‡mvbvjx e¨vsK wjwg‡UW

........................................... kvLv
wnmve †Lvjvi Av‡e`b dig
A-e¨w³K wnmve
ZvwiL t ..................................... wnmve b¤^i t ...............................................
MÖvn‡Ki AvB.wW. b¤^i t.................................

Dc-gnve¨e¯’vcK/mnKvix gnve¨e¯’vcK/e¨e¯’vcK
‡mvbvjx e¨vsK wjwg‡UW
...........................kvLv|
g‡nv`q,
Avwg/Avgiv Avcbvi kvLvq wbgœiƒc GKwU wnmve †Lvjvi Rb¨ Av‡e`b KiwQ| AbyMÖnc~e©K Avgvi/Avgv‡`i e¨env‡ii Rb¨
..................................cvZvi GKwU †PK ewn mieivn Ki‡eb| Avgvi /Avgv‡`i we¯—vwiZ Z_¨ wb‡gœ cÖ`vb Kijvg t
1. wnmv‡ei bvg t ............................................................................................................................
2. cÖwZôv‡bi aiY (wUK w`b) t
cÖvB‡fU/cvewjK wjt
Askx`vix
†hŠ_ D‡`¨vM
GKK gvwjKvbv

miKvix
GbwRI
K¬ve/†mvmvBwU
Ab¨vb¨ (wjLyb)...................

3. (K) ¯^Z¡vwaKvixi bvg ....................................................................................................................

(L) Askx`vi‡`i bvg I As‡ki cwigvb ............................................................................................
(M) cwiPvjK‡`i bvg I c`ex ........................................................................................................
4. wnmv‡ei cÖKvi (wUK w`b) t
mÂqx
PjwZ
Gm.wU.wW
¯’vqx
ˆe‡`wkK gy`ªv
Ab¨vb¨...........
5. gy`ªv (wUK w`b) t
UvKv
Wjvi
BD‡iv
cvDÛ
Ab¨vb¨ ................
6. cÖwZôv‡bi wVKvbv t
K. †iwRóvW© wVKvbv t...............................................................................................
L. e¨emv¯’j/Awd‡mi wVKvbv t...............................................................................................
M. KviLvbv/wkí cÖwZôv‡bi wVKvbv t...............................................................................................
7. †UªW jvB‡mÝ b¤^i t............................................................ ZvwiL .........................
Bmy¨Kvix KZ…©c¶ t...............................................................................................
8. wbeÜb KZ…©c¶ I †`k t...............................................................................................
(†`kx/we‡`kx Dfq ai‡Yi Rb¨)
9. wbeÜb b¤^i t............................................................ ZvwiL .........................
10. U¨v· AvBwW b¤^i (TIN) t...............................................................................................
11. f¨vU †iwRt b¤^i (hw` _v‡K) t...............................................................................................
12. e¨emv‡qi cÖK…wZ (we¯—vwiZ) t...............................................................................................
13. MÖvn‡Ki Ab¨vb¨ e¨vsK wnmve (hw` _v‡K) t
e¨vs‡Ki bvg kvLv cwiPvjbvK…Z wnmv‡ei cÖK…wZ (wUK wPý w`b)
K .............................. K .........................
Rgv wnmve
FY wnmve
Ab¨vb¨
L .............................. L .........................
Rgv wnmve
FY wnmve
Ab¨vb¨
M .............................. M .........................
Rgv wnmve
FY wnmve
Ab¨vb¨
14. cwiPq`vbKvixi Z_¨ t
K. bvg t......................................................................................................
L. wcZv/¯^vgxi bvg t......................................................................................................
M. gvZvi bvg t......................................................................................................
N. wVKvbv (eZ©gvb I ¯’vqx) t......................................................................................................
O. wnmve bs t......................................................................................................
P. kvLvi bvg t......................................................................................................
Q. ¯^v¶i (ZvwiLmn) t.....................................................†Uwj‡dvb b¤^i..............................

* we‡kl `ªóe¨ t wjwg‡UW †Kv¤úvbxi †¶‡Î cwiPq`vbKvixi cÖ‡qvRb †bB| Z‡e †Kv¤úvbxi †evW© Ae WvB‡±im Gi
†iRy‡jkb, †g‡gv‡iÛvg GÛ AvwU©‡Kjm Ae G‡mvwm‡qk‡bi mvwU©dvBW Kwc I mvwU©wd‡KU Ae BbK‡c©v‡ikb Ges
cvewjK wjwg‡UW †Kv¤úvbxi †¶‡Î mvwU©wd‡KU Ae K‡g݇g›UI mshy³ Ki‡Z n‡e|
15. cÖv_wgK Rgv t cwigvb t............................................................................................
16. Gd.wW.Avi msµvš— Z_¨ t cwigvb t....................................................gy`ªv t.................................
†gqv`Kvj t gvm eQi w`b| †gqv`c~wZ©i ZvwiL t........................
bevq‡bi †¶‡Î t
Avmj Ges my` bevqb Ki“b
ïaygvÎ Avmj bevqb Ki“b

ïaygvÎ Avmj bevqb Ki“b, my` ..............................b¤^i wnmv‡e Rgv Ki“b

cÖ‡hvR¨ b‡n|
17. we‡kl ¯‹xg msµvš— Z_¨ t
¯‹x‡gi bvg t...............................................................................................................................
¯‹x‡gi ‡gqv` t.....................GKKvjxb Rgv/wKw¯—i cwigvb t.................. wKw¯—i msL¨v (evwl©K) t...............
‡gqv`v‡š— cÖ‡`q t.........................................................gvwmK cÖ‡`q t..............................................
18. A‡_©i Drm t...............................................................................................................................
bwgbx Av‡jvKwPÎ (d‡Uv)
(MÖvnK KZ…©K mZ¨vwhZ
19. bwgwbx msµvš— Z_¨ t ;```````````````````
Avwg/Avgiv GB wnmv‡ei A_© Avgvi/Avgv‡`i g„Zz¨i ci wbgœv³fv‡e wb‡gœv³ e¨w³/e¨w³‡`i‡K cÖ`v‡bi Rb¨ g‡bvbxZ
Kijvg| Avwg/Avgiv Dwj−wLZ g‡bvbqb †h †Kvb mgq evwZj ev cwieZ©‡bi AwaKvi msi¶Y Kwi| Avwg/Avgiv GB g‡g©
Av‡iv m¤§wZ Ávcb KiwQ †h, Avgvi/Avgv‡`i wb‡`©kbv †gvZv‡eK †jb‡`b e¨vsK †Kvbfv‡e `vqe× n‡ebv|
bwgbx/bwgbx‡`i bvg t (1)..............................(2)...................................(3)..............................;
Rb¥ ZvwiL/eqm t...............................................................................................................
wcZvi bvg t...............................................................................................................
gvZvi bvg t...............................................................................................................
¯^vgx/¯¿xi bvg t...............................................................................................................
bwgbx/bwgbx‡`i t (K) eZ©gvb wVKvbv t...................................................................................
(L) ¯’vqx wVKvbv t...................................................................................
‡ckv t...............................................................................................................
wnmveavixi mv‡_ m¤úK© t...............................................................................................................
As‡ki cwigvb (%) t...............................................................................................................
RvZxq cwiPqcÎ b¤^i t...............................................................................................................
*(†Kvb Awbevmx‡K bwgbx Kiv n‡j H Awbevmx mswk−ó wnmv‡ei A_© cÖvc¨ n‡j cÖvß A_© we‡`‡k †cÖi‡Yi †¶‡Î we`¨gvb ˆe‡`wkK gy`ªv wbqš¿b
AvB‡bi wewa weavb cÖ‡hvR¨ n‡e|)

20. wnmve cwiPvjbvKvix msµvš— †NvlYv I ¯^v¶i t

Avwg/Avgiv GB g‡g© wbðqZv cÖ`vb KiwQ †h, Avwg/Avgiv wnmve msµvš— hveZxq wbqgvejx/kZ©vejx c‡owQ Ges D³
wbqgvejx/kZ©vejx †g‡b Pj‡Z eva¨ _vKe| Avwg/Avgiv ¯^Áv‡b †NvlYv KiwQ †h, Dc‡ivwj−wLZ Z_¨vw` mZ¨| Avcbvi
Pvwn`v †gvZv‡eK cÖ`Ë Z‡_¨i AwZwi³ mswk−ó †h †Kvb cÖ‡qvRbxq Z_¨vw`/`wjjvw` mieivn Kie|

MÖvn‡Ki ¯^v¶i, bvg, c`ex I ZvwiL

1. ¯^v¶i t 2. 3.
bvg t
c`ex t
¯^v¶‡ii ZvwiL t
----------------------------------------------------------------------------------------------------------------
e¨vs‡Ki e¨env‡ii Rb¨

‡PK ewn b¤^i..................................Bmy¨i ZvwiL.............................Kg©KZ©vi ¯^v¶i...................................

gš—e¨ t

......................... .........................
wnmve †Lvjvi Kg©KZ©v Aby‡gv`bKvix Kg©KZ©v
bvghy³ mxjmn ¯^v¶i I ZvwiL bvghy³ mxjmn ¯^v¶i I ZvwiL
 ............................. e¨vsK / e¨vsK wjt
Av‡jvKwPÎ
....................... kvLv
wnmve †Lvjvi dig t e¨w³ msµvš— Z_¨vejx
GB digwU cyiYc~e©K e¨w³ I Ae¨w³K wnmv‡ei g~j As‡ki mv‡_ mshy³ Ki‡Z n‡e|

ZvwiL t ..................................... wnmve b¤^i t ...............................................

MÖvn‡Ki AvB.wW. b¤^i t.................................

1. MÖvn‡Ki bvg t......................................................................................

2. wnmv‡ei mv‡_ m¤úK© (bx‡P cÖ‡hvR¨ †¶‡Î wUK w`b) t

1g Av‡e`bKvix
2q Av‡e`bKvix
3q Av‡e`bKvix
WvB‡i±i
Askx`vi

bvevjK
AwffveK
G¨vUb©x †nvìvi
wmM‡bUwiR
Ab¨vb¨ .........................

3. wcZvi bvg t......................................................................................

4. gvZvi bvg t......................................................................................
5. ¯^vgx/¯¿xi bvg t......................................................................................
6. RvZxqZv t......................................................................................
7. Rb¥ ZvwiL t......................................................................................

8. wj½ (wUKv w`b) t
cyi“l
gwnjv

9. †ckv (c`exmn) t......................................................................................
10. RvZxq cwiPqcÎ b¤^i t......................................................................................
11. cvm‡cvU© b¤^i (hw` _v‡K) t......................................................................................
12. U¨v· AvBwW b¤^i (TIN) (hw` _v‡K) t......................................................................................
13. WªvBwfs jvB‡mÝ b¤^i (hw` _v‡K) t......................................................................................
14. eZ©gvb wVKvbv (Avev¯’j) t......................................................................................
15. ¯’vqx wVKvbv t......................................................................................
16. †ckvMZ wVKvbv t......................................................................................
17. †hvMv‡hvM t

‡Uwj‡dvbt evmvt.................................... Awdmt.............................

‡gvevBjt................................ B-‡gBjt................................ d¨v·t..............................
18. †µwWU KvW© msµvš— Z_¨t
Bmy¨Kvix cÖwZôvb I KvW© b¤^i (hw` KvW© e¨enviKvix nb) t 1|............................................................
2|............................................................
19| †iwm‡WÝ ó¨vUvm (wUK w`b) t
†iwm‡W›U
bb-‡iwm‡W›U
(cÖ‡qvRbxq †¶‡Î e¨vsK MvBWjvBÝ di G·‡PÄ Uªvb‡RKkbm Gi wb‡`©kbv AbymiY K‡i Z_¨ msMÖn Ki‡e)

¯^v¶i (ZvwiLmn)
 MÖvnK cwiwPwZ m¤úwK©Z dig (KYC Profile Form)t
(e¨w³ I cÖwZôv‡bi wnmve †Lvjvi †¶‡Î eenvh©)

1. wnmv‡ei bvg t

2. wnmv‡ei aiY t

3. wnmve ev m~Î (Reference) b¤^i t

4. wnmve †Lvjvi Kg©KZ©vi bvg t

5. e¨emv‡qi cÖK…wZ Ges Znwe‡ji Drm t

6. Znwe‡ji Drm wKfv‡e wbwðZ Kiv n‡q‡Q Ges e¨emvwqK m¤úK© ¯’vcbK‡í e¨emv‡qi cÖK…wZ
wek`fv‡e D‡j−LKiZt e¨emv‡qi mv‡_ †jb‡`‡bi cwigvb mvgÄm¨c~Y© wK-bv Zv eY©bv Ki‡Z n‡e t

7. wnmv‡ei cÖK…Z myweav‡fvMx (Beneficial Owner) m¤úwK©Z Z_¨vw` (†K¤úvbxi †¶‡Î wbqš¿bKvix †kqvi
†nvìvi Ges 20% ev Gi AwaK GKK †kqvi †nvìvi Gi we¯—vwiZ Z_¨vw`) t..............................................
.................................................................................................................................
8. cvm‡cvU© b¤^i .....................................d‡UvKwc M„nxZ wKbv? t nu¨v / bv (cÖ‡hvR¨ †¶‡Î)
9. ‡fvUvi AvBwW KvW© b¤^i.........................d‡UvKwc M„nxZ wKbv? t nu¨v / bv (cÖ‡hvR¨ †¶‡Î)
10. RvZxq cwiPqcÎ b¤^i............................d‡UvKwc M„nxZ wKbv? t nu¨v / bv (cÖ‡hvR¨ †¶‡Î)
11. wU AvBGb ..........................................d‡UvKwc M„nxZ wKbv? t nu¨v / bv (cÖ‡hvR¨ †¶‡Î)
12. f¨vU †iwRt b¤^i...................................d‡UvKwc M„nxZ wKbv? t nu¨v / bv (cÖ‡hvR¨ †¶‡Î)
13. WªvBwfs jvB‡mÝ b¤^i.............................d‡UvKwc M„nxZ wKbv? t nu¨v / bv (cÖ‡hvR¨ †¶‡Î)
14. Abvevmx (Non-residence) Ges we‡`kx‡`i wnmve †Lvjvi KviY m¤ú‡K© wbwðZ nIqv|
wfmvi cÖK…wZ [AvevwmK/KvR (Work)] ....................................................................

15. MÖvnK wK K‡ib/cÖwZôvbwU wK ai‡Yi e¨emv‡q wb‡qvwRZ i‡q‡Q ?

µwgK bs cÖK…wZ wi¯‹ †j‡fj †¯‹vi
1 Ry‡qjvix/¯^‡Y©i e¨emv D”P 5
2 gvwb †PÄvi/Kzwiqvi mvwf©m G‡R›U D”P 5
3 wi‡qj G÷U G‡R›U D”P 5
4 wbg©vY cÖKí †cÖv‡gvUvi D”P 5
5 Ad‡mvi K‡c©v‡ikb D”P 5
6 wPÎKjv/Gw›U‡Ki wWjvi D”P 5
7 ‡iu‡¯—viv/evi/bvBU K¬ve/AvevwmK †nv‡Uj Gi gvwjK D”P 5
8 Avg`vbx/ißvbx G‡R›U D”P 5
9 bM` A_© jMœxKvix e¨emvqx (gv‡m 25 j¶ UvKvi) D”P 5
10 †kqvi/÷K wWjvi D”P 5
11 Rbkw³ ißvbx e¨emv D”P 5
12 wewfbœ Ae¯’v‡b Kvh©µg D”P 5
13 Pjw”QÎ cÖ‡hvRbv/cwi‡ekbv ms¯’v D”P 5
14 A‡¯¿i e¨emv D”P 5
15 ‡gvevBj †dvb Acv‡iUi D”P 5
16 evwl©K 1 †KvwU UvKvi AwaK A_© jMœxKvix e¨emvqx D”P 5
17 Uªv‡fj G‡R›U D”P 5
18 cwienb Acv‡iUi ga¨g 3
19 A‡UvwWjvi (wiKwÛkb Mvox) ga¨g 3
20 wjwRs/dvBb¨vÝ †Kv¤úvbx ga¨g 3
 21 ‡d«BU/wkwcs/Kv‡M©v G‡R›U ga¨g 3
22 BÝy¨‡iÝ/†eªvKv‡iR G‡RÝx ga¨g 3
23 ag©xq cÖwZôvb ms¯’v ga¨g 3
24 we‡bv`bKvix cÖwZôvb cvK© ga¨g 3
25 ‡gvUi cvU©m Gi e¨emv ga¨g 3
26 ZvgvK I wmMv‡i‡Ui e¨emv ga¨g 3
27 A‡Uv cÖvBgvix (bZzb Mvox) wbgœ 2
28 †`vKv‡bi gvwjK (KzPiv) wbgœ 2
29 e¨emv-G‡R›U wbgœ 2
30 ¶z`ª e¨emvqx (evwl©K Uvb©Ifvi 50 j¶ UvKvi bx‡P) wbgœ 2
31 ¯^D‡`¨vMx †ckvRxex wbgœ 2
32 K‡c©v‡iU Kv÷gvi wbgœ 2
33 evox wbg©vY mvgMÖxi e¨emv wbgœ 2
34 Kw¤úDUvi/†gvevBj †dv‡bi wWjvi wbgœ 2
35 mdUIq¨vi e¨emv wbgœ 1
36 Drcv`bKvix (A¯¿ e¨ZxZ) wbgœ 1
37 PvKzix n‡Z AemiMÖnYKvix wbgœ 0
38 PvKzix wbgœ 0
39 QvÎ wbgœ 0
40 M„wnbx wbgœ 0
41 K…wlRxex wbgœ 0
42 Ab¨vb¨.................(aiY Abymv‡i e¨vsK wi¯‹ †¯‹vi cÖ`vb Ki‡e) wbgœ 0

(16 †_‡K 21 b¤^i †Uwe‡j †kªYxi Dשmxgv GKB †kªYx‡Z we‡ewPZ n‡e| D`vniY t 50 j¶ UvKv 0-50 †kªYxfy³ n‡e)

16. MÖvn‡Ki bxU m¤ú‡`i (Net Worth) cwigvY t

cwigvb (UvKvq) wi¯‹ †j‡fj wi¯‹ †iwUs
1-50 j¶ wbgœ 0
50 j¶ - 2 †KvwU ga¨g 1
>2 †KvwU D”P 3

17. wnmve †Lvjvi aiY t

aiY wi¯‹ †j‡fj wi¯‹ †iwUs
wi‡jkbkxc g¨v‡bRvi/kvLv KZ…©K wbgœ 0
WvB‡i±i †mjm G‡R›U KZ…©K ga¨g 1
B›Uvi‡bU D”P 3
AhvwPZ/¯^cÖ‡Yvw`Zfv‡e D”P 3

18. MÖvn‡Ki AbywgZ gvwmK †jb‡`‡bi cwigvY t

PjwZ wnmv‡e †jb‡`‡bi mÂqx wnmv‡e †jb‡`‡bi wi¯‹ †j‡fj wi¯‹ †iwUs
cwigvY (j¶ UvKvq) cwigvY (j¶ UvKvq)
0-10 0-5 wbgœ 0
10-50 5-20 ga¨g 1
>50 >20 D”P 3

19. MÖvn‡Ki AbywgZ gvwmK †jb‡`‡bi msL¨v t

PjwZ wnmv‡e †jb‡`‡bi mÂqx wnmv‡e †jb‡`‡bi wi¯‹ †j‡fj wi¯‹ †iwUs
msL¨v msL¨v
0-100 0-20 wbgœ 0
100-250 20-50 ga¨g 1
>250 >50 D”P 3
20. MÖvn‡Ki AbywgZ gvwmK bM` †jb‡`‡bi cwigvY t
PjwZ wnmv‡e †jb‡`‡bi mÂqx wnmv‡e †jb‡`‡bi wi¯‹ †j‡fj wi¯‹ †iwUs
(j¶ UvKvq) (j¶ UvKvq)
0-10 0-2 wbgœ 0
10-25 2-7 ga¨g 1
>25 >7 D”P 3

21. MÖvn‡Ki AbywgZ gvwmK bM` †jb‡`‡bi msL¨v t

PjwZ wnmv‡e †jb‡`‡bi mÂqx wnmv‡e †jb‡`‡bi wi¯‹ †j‡fj wi¯‹ †iwUs
msL¨v msL¨v
0-15 0-5 wbgœ 0
15-30 5-10 ga¨g 1
>30 >10 D”P 3

22. mvwe©K SzuwK wbiƒcY t

wi¯‹ †iwUs SzuwKi cÖK…wZ
>=14 D”P
<14 wbgœ

gš—e¨ t

(*wi¯‹ †iwUs 14 Gi Kg n‡jI KviY D‡j−Lc~e©K Subjective we‡ePbvq MÖvnK‡K D”P SuywK m¤úbœ wn‡m‡e wbiƒcY Kiv †h‡Z cv‡i)

23. wnmveavixi wVKvbv (mg~n) hvPvB Kiv n‡q‡Q wKbv ?

24. D³i nu¨v n‡j wKfv‡e hvPvB Kiv n‡q‡Q ?
25. cwjwUK¨vwj G·‡cvmW cvimbm& (PEPs) t (G.Gg.Gj. mvK©yjvi-14 Abymv‡i)
K. wmwbqi g¨v‡bR‡g›U n‡Z Aby‡gv`b †bqv n‡q‡Q wK bv? nu¨v / bv
L. m¤ú‡`i Drm t
-------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------
M. MÖvn‡Ki ms‡M gy‡LvgywL mv¶vrKvi †bqv n‡q‡Q t nu¨v / bv

cÖ¯‘ZKvix t ch©v‡jvPbvKvix t
(wnmve †Lvjvi Kg©KZ©v/wi‡jkbkxc g¨v‡bRvi) (kvLv e¨e¯’vcK/kvLv Acv‡ikb cÖavb)

¯^v¶i (mxjmn) t ¯^v¶i (mxjmn) t

bvg t bvg t
ZvwiL t ZvwiL t

26. wnmve msµvš— Z_¨vw` me©‡kl K‡e Review & Update Kiv n‡q‡Q ?

Review & Update Kvix Kg©KZ©vi bvg t

¯^v¶i t
bvg t
ZvwiL t
 m¤¢ve¨ †jb‡`‡bi AbygwZ gvÎv (Transaction Profile) t

1. wnmv‡ei bvg t

2. wnmv‡ei aiY t

3. wnmve ev m~Î (Reference) b¤^i t

weeiY ‡jb‡`‡bi msL¨v m‡e©v”P ‡gvU cwigvb

(gvwmK) †jb‡`‡bi A¼ (gvwmK)
(cÖwZwU
†jb‡`‡bi)
Rgvt

bM` Rgv (AbjvBbmn)

UªvÝdvi/ BÝUªy‡g›U Gi gva¨‡g Rgv

d‡ib †iwgU¨vÝ Rgv

ißvbx n‡Z Avq

Ab¨vb¨ (wbw`©ófv‡e) ....................

†gvU m¤¢ve¨ Rgv

D‡Ëvjbt

bM` Rgv (AbjvBbmn/G.wU.Gg mn)

UªvÝdvi/ BÝUªy‡g›U Gi gva¨‡g cwi‡kva

d‡ib †iwgU¨vÝ D‡Ëvjb

Avg`vbx eve` e¨q

Ab¨vb¨ (wbw`©ófv‡e) ....................

†gvU m¤¢ve¨ D‡Ëvjb

4. †jb‡`bK…Z A‡_©i Drm t .............................................................................................

Avwg/Avgiv wbgœ¯^v¶iKvix(MY) G g‡g© wbðqZv cÖ`vb KiwQ †h, m¤¢ve¨ †jb‡`‡bi AbywgZ gvÎv
Avgvi/cÖwZôv‡bi ¯^vfvweK cÖK…Z †jb‡`b| Avwg/Avgiv Av‡iv wbðqZv cÖ`vb KiwQ †h, cÖ‡qvRb‡ev‡a
Avwg/Avgiv m¤¢ve¨ †jb‡`‡bi AbywgZ gvÎv ms‡kvab/ nvjbvMv` Kie|

¯^v¶i t ¯^v¶i t
bvg t bvg t
c`ex t c`ex t
ZvwiL t ZvwiL t