1°, om” FINVASIA SECURITIES PVT. LTD. FINVASIA Pe a sty Invest with Intelligence ee rieeae: coe anee Amery tneaet ‘SEBI REGN. NO. IN-DP-S17-2017 » DP 1D : 12084300 CENTRAL KYC REGISTRY | Know Your Customer (KYC) Application Form | Individual Important instructions: 1) ills rare a re mney £) List Ste UT end par nan Mota Vee et, 1968 val the an 2) easat netamin Elen ang n BLOCK tes, Ltt ve carat 80316 eur cosesis aval a ere (©) Plz eaten DO MRL YY re, (G)RYC nuntar of plea iano apt slo ©) Pn mad vecon ie dtl acne ndnacre Hot parte scion opt sewed ne box vale ele ho ihe nd seen nor ein of scone nt cre be ce, For office use only ‘Azoleaton Typet New) Update (obo ety tani sitter) «YC Number (Mandatory for KYC update request) Account Type” Normal Simplified (or ow sk customers) Sma 111. PERSONAL DETAILS (Pease fernstucton A atthe ad) Prof FretNane Name 5 Name" (sare 310 prot Maiden Name (Harv) Father / Spouse Neme* Mother Neme* Date of Birt PHOTO Gender COM Male (0 F Female Transgender Marital Siatus* 0 Macias D Unmactied O others Cizenshipt (DIN tncian 5 Others (180 3168 Country Code ||) Fesidertal Satust (Resident naivdual (1 Non Resident Indian 15 Foreign National 5 Person of indian Oxi (Occupation Type" [1 SSewice (Li Private Sector C1 Public Sector) Goverment Sector) Dooher (Professional C SettEmployed C Retved (Housewle Cistudent) Ci epusnese (1X: Not Categoised (1.2. TICKIF APPLICABLE [RESIDENCE FOR TAX PURPOSES IN JURISDICTION(S) OUTSIDE INDIA. (Pease ff nstecton Bat the nc) ADDITIONAL DETAILS REQUIRED® (Wendy ony # sston 2 teed 180 3166 Country Code of Jurisdiction of Residence “Tax dentcaton Numbor or equivalent issued by jeden) Place Cy of Bint 150.3186 Country Code of Birth” 13. PROOF OF IDENTITY (Pol)* Paso reerinstucton Cat he end) (Carte copy of any one of folowing Pooler (Pol need fo be eutmte) |A-Passpor Number Passport Expity Date 51 B-Voter ID Gard (PAN Card - Diving Licence Driving Licence Expity Date E-UD (Aadhaw} F-NREGA Job Cars Others (any Socument res bythe canta goverment ‘donsiaton Number ‘S- Simpiod Measures Account - Document Type code fe 4, PROOF OF ADDRESS (PoA)* (11 CURRENT / PERMANENT /OVERSEAS ADDRESS DETAILS (Passe se nsbucionD st ne erd) (Carte copy of any oe fn lowing Poo Aaoees P08 ned fo be subi) sification Number Address Type) Residental/ Business i Resident Business Registered Ofce Dunspectiad Proof of Adckess* [Passport 1D Diving Licance (un (Aacnaay 5 Voter identity Card CNAEGA Job Card CI Others 1D Simpites Measures Account - Document Type code (iy Tow Vilage" Pin Post Code" State/UT Godot 180 3166 Country Code" aFiNnvasia Invest with Intelligence Pin Post Code" | Line Lne2 Lines Diswiet” [| LI 1] Sane as Curent Pomane Ovens ses dete une 1° I I I I Line I Line I I | Ta. (om I FAX I Adon ct Relea Peon (Deletion ot Related Person Related Person Type Guardian of Minor é Pret Fist Name Name’ Ct I ‘A- Passport Number 8: Voor 0 Card (PAN Card - Diving Licance E- UID (Aachaar) F-NREGA Joo Card Others lary decunent oii by the ceteleovernmert) ‘- Simpled Measures Account - Document Type code ooogoooo Date I Place Documents Received | Certified Copies (PV Done [7 Same as Curent Pormanent/ Overseas Adres oils (hn case of mula corespandence eal adoseas, please fl Annexure At) Ci Assignee (HVC number and name ar provided below det fscton Bae opal PROOF OF IDENTITY Pel] OF RELATED PERSON" (Please oe sneton (Hat the en) ‘+ ety cnsanto cog eat etalk ge) Soph SEnal one abeopdnmunbronal es I I I City/Town Vilage Stale /U.T Code" 180 9166 Country Code" [U Seme as Corespondonce Loca Ades desis T I I TT I I C1 ety town vitager | ZIP /Post Code" | | | 180 3168 County Code YC Naber ofReted Person (avaiable) (Authorized Representative Tea ; LastName PesspottExpty Date Driving Licence Expiy Date I ‘dentitation Number ‘contain Number Emp. Branch lutein wistaiatati |———RYC/INPERSONVERIFCATION CARRIED OUTBY = INSTITUTIONDETARS Date (piel= ie) Name FINVASIA SECURITIES PVT. LTD. a LL TTTTTTITT) tote LT es eee eee Enea TT TTT TTT et Emp. Designation LITT) @)