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Paytm Wallet KYC upgrade form Paytm ‘Allfelds marked by* are mandatory. Form should be filled in English and in capita eters only. ‘Wallet details 1. Wallet inked mobile number* Identity details 1.Name* 2.cender+ [|Male [~ ]Femate [ |thiedGender 3. Dateofsirth* [0 m 4.Nationalty* [_ ]indian [_ ]others 5, PAN Number 6, Aadhaar Number 7. Proof of identity* (please tick) [| Aadhaar Driving License PAN Card Passport [| voter iD NREGA Job Card 8, Proof of Addresstiplease tickvr) [| Aadhaar Driving License Passport Voter ID NREGA Job Card ‘Address details 1. Correspondence Address* Giy/Townnal state Pincode Declaration {tere consent One7 fr etanig ad autentatng my Xe Your Customer KY) ifr wth reeant cutorty fg, NSDL, UDA tte Transp Det. for uting YC eaueer efor Pye Wet suet meby Ore. Farther for beret autheteaton,|underatandthat my Homeric nformatin wilnorbe tore /shared anil be submited Cota dees Oat epoaoryforastentiaton 2, Permanent cunt Number PAN) equ for undertaking een ransacons Under Ince Ta estos. By Ne Powdn AN above, erty delat am rot an ext PAN older 3. Promoter of 757 Communications Linked has receedn-rincl appro INSPwAW DL oIBSEIBIES PressheeaseDspayasppieBA7S4) Fon Bin August 20159 apn a pment |carsento mite my Pay Wale cau clang the KYC feat) othe ayn Fayents Bank upan ay Parents Bank resin ral approval rom 4. thereby concen Payments Sank ks alates and /orparner to dactofes fo bank accounts and nancial routs My aceptanc of uh ofr) shale carmmuncte rough acceptance of Speatcterms and condor eer ysl oly My acceptance of suc pred wing cosent share KY Infomation Wh espe Serve rove othe produ 2 pe the uses ac ory under Ko Your Customer (KY) Master Deco, 216 ftps: /aw orginespteMateaonUser apse 102824NaderO. 5, Ldeare that aman insonceent. 6 hereby ecarethat neces furshed above are vue ad corto thebestof my knowlege and copes of FO and POA ae re copy of rhs Pace pate For office use only 5 Nameofthe agent 2 5 agentio® g ‘Originals seen & veried* Documents collectes* ‘Acknowledgement Receipt Wallet inked mobile number* Name of the agent Date