Declaration of KYC Document Submission

To
IndusInd Bank Limited

__________________ Branch

Dear Sir / Madam,

My/Our Savings / Current A/c No is: __ __ __ __ - __ __ __ __ __ __ - __ __ __

I____________________________________ (Account Holder/s) do hereby solemnly declare that the information given below with
respect to my/our bank account mentioned above is correct and up-to-date. The documents provided as proof of identity & proof of
address and the photograph attached are my/our true verification documents.

Residence Address Office Address

I would prefer my mailing address to be (please tick as appropriate): Residence Address Office Address

Changes to any of my addresses will be intimated to your bank along with the required proof of address.
My Permanent Account Number and contact details are given below:

PAN Number Residence Phone Office Phone Mobile E-mail Address

I also confirm having enclosed a self-attested copy of the following documents as the proof of identity and proof of address
(Kindly tick the relevant document in the list below):
Identity Proof Address Proof

Passport Passport
Driving License Driving License
PAN Card Voter ID Card
Voter ID Card Latest Electricity Bill
Photo Ration Card Latest Telephone Bill
Other (please mention) Ration Card
Life Insurance Policy Receipt
Property / Water Tax Receipt
Other (please mention)

Full Name of the Account Holder/s:

Signature of the Account Holder/s: Date:

Note: In case of joint accounts or accounts with multiple signatories, the declaration has to be filled and submitted for each individual holder.