KNOW YOUR CLIENT (KYC) | APPLICATION FORM (FOR INDIVIDUALS ONLY) Trading ID :

Please fill in ENGLISH & in BLOCK LETTERS with black/blue ink & tick the appropriate options
Application Type New Modification KYC Demat A/c No. :
KYC Mode* Please Tick Normal EKYC OTP EKYC Biometric Online KYC Offline KYC Digilocker

A. IDENTITY DETAILS
1. Name of Applicant FIRST NAME MIDDLE NAME LAST NAME
2. Maiden Name FOR MARRIED WOMEN ONLY
3. Father’s / Spouse Name FIRST NAME MIDDLE NAME LAST NAME
PHOTOGRAPH
4. a. Gender Male Female Transgender Please affix your
Single recent passport
b. Date of birth DD / MM / YYYY c. Marital Status Married Others size photograph
5. Nationality Indian 6. Residential Status Resident Individual and sign across it

7. PAN 8. Specify the proof of identity submitted : Aadhaar xxxx xxxx _ _ _ _

Passport (Expiry Date: DD/MM/YYYY) Driving License (Expiry Date: DD/MM/YYYY) Voter ID
B. ADDRESS DETAILS

1. Correspondence/
Local Address

City/Town/Village District
Pin Code State Country
2. Contact/Mobile No Tel (Res.)
Tel (Off.) Email id
3. Specify the proof of address submitted for Residence / Correspondence: Please submit ANY ONE of the following valid documents & tick (�) against the document attached.
LatestTelephone Bill Latest Electricity Bill Passport Driving License Latest Bank Passbook Latest Bank Account Statement
Aadhaar Voter Identity Card Ration Registered Lease / Sale Agreement of residence Any other proof of address document (Specify)

4. Permanent Address
(if different from above
correspondence address)

City/Town/Village District
Pin Code State Country
C. OTHER DETAILS

OR

DECLARATION
I 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 changes therein, immediately. lncase
any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.
I would like to reactivate my account and hereby state that all the transactions effected in my Trading/Demat account till date were authorised by me and I acknowledge /
confirm all the transactions and account balances till date.
Kindly consider my DP holding statement as Income Proof
I hereby consent to receiving information from Central KYC Registry/KRA through SMS/Email on the above registered number/email address.

Date : D D M M Y Y Y Y Place:
Signature of Applicant

FOR OFFICE USE ONLY

Details of Employee / Documents Verified with Original / IPV
KYC Verification Carried Out BY
Authorized Signatory
Name & E Code
Designation Seal/Stamp of the Intermediary
Date
Signature