SRM A:PERSONAL DETAILS APPLICANT Co APPLICANT GUARANTOR

Nisting Custorner Yes

I Yes. CIF No/ Aceount No

First N e Middte Name Last NAma

Narne
Date fRith PAN

Mobile

-mal

Narme of Spouse

Name of Father

Gender Male Female Third Gender

Marital Status Single MArried Divorced Widowed

Detai ofKYC (Minimum onr to be flled)

1)Aadhaar /UD No

2) Voter lD No.

3) Passport No.

4) Drivino License No.

5)MGNREGA Jotb card No.

6 Letter issued by NationalPopulation Register Containing Name and Address:

Re sidential Status: Residernt Indian (RI) Nog-Resident Indian (NRI)

Person Of Indian Origin (PIO) Forelgn Citizen

FOR DEFENCE PERSONNEL:

Indian Army 1Indian Navy Indian Air force

IS YOUR SERVICE UNDER:

Defined Benefit Pension New Pension Scheme

Residential Address:

Permanent Address:

Address 1:

Adaress 2:

Address 3:

Village City:

District: State:

Pin Code:
Country:.

Current address same as the permanent addressYes No

Current Address:
Address 1:
Address 2:

Address 3

Village City:

District State

Pin Code:
Country:
Current
Address type for communication: Permarent

Rented Cormpany lease Owned

Residentialtype
Years residing in current address: Monthsresiding in current address:

Relationship with Primary Applicant:

Sister Son Daughter Daughter -in-law
Father Mother Brother
Spouse
Others, Please specify
custorner:
No. of existing house/plot owned ind1vidually or jointly by the