant should be sel-altested and accompanied by originals for verification. In case the orginal of ary dacument is nat produced for verfcation, then the copes should be properly attested by enies authorzed for artesting he documents 35 pet the below mentioned. If any proof of identity ar addtes is in 2 foreign language, then translation nto English isrequired, Name aires ofthe applicant entionedon the KYCform, should match with the documentary proc submited, Hcomespondence & permanent adctess ate diferent thenproos for bothhave tobe submited. Sole propetor mst make the application in is india mare & capa Foc non-esiers and reign nationals (allowed tote subject 22 AB anc EMA guideline) copy of pasporsPOCardOCICard ane overseas adress protismandstoy For foreign entities, CINis optional: and inthe absence of BIN no for the dtecors thei passport copy shouldbe given. 19, In case of Merchant Navy NRIS, Matine’s declaration or cerifed «copyot COC (Continuous Discharge Certificates tobe submited 10.Foropening an account with Depostorpatipant or Mutua Fund, for amino; photocopy of the School Leaving CerfcateMak sheet isued by Hagher Secondary BoardPasspot of MinrBith Cerfcatmustbe provided Poltically Exposed Persons (PEP) are defined as individuals who are “orhavebeenenusted with prominent publicfunctions ina foreign county, eg, Heads of States or of Governments, senior polticans, senior Governmertjuccialimiltry officers, senior ‘executives of state owned corporation, important political party officials et, Proof of Identity POI of Identity: 1. PAN catd with photograph. This is 3 mandatory requirement forall applicants except thse who are specticaly exempt from obtaining PAN (listed in Section) Unique Hentticaton Number (UID) (Aadhaat/ Passport / Voter ID «ard Drvinglicense ist of documents admissible as Proof Identity card! document with applicant's Photo, ssued by any ofthe follwing: CenvalState Government and its Departments, StatutorReguatory Authorities, Public Sector Undertakings, Scheduled Commercial Banks, Public Financial stitutions, Colleges| affiliated to Univestes, Professional Bodies such as ICAL, CWA, ICSI Bar Counc et, to their Members; and Credit card/Debit cards issuedby Banks, Proof of Address (POA): List of documents admissible as Proof ‘of Adress: (*Documents having an expiry date should be valid on the date of submission.) 1. PassportVotes Identity CardRation CardiRegitered Lease or Sale Agreement of ResdencelDriving Licenselat Maintenance billinsurance Copy Uti bil the Telephone il (onl landline, Elect billor Gas bil Notmotethan 3 months old Bank count Statement?Passbook-Not mare than’ manths ol, Sof-declration by High Court and Supreme Cour judges, giving the new adéressinrespectoftheirown accounts, Proof of adress issued by any of the following: Bark Managers of Scheduled Commercial Banks/Scheduled © Co-Operative BanktMukinaional Foreign BanksiGazetted OffcerNotary publifElected representatives tothe —_Leglatve AssemblyPaclament/Documens issued by any Govt, or Statutory Authority. entity carddocument with adress, issued by any ofthe following: Cenval/tate Government and its—_—Deparments StatutoniRegultory Authorities, Public Sector Undertakings, Scheduled Commercial Banks, Public Financial Instutions Colleges atilated to Universities and Profesional Bodies such as ICAL CWAI, ICS} Bar Councils, tothe Members For Fis accourt, Power of torey given by Fsub-account to the Custodians (hich are dy notated andr apostle or consulaise) hat ives the registered adress shouldbe akan 8. Theproof of addressinthename ofthe spouse maybe accepted, Exemptions/clatifications to PAN, (Sufficient documentary evidence in support of such claims tobe collected) 1. Incase of tansactons undertaken on behalf of Central Government andior State Government and by officals appointed by Cours eg. Official iquidater Courtreceiver ete Investors resin inthe state of Sikkim UNentitesimltiateral agencies exempt from paying taxesfiling tax rerunsin Inia, SIP of Mutual Funds uptoRs 50,000/-pa In case of instrutonal dents, namely, Fs, Mis, VOFs, PVC, Scheduled Commercial Banks, Muliateral and ailateral Development Financal Insitutions, State Indusval Development Corporations, surance Companies reostered with IRDA and Public Financial Institution as defined under section 4A ofthe Companies ‘Act, 1956, Custodians shall vey the PAN card details with the iginal PAN card and provide duly cerited copies of such verfed PAN detalsto the intermediary. List of people authorized toattest the documents: 1, Notary Publi, Gazeted Offices, Manager of a Scheduled CommercialCo-opeatve Bank or Mulinational Foreign Banks (ame, Designation & Seal shouldbe axed onthe copy) 2. In case of NRb, authorized officials of overseas branches of Scheduled Commercial Banks registered in India, Notary Public, Court Magistrate, Judge, Indian EmbassyiConsulate General inthe country where the clent resides are permited to allest the documents Please Sub the KYC Documents on A Si Paper Onl