/No: 638549 al pee OANA sence ede cd sae oper (ken) sve 8 _nctti s/o ofc we) Since cere res aque rk (Rh earn care TE fe) CUSTOMERINFORMATION FORM (FOR NEW PERSONAL INDIVIDUAL CUSTOMERS ONLY) ata atte cent iret decetrermire oie, ote AT eat rnrohincartockeensndenbectiponepetrspicevienrea vTievppositebot | ey w shoe (v) ee a ae /CUSTOMER TYPE: a Say ater tent afte artes AFR Gee Oe On Oe ee are eal eee (2)zaftcrra faa/ PERSONAL DETAILS : CCC eite/rte 0 4/Fatnames COEEET TT rt tT Ptr tt ttt Tee fuee eases erat ofan CLOT) erie ‘em er f/f a Name ot Father or Spouse Kame COEEETI TT tr Prt ttt Pt ttt itt ttt tt itt a = / maa roe [Fo arta (OT) re rr fe 8 "Mothers Maiden Name COEEETI TT tr rt tr ttt ttt tri ttt Toren oars Fem Samet ee eee ee ee COS ee see eee 1 Om Om, miteee COO eee SO Os. ee mena tame nter ier h a gerrst es anse ee AAE ] Ene eet nen am her k of mee ‘pucrtinserintoe sa Soneteramer’ 1 Su inchoate senawasrante )iamten xe wer Socnanecttaet Seraenateg nam [2 ar Fru n/ reer Residential / Correspondence Address: PTT TT staan TTT EET ET TTT Titra Pie sehce moet powatseeevisne: (TT TT TT TTT TTT tt ttt mee CLLTTTTITITITTT Itt) eye = cenpivmoges CLIT TTT TT TI TI Titty Sime CLiTT Ti tii tititii U1 fe CLIOLTIT TIT ttt & FCCC Lise LC Rovhenetoreme COLLET fe CLE) See i a Paced See CO CR O.3r a et ot rt, sec 8 a rt en rae ek Iiiprmanent Accents some ein Aras ater pave provide our permanent adden Below (8) se at/ Permanent Address: aie roe weegipne LTT TTT TTT Spenttiaiongnenes CLE TTTTTTIt TT ttt tt tit mer. CLILITITTITITII III) sme CLL LI1I eye Sia COCCI) te COT TH see CLOT TTT TTT) ne, CTT TT et, CT Stee CTT es Co) Feehan 01S eae io COC TTT) a CTT TTT TTT TTT)Ce “ ‘bare fears /KYC DETAILS: srt an fee Proof of Wet Deals —— acter atm eC ] ptraroe ort te = 2 @ wee ee ee ‘1 ST at Ree/Proo of Adress Detal aria Fa J fase oe ee ae ts eth es RA we fest Peo De oh tine Sr Sten Mae of he Decne 5 -caftrarett sreetta are & art #/1N CASE OF NON-RESIDENT INDIAN ACCOUNTS: (a) wher /Declarations: 4/4 yfe exer &/ 8 FH /es se ee bg dom cara / anaes ye Bar Pra eat /ai we m/sec fers ees ie cont thet amv ae of ian natioalty/Pesons of indian origin reiing ouside india for tnolomenbusnsoctionfrindefele peed fame ha E/E eh rae Rg aa sth ww gee fe as FET / SH We also undertake to inform thebankin sting nmecitlyfmyorrtrn oleate pemanent eden kes wr Ee /Sentane fap (b) ceardsit or scares fur AaT/Documents Verified : Ke/meh sforw/arehe gorare/te gre om weet exe sre./ By Bank/NotaryPublicIndianEmbassyPersonsknow tothe ark COlMOoOTT) tebe eg FE or era WE / ‘Sannure Seale aocoentverying whey Hu aoe here bbe wr ae wl: Name umber of Suis Comespondent Factor ‘Rats whe Aes ea / ‘waft sh Fe /FOR OFFICE USE srg gar Pre re fg eet se ri ag ce A ee te R&T ME /Coples ofthe customer ‘eni'eationand residence proof areciosscheckedwith orginal documents certified putting bane’ seal&authentcatin. + aoe, (fet), (corm) saftey stg cer/Pemt (anmicemr ® amd A) @ sam oe nf/Location!Resdence of the applicant (in case of need) has been verified by ase (otieer (Designationjon fF 1 cs or a ed Pr ego Fy eer eT aw ene eer / Incase of literate Customerthe este secount ere ead ‘utandexplsinectotnecustomerinvernaclsonquage ct /eren se et ema wes Ere ate FST Name of fficerranch Manager Signatore of oFicer/Sranch Manager & Index No‘afta SIrart/Personal Information se fete caster Ten Of Of os O8%F Om Osco sao = OF" oO" Otte S os = Oss. Off. OS ooo OO Tine Cl poeatess C1 Saiensecyy LT essen 1 Somers C] frany Sees COS C1 eine C1 nate ee bse ee Cote 1 Senet) Ld) eT pes nee mae mit Rinesecer See ate Bie C1 Saciteceesy Cd ae fl ] Kaus [ ] Meteorites CO] Eee lee Cee Lips Crm Ean Oo sna Cee cae rer Desa Scoemafcone C Sangrenson [7] fcrorermmiL—] seteeatotenen ] fcamens Cl Ses aentoeey 1] safc Assets ae Eine Oe Oe OS, Sorin Cd) a eee om ae ese een lea eee ee ee Sion o8% of feet o% o% et of ae LY Or ave OL | |60Ot <2, C7 ‘ares Fam /Famlly Detals 1 of / Spouse name = a = Eas COs Com. CLIO ORR ‘ud chilean Name CLTTT TT TTT TTT tit te ttt tt tt tt tt tt ttt ttt} ee Fiat ame ‘4a Rae [FHP Seaman Name an ot * eS on). oe own COT] fr Sindee C1 it C1 Rte CLTTT TTT TT TTT Tr TT TT tt Tt} eer Fit tame 4a Name Fees arate ie = CO we 8 CO be COT She C0 i 0 Fone arupton IEA e/a EB a combate an Aznar & Sr /Ft ame { ) = wt or nk Bane Typeetacoun ee wat asian sk t J fina J Fpectacoun ]Ci seer gd arg ae eet wo (ae / etree sl Fe) INTERVIEW AND CUSTOMER DUE DILIGENCE FORM (TOBE USED FOR APPLICANT/SIGNATORY) ‘eratemrdy/ForBorkuse only gs Fm: Name of Cromer snes thréew customer’ [T1111 TTT CXOTT TTT TT TTT TTT TT TTT TT tT) FOV Tit Name "oil Nae [00 Surname rer ei te eo ae 8S TI eT fecevedhefolowing documents anc andacdressmentionedIrthe appitionfomverfledithoigina ent root erence Poot 9 fete samme @ wae (T= Rer/ Aa Tek) Pre TATE Te RRNA HOT TRE. TT OME A STRAT Canbeintnenane of lat ve Paes Spouse with whom pospectivecustomerslving along obtain dedaraton rom therlaive. Document should rotbeolerthan three months ved Pur er aT /Duration of tay st present pace / years; 3 era & ae Qe MRT aN/if less than 3 years previous {ie & ads rt lormetonsbowtincamect he ppeans ee eee Cl ae ero eee eee Le 000 [7 «ano -scoco [7] esoo00-raaee[] >€ en /toe see /aM: Feat seta eM) ] cere D € 0m RUS Of OF< O% OSES momo 1 ‘armored or era / Verification ofAccountinformation: 538g we conenindagoun ere @ ot saan 98 ae Fone fe # a 8 we 1 ravine tom weetncetngagons 1 Necinine cle th Seine See ‘anf /erar str fic /Decionofthe OfficerBranch Manager CRS omer cee eee ee f= COCOO TH sent /aran sue ever Signature of OfferfBranch Manager