Know Your Client (KYO) Application Form (For Non-Individuals Only) Please fill in ENGLISH and in BLOCK LETTERS CvL ‘Application No.: ‘A Identity Detals (please see guidelines overieat) 1. Name of Aplant ease wite comple ame spr Caate of crpraton!Rgstatn; kag one box Hank betwen 2 wads leased sl abr he Na 2 Date of Incorporation Pace of Incorporation 3. Registration No. (eg. CM) Date of commencement of business 9 | | / i 4, Sats ese cc) Pate td. Co. Cl Paice Co. Body Comore) parmestip C1 Tus/ Charts NGOs ind ign ace Ca Ca Chay Chace Cleat C1 covenmen 8ady Cl Non Govenent xganiaton Ti oetece Erabisiment Cl Body of evita Cl Sodey CUP C0 othe cues 5. Permanent Account Number (PAN) (MANDATORY) Pes endse a dy attested copy f your PAN Card 1, Adress Detals (please see guidelines overleaf) 1. Ades for Corespondence iy | sa 2. Contact Details H.R) 150) | (TO) Fee) 50 ‘Mabe | 050) | (S10) Fax) (50 eal Proof of address tobe provided by Applicant. Please submit ANY ONE of the following valid documents & tick () against the document attached rates eleshone ill Land Line) atest Hetty ail Cites ank Account Statement. CIRepstered Lease / Sle Agreement of Ofice Premises 1 Any other prot of adress document (as Isted overeat lee sec ‘ot more tan 3 Mah Wally date of poet ef addres baited 7 [7] 7TAIAITIEIELELED Registered Address (f diferent from above) iy ge oral Cole sal cut Proof of address tobe provided by Applicant. Please submit ANY ONE of the following valid documents & tick () against the document attached rates eleshone Bil only Land Line) atest Fletty ail Cites ank Account Statement CHResstered Lease / Sle Agreement of fice Premises 1 Any other prot of ares document (sted overeat ese secy ‘hol rare tar 3 arth 8 Valiyxpy date af prot of adress ubmited TT © Other Detail (please see guidelines overleaf) 1. Gross Annual Income Details Please tick (vj CIBelow Vac Ct-Slac [S10 tae [N05 ac C25 tacet Cre > 1 Cove 2, Netaworth in &,")*! ot be oer than + yea as on (date) / / 3. Name, PAN, DIN/UID, residential address and photographs of Promoters/Partners/Karta/Trustees/whole time directors (Please use the Annexure to fi in the detail) 4.15 the entity involved/providing any of the following services YES TNO Fer Foreign Exchange / Money Changer Sevues CIYES LINO ~ Gaming / Gambing / Lottery Sences (eg. casnas, beting syndicates) CIYES [NO Money Lending /Pawring CIYES CINO 5. Any other information DECLARATION We hereby declare that the details furnished above are wue and NAME & SIGNATURE(S) correct tothe best of myfour knowledge and belief and vwe undertake {o inform you of any changes therein, immediate. Incase any of the OF AUTHORISED above information is found to be fase or untrue or misleading or PERSON(S) ‘misrepresenting, amvve ae avae that we maybe helliabe fr. Pisce FOR OFFICE USE ONLY AulCetereday name OR cde Sealstamp ofthe stermedany soul contain Stott Nae (1 ongal Veet se Cerifled Docent copies ected Designation 1 tates) Yue copies of documents eed Nae te i batex INSTRUCTIONS / CHECK LIST FOR FILLING KYC FORM, Iwronran ons: 1. Salatesedese cama alles 2 Copies ef alte decens sina by te apart shoud be sal ated nd “compared rial fr een. mete arly coer ‘eas ‘or wenn, then te pies shoud be popely ated y ets Sitesnteatetngttecocmen arb ae meni ay oe fet o abs alg gn he tasaton Els sree, Name aes fh alan etn an he KY em, ld mae win he acre a bd crepenaince& pemanent aes teen, un cl fr bah hae be sme Salepratrmasainteaplaoninhs idiualrane apt fer nonescrs an an raerasonedt tae sgn Land FA atin, cy of pesmeeOCeatCCe ard owsts aes prot ont Far foe ees Cs epona adn the abso of IN rf he dec thease cn sodden bree of Maran Ny NR nas ccaen oF etd coy of COC {Comin DiehargeCerie) tobe samie Fer cain 2 azn wth Dest parent of Muna arg, fer 2 ino procrny othe Shea Leng Cerio she sued by Higher Secday SeardPasponcitararith arate mse poi rail Sead Poses (PP) ae cend a ini who ae et hae bee feted wo periment” pun ners a Heh eu eg, Het Sats or Corres, epi, se! Canvass a2, Sei css of sae owned penn, porat glial ary eae Proof ot enti POH Use doaes sense ashestt ety: TP ead ath oogah Tes 2 mite mgutenenl Gel ‘plat exe toa spect een oman Pk Jd Secon, Unguetenfxionhinoe (U0) taco Paseo D erdDrveg eve ety car decert ih spats Pho, ued by ay of the (leg: Cercaate Covenmes df Oeptness. Sarayhaquoy homes, ible Seer Uaeeangs SheieaConmeca™ fas Fle Fran Petuzenh Caages ale te Unvestie, Ptsond Ss su af ICA IOWA Sar Curl ete, ote Darbar re cients sed by sank Proof of Address (POR): Uist of cocmens airisible as Rot of Adsess (MOscavenshoinganeapiytestoudbeaidotbedeedsibnsion) 1. Unga lation Munber (0) Pachaiasprices Heny Catan 2 Incase of Nonindlvduals, adltonal documents tabe ataned rom nanindviduals, oer Codes on Sale green a esrb est biarace bien 9 Uys th Teephee Bl ony ar in ey le Gas bl -Ret maw an remo BrkdeoiStammePastet etna tan nonvas Sadan 9 High Cour an Suene Cut jugs ig he ew aes in respec omacots. rot of sites sate ay ay ef the fang Bank eae of Sede (Gems! fanaSehdued! —CeOpene™ Sulrter feege anisteered Chemay pibliaced repens tote lage ‘sendy PalanersDocamens suey ay Go aS her lesitycddecarant with ates, sid by any of he fling: CntaSae Sommers ed ib rpateen Siatoyiegusioy Auheres, Pb Sect Undeaigs Snes Carmerea fan Pie Fran IniensClngs edt Unvetes adPsesens Bees uch A, KW, Ba CO Fer Fis acount, Pane o Ate gen by Fsubacour wo he Casas whic ay rind seer aos er conse ages he rei sss 1 Theproutofadiatintenaneotnszotenaybe aca xemptonsidaiieatinste PAN (suet aocanenn vaeernsppriun eins tbecsecd) 1. 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