No-II 10 KYC DETAILS UPDATION KYC ANNEXURE 'B'

STATE BANK OF INDIA:, Branch

1. PERSONAL DETAILS
Last Name
Prefix First Name Middle Name
Name (Same as lD proo IIIIIOMIIIIDIII|IITI

Account No
PHOTO

Residential Status: Resident Individual Non ResidentIndian

Foreign National Person of Indlan Origin
Occupation Type: S-Service ( Private Sector Public Sector Government Sector)
0-Others (Professional Self Employed Retired HousewifeStudent)
B-Business
x-Not Categorised Please Specify.. * * *

Annual Income/Tumover
2. 1DENTIFICATION INFORMATION

MANDATORY: PAN No D I #PAN not aviable FORM 60 to be submtted)

(certified copy of any one of the following documernts to be submitted)
OVD: PassportVoter ID Driving Licence NREGA Job CardLetter issued By National
Population Register
DOCUMENT NO: I LIIIII 1III11I]AADHAR NO (Voluntary) II1II
3. CURRENT/PERMANENT/OVERSEAS ADDRESS DETAILSS

OVD: Passport Voter ID Driving Licence NREGA Job Card Letterissued By National
Population Register
DOCUMENT No: IIIIIN ||1IITIIN
I submit my Aadhar number and voluntarily give my consent Please a tick mark)

Aadhar No
3.1 Current/LOCAL ADDRESS DETAILS
Line

Line 2

Line 3 City/Town/Village
Pin/Post Code State/U.T II
District
4 CONTACT DETAILS
Tel(O LIIIILTel( R e s ) 1 I I I I Moble D

Enal DLTI I 11III1IID

5. APPLICATION DECLARATION
Isubmit my Aadhar copy and voluntarly give my consent to use the same ID/Address proof document (Strike of if
Aadhaar not submited). I hereby declare that the details furnished are true and correct to the best of my knowledge and
belief.I undertake to inform you of any changes therein, immediately. In càse the above information is found to be false
untrue or misleading or misrepresenting, Iam aware that I may be held liable for it.

Date(OD-MM-Ym Place I1
Signature/Thumb Impression of customer
6. ATTESTATION/FOR OFFICE USE ONLY

Documents Received Proof of identify Proof of Address

KYC VERIFICATION CARRIED OUT & ENTERED IN CBS ON-- --BY

Maker Checker
This form along with the KYC Documents be sent to LCPC for storage.
ldentity/Address details to be verified with bank records.
AcknoMdadaomont to