KYC Application Form (For Individuals only)

EMP CODE :
ALL FIELDS ARE MANDATORY

1 Name in full:
(BLOCK LETTERS)
First Name Middle Name Surname

2 Father's/Husband's Name
3 Present Address:

Resident No.

4 Permanent Address:

Resident No.
5 Date of Birth: Religion- Hindu

6 Marital Status: Married Caste- Maratha

7 Blood Group B+ PAN Card No :

8 Educational Qualification: Diploma In Automobile Engineering

9 Bank Account No. IFSC Code

10 Driving Lincence No. - Passport No.

11 Adhar Card No. Ration Card No.

12 Family Details: Name Relationship DOB Contact No.

** . YOU ARE ADVISED TO PROVIDE ALL KYC DOCUMENTS AVAILABLE WITH YOU IN ADDITION TO MANDATORY KYCS TO AVAIL
BETTER SERVICES. SELF-ATTESTED PHOTOCOPIES OF THE DOCUMENTS and 2 NOS RECENT PASSPORT SIZE PHOTOS MUST BE
ATTACHED WITH THIS FORM.

Date 3rd Dec 2018 Signature

FOR OFFICE USE
Mr./Ms./Mrs. ………………………………………….………….. HAS JOINED ON ………..……………..

Name of the Dept./Site : Located at : ……………………………

……………………..

Certified By Authorised Signatory