KYC DETAILS FOR UPDATION

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1) CIF NO : _________________ _ A/C NO :__________________

2)FULL NAME OF CUSTOMER : _______________________________________

3) CURRENT ADDRESS : _______________________________________________

:_______________________________________________________________________
_______________________________________________________________________

4)MOBILE NO : ________________ 5) EMAIL ID: _____________________________

6)OCCUPATION : _________________ 7) ANNUAL INCOME : ____________________

8)KYC DOCUMENT SUBMITTED (SELF CERTIFIED) – Tick any one of the following

AADHAR CARD : ____________________ DRIVING LICENCE: _________________

VOTER ID CARD : _________________ ____PASSPORT : _______________________

PAN CARD :_______________( Please Provide Form 60 duly signed if Pan No is not available)

ELECTRICITY BILL / TELEPHONE BILL / RENT AGREEENT

(Attached Xerox copy of the Documents}

9)CUSTOMER DECLARATION :
I hereby declare that the details submitted by me for my identity and address are true to the
best of my knowledge and belief. I authorize the Bank to update my KYC details / address as per
information provided by me. I undertake to inform you of any changes therein, immediately. In
case the above information is found to be untrue or misleading or misrepresenting, I am aware that I
may be held liable for it .

Date :
Place : Signature / Thumb impression of Customer
Name:
Mob No:
FOR OFFICE USE :
Annexure "B" submitted by the customer verified and KYC Updation date entered in CBS.

Maker : Checker :

BRANCH MANAGER