Date:

KNOW YOUR CUSTOMER (All fields mandatory)

PERSONAL DETAILS
1 Name (As per PAN)
2 PAN No.
3 Aadhaar No.
4 Mobile No.
5 E-mail ID
6 Date of Birth
7 Place of Birth
8 Father's & Mother’s Name
9 Marital Status
10 Joint Applicant names (if any)

11 Guardian Name and PAN (if applicable)

12 Address
City: State:
Pin code: Country:
13 Nationality
14 Country of Tax Residence
15 Overseas Address (if applicable)
BANK ACCOUNT DETAILS
1 Bank Name
2 Account Type (Current/OD/Savings/NRE/NRO)
3 Branch
4 Account No.
5 MICR Code
6 IFSC Code
OTHER DETAILS
1 Political Exposure (Yes/No) No
2 Occupation
3 Mode of Holding
4 Gross Income p.a and Tax Status (approx.)
5 Net-worth (approx.)
NOMINEE DETAILS
1 Nominee Name
2 Nominee Date of Birth & Relationship
3 Nominee Email ID
4 Nominee Mobile no.
5 Nominee Address

Kindly enclose the following:

*Pan card copy – self-attested *Aadhar card/Address proof copy – self-attested *Cancelled Cheque Leaf