Apex ID: Base Branch: Selected Client ID:

Branch: CKYCR No.:

II. Existing Data as III. Information to
Sl. I. Data Fields
per Bank Records be Updated
1 Title: (Mr/Mrs/Ms/Others)
2 Name of Client: (as per KYC document)
3 Father's Name:
4 Mother's Name:
5 Correspondence/Local Address
PIN Code: (mandatory)

6 Permanent Address Same as Above: (Yes/No)

7 Current/Permanent/Overseas
(Address as per KYC document)
PIN Code: (mandatory)
8 Permanent Address Type: (Residential/Business/Office)
9 Customer Category: (General/OBC/ST/SC/Staff/Others)
10 Date of Birth:
11 Place and Country of Birth:
12 Gender/Sex: (Male/Female/Transgender)
13 Marital Status: (Single/Married – Spouse Name*)
14 Religion: (Hindu/Muslim/Christian/Sikh/Jain/
Buddhist/Zoroastrian/Parsee/Others;)
15 Citizenship/Nationality: (Indian/Others)
16 Residential Status: (Resident/Non-Resident*/
Person of Indian Origin*/Foreign National*)
17 Educational Qualification: (Professional/Graduate/
SSC/Literate/Illiterate)
18 Disability, if Any:
19 *FATCA/CRS Submitted: (Yes/Not applicable)
20 Address Proof Type: (attach) (Aadhaar/Voters ID/
Driving Licence/Passport/NREGA/NPR)
21 Mobile Number: (with Country Code*)
22 E-mail ID: (in block letters)
23 Occupation: (Service/Business/Agriculture/Retired/
Professional/Self-employed/Housewife/Student)
24 Organization Name
25 Annual Income slab: (Below Rs.1 lakh/Rs.1 to 5 lakh/
Rs.5 to 10 lakh/Rs.10 to 25 lakh/Above Rs.25 lakh)
26 Source of Income (Salaried/Business/Pensioner/
Agriculture/Others-Specify*)
27 PAN/Form-60: (attach)
Customers declaration: I confirm that the clients and accounts mentioned in your letter belong to me and also give my consent that the information provided by me in my customer profile form may be updated across all my deposit
accounts maintained with the Bank. I also hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any change therein immediately. I hereby consent to
receive information from the Central KYC Registry to my SMS/Email. The Aadhaar Card if submitted, is with my explicit consent. I am also aware that any change in my existing Mobile number or/and e-mail ID shall also be made effective
in the Mobile or/and Net-Banking facility is enjoyed by me. I also hereby affirm and declare that my correspondence address is as indicated above (Item.5). I understand that the positive confirmation letter sent by the Bank to that address,
if returned undelivered may result in the Bank stopping all operations of my account without further notice.

For Branch/Office use

Customer Risk Categorisation:
Signature of Customer Low Medium High

KYC Details/Customer Signature

Verified and Found Correct

Name of Customer Name, EMP Code and

CSB_01_19_05_22

Paste Recent Signature of BM/BOM/RO

Colour Photograph Date:

CSB Bank Limited - Regd. Office: CSB Bhavan, Post Box No.: 502, St. Mary’s College Road, Thrissur, Kerala 680 020 | 24x7 Toll-free: 1800 266 9090 | www.csb.co.in | CIN: L65191KL1920PLC000175