a eT UP eR MCMC EE UR od TL a IDBI BANK CKYCR & FATCA/ CRS Bank Aisa Dost Jaisa Important Instructions: 1A) Fields marked with are mandatory fel, 8) Tick’ * wherever applicable. ) Please fillthe form in English and in BLOCK eters Please fillthe date in DD-MM-YVYY format. Photo © Forparticla section update, please tick(v) inthe box section number and strike of the sections not required to be uploaded. #7 Please read section wise detalledguidelinesinstructions at the en. 6) KYC number of apalcantis mandatory for update application HH The’OTP based E-KYC' check boxisto be checked for accounts opened using OTP based E-KYC in non-aceto face mode, For office use only customer Application Type* [|New [_]Update KY Number Account Type [~] Normal [~] Minor [_ ] achaar OTP based EXC fin nonface to face mode) acl 41. Personal Detalls* (Please refer instruct -nce-ncra FirstName Middle Name thane Prati Fit ame Tide Nae TantNane Maiden Name Father/Spouse Name ‘Mother Name Date of Birth -T Gender* [_] mate] F-Femate[_]transgenéer PAN® Fm 60 fumishes 2. Proof of Identity and Address” (Pi ruction B atthe end) 1) Certifed copy of OVD or equivalent e-document of OVD or OVD obtained through be submitted anyone afte otawing O¥0») [A- Passport Number 8 -VoterID Card {C-Driving License : | 0 -NREGA Job Card Hi E National Population Register Letter F -ProofofPossesion of Aadhaar NERVE Authentication 1) Offine verification of Aadhs Address Line" Une 2 Line City/Town village” Distriet™ Pin/Post Code" stateuT StatelU.T Code* country Iso 3166 country Code*| 3. Current Address Details (Please refer instruction 8 atthe end) [Same as above mentioned address (In such cases address details as below need not be provided) 1) Certied copy of OVD or equivalent e-document of OVD or OVD obtained through digital KYC process needs to be submitted (anyone ofthe follwing OVD) [A- Passport Number 8 -VoterID Card (C-Driving License D-NREGA Job Card E National Population Register Letter F -Proof of Possession of Aadhaar I E-XYC Authentication 1) Offine verification of Aadhaar IV) Deemed Proof of Address Document Type code (Place eferintruction B16 atthe end) Address Line 1* Line2 3 8 2 i 3 Lines ityrTownivill stateuT ‘State/W.T Code ‘country 150.3166 Country Code® Distriet® Pin/Post Code”(oa Bank Aisa Dost Jaisa 4, Contact Details (All communications will be sent to Mobile Number! Emai-1D provided) (Please refer instruction C atthe end) Tel.(ort) > Tel Res) - Mobile : EmaitiD 5. Tick if Applicable (/) Residence for tax purpose in Jurisdiction(s) [ADDITIONAL DETAILS REQUIRED" (Mandatory only if above is Yes) 1503166 Country Code of Jurisdiction of Residence® county ‘Tax dentifiation Number or Equivalent (fssued by jrsietion)* Place Cty ofith® Country ofBith 1503166 Country Code of Birtht “TIN Functional equivalent | Validity of docum Country / Countries of] Address in the jurisdiction Number issuing Country | evidence Cai 5.1. ADDRESS IN THE JURISDICTION DETAILS WHERE APPLICANT IS RESIDENT OUTSIDE INDIA FOR TAX PURPOSES" (Applicable section Si yes) ‘Same as Proof of lent and Address details as in Section 2 [__] Same as Current Address deals as in Section 3 Line * Line Lines ityrTownvlage’ Distriet® u state State/U.T Code” country code?| 6. Romarks (if any) 7. Applicant undertaking and FATCA / CRS declaration : ‘The account holder/s) certify that: 4) Theinformation providedin the Form sin accordance with section 858A ofthelncomeTaxAct, 1961 read with Rules 114Fto 114H ofthelncome taxes, 1962, b) The information provided by me/us in the Form its supporting Annexures as wel a in the documentary evidence provided by meus ae, to the best of our knowledge and belie true, correct and complete an that weave not withheld any mater information that may affect the assessment/eategorzation ofthe accountasaReportableaccountorotherwise live permit/authorize 1DB1Bankto collect sore, communicate and process information relating to the Account and all transactions therein, by IDBIBankand any ofits afilates wherever situated including sharing, transfer and disclosure between them and tothe authorities in anor outside India of any confidential Information forcomplance withany law orregulation whether domestic orforegn, | /Weundertake the responsiblity to declare and disclose wthin 30 days from the date of change, any changes that may take place inthe information provided in the Form, its supporting Annerures as well sn the documentary evidence provided by us or if any certification becomes incorrect and to provide fresh self= ceticatonalong with documentary evidence. Liwie also agre that our allure to disclose any material factknown tous, now orn ature, may invalidate our application ang IDB Bankwouldbe within itsrightto put restrictions in the operations of my/our account or close it or report to any regulator andor any authority designated by the Government of Ina forthe purposecr take anyotheractionasmay be deemed ppropriateby D8IBankithe deficiency isnot remedied by uswithinthe stipulated period 4) WWeheredy accept andacknowledge that IDBIBank shallhavethe ight and authotty ta carty out investigations rom thenformation avalabein public domain forconfing thelnformation povided'oy me ustoIDBIBank 9) Itshallbemy/ourresponsibiltiesto educate myself ourselvesand to comply ataltiees wthallrelevantaws relating reporting under section 285BA cf the Act readwiththe Rules thereunder 1) Wealsoagreeto furnish suchinformation and/or documents as DBI Bankmay require fromtimetotimeon account ofary changein law ether ininglaor abroad Inthesubjectmatternerein 1) le shallindernifyIDB1Bankforanylssthat may arise te DBI Bankon accountof provilngincorectorincomaleteinformation. “Thereby declare thatthe detalls furnished above are rue and core to thebestof my knowlege and belief and undertake to nform you of any changes ‘therein, immediately Incase any the above informations foundto befalseorunttue ormisleading or misrepresenting, am aware that maybe helaiable forit. Mypersonal/KYC detlsmay be shared with Central KYC Registry + Thereby consentto receiving information from CenralKYCRegisty through SMS /Emailon the aboveregisteredrumber/emailaddress. 4) Date ETm[m lace Signature /Thumb Impression of Applicant ana (oa Bank Aisa Dost Jaisa 8. Attestation / For office use only Documents Received [__] Certifed copies E-KYC data received from IDA! [ ] Data received from ofine verification [_] Digital KYC Process Fgulvalente-document [| Video Based KC KYC VERIFICATION CARRIED OUT BY (Te he completed mandatorily) Employee Name Employee c Employee Designation Branch SeliD Date - Employee Signature Institution Details name [JO Tet] [elle |e] [eli [my [tle lo code [1 [N]2[o]3 [2 Institution Stamp Instructions / Check list / Guidelines for filling individual KYC Application Form larfication / Guidelines on filling Personal Detail section 1, Name: The name should match the name as mentioned in the Proof of Identity submited faling which the application i able be rejected 2. One the following is mandatory: Mother name, Spouse's name Fathers name 1. Clarification / Guidelines on filing Current Address Details section 1In case of deemed Proof of Address sucha: utility bill the document need not be uploaded on CKYCR 2. Proof of Address tobe submitted only ifthe submitted Proof of Kentity doesnot have current address or addres as per Proof of Identity is invalid or notin a aa Ste /U. cade adi PotCodel vt be mato fora arse a LisNtonsoneef tnditoobesaeced mene fone eNteaoherean ste ected Sinstte erect. ane btobesete cee efonine= santero tobe seed {lhtefacumens orDeane est hates P acument cose) Description el o sity ill whieh isnot more than wo months old of any service provider (lect telephone, past-aid mail phone pipe gas wate bil. 02 | Property or Municipal taxreceipt 8 Pension or fariy pension payment orders (PPOs) issued toretired employees by Government Departments r Public Sector Undertakings,fthey containtheaderess (04 | Letter of llotment of accommodation rom employer issued by State Government or Central Government Departments statutory or regubtory bodes, public sector undertakings, scheduled commercal banks, fnancialinstittions an listed companies and leave and licence agreements With suchemploersallating offi accommodation. 7. The Bankshallredact fis gt) fthe Aadhaar number from Aadhaar elated data and documents suchas proof of possession of Aachaar, while uploadingon CKYCR. {8 "Equivalent e-document” means an electronic equivalent of document, issued by the issuing authority of such document with its valid digital signature including documents sued tothe digital locker account ofthe client 35 per rule 9 the Information Technology (Preservation and Retention of Information by Intermediaries Providing DigitalLockerFacities) Rules, 2016, 9.igitalkYC proces has tobe cariedoutaestipulatedinthePML Rules, 2005, . Clarification /GuidelinesonfilingContactDetal'section 1Pleasemention w- cigit country code and 10g mobilenumber efor Indian mobilenumber mention 91-9999999959) 2.Donotadd'0'inthebeginning of Mobilenumber D_ Clarification Guidelines on filing Related Person Detals'section 1 .ProvidekYCnumberofreated person favallsle, .Clarficatonon Minor 1. Guardian details ae optional for minors above 10 years of age. However incase guardian deta sae avalabe for minor above 10 years ofage, the same (or CKYCR numberof guaran) stobe uploaded, IDBIBank Limited, Regd. Office: IDBI Tower, WIC Complex, Cuffe Parade, Mumbai - 400 005, Toll Free Numbers: 1800-208-4324 / 1800-22-1070, Non-Tell Free Number: 022 67719100, Visit us: vib bank in| we