Know Your Client (KYC) Al pstox Application Form (For Individuals Only) Please fil type the form in English and BLOCK letters. Sign all areas marked with ‘3°. Once completed, please mail the completed form along withthe necessary ‘roofs to our corporate office in Mumbal A. Identity Details (please see guidelines) FULL NAME (As appearing in supporting identification document: POOJA ANAND BHOJNE FATHER /SPOUSE'S NAME: ANAND GOVIND BHOJNE MAIDEN NAME: (f any) MOTHER NAME: GENDER [J mae [Z] FemaLe [] T-TRANSGENDER MARITALSTATUS [] MARRIED [2] UNMARRIED CITIZENSHIP 7 IN-INDIAN OTHER DATE OF BIRTH (éd/mmiyyy) 02/10/1999 RESIDENTIAL STATUS [JZ] RESIDENTINDIVIDUAL [[] NONRESIDENTINDIAN [-] FOREIGN NATIONAL C1 PERSON oF INDIAN ORIGIN PAN (lease enclose a dulyatested copy) EVPPB3908E ‘Applicant E-Sign PROOF OF IDENTITY SUBMITTED FOR PAN EXEMPT CASES (Please Tick) 1 A-padhar card roan C1 6 Passport Number Oe voterio CO D- Driving License _E-NREGA Job Card CO F-nor OD z-others PAN B. Address Details (Please see guidelines) Address Type CiResidential / Business 7] Residential [Business [Registered Office] Unspecifi ADDRESS FOR RESIDENCE/CORRESPONDENCE: ROOM NO 6 SHREE SAI NIWAS CHAW, L PENKAR PADA ROAD CHIMAJI NAG AR NEAR NIRBA DEVI MANDIR CITYTOWN/VILLAGE: THANE stare. MAHARASHTRA pIncove 401105 bistRIcT; THANE couNTRY: India PERMANENT ADDRESS OF RESIDENT APPLICANT IF DIFFERENT FROM ABOVE Bi OR OVERSEAS ADDRESS(MANDATORY) FOR NON RESIDENT APPLICANT: ROOM NO 6 SHREE SAI NIWAS CHAW, L PENKAR PADA ROAD CHIMAJI NAG AR NEAR NIRBA DEVI MANDIR CITYTOWN/VILLAGE: THANE STATE MAHARASHTRA Pincove 401105 DISTRICT: THANE ‘COUNTRY: India PROOF OF ADDRESS" attested copy of any 1 POA for correspondence and permanent address each to be submited) [A-Aadhar card soon CB Passport Number tenon Dc-voteri [1-Driving License tenyoie C1 E-NREGA Job Card Cr-Ner Oz-others ———— Wor docannt Ce GommePetre reed best of my/our knowledge and belief and l/we undertake to inform you of any |)Me hereby deciare that the KYC details furnished by me are true and correct to the Applicant e-SIGN Applicant Wet Signature Jmmediately. In case any of the above information is OF untrue or misleading or misrepresenting | amyWe are aware that We may be held lable ort I/We hereby consent to recelving information from CV KRA through SMS/Emall on the above registered number/emall address, | amMWe are also aware that for Aadhaar OVD based KYC, my KYC request shall be validated against Aadhaar detale. |e hereby consent to sharing my/our masked ‘Aadhaar card with readable QR code or my Aadhzar XML/Digllocker XML fle, along with passcode and the entire account opening form along with supporting documents as applicable, wth KRA and other Intermediaries with whom | have a business relationship for KYC purposes only. Place THANE Pate 01/03/2024 FOR OFFICE USE ONLY IPVDone [on (dd/mm/yyyy) AMC/Intermediary name OR code 1 originals verified) True copies of documents received KYC Number (Mandatory for KYC update request) Application Type (] New Update 1D attested) True copies of documents received Main Intermediary Account Type [] Normal [] Small CO Simplified (To be filled ifthe name on documents is different) names as spelt in respective proofs: Name as per Income Tax POOJA ANAND BHOJNE Name as per Bank Proof Pooja Anand bhojne KYCMode* Normal _|EKYCOTP _) EKYCBiometric [JOnlineKYC — Offline KYC [ DECLARATION FOR NAME MISMATCH SealStamp ofthe intermediary should cont Stffhsme Designation Name ofthe Organlzation ‘Signature Pace Digilocker This is to bring to your notice that my name's spelt differently in my Identity proof, Address proof and Bank proof. Please find below the Name as per Address Proof Name as per income Proof Commodities india Pvt. Ltd. for any act done or omitted to be done on the above declaration. CLIENT'S SIGNATURE [12] X hereby confirm that al the said names belong to me. | hereby state and confirm that whatis stated above is true and correct information. | agree to indemnify and keep RKSV Securities India Put. Ltd. / RKSV Commodities India Pvt. Ltd. indemnified at all times from and against all costs, charges, damages, penalties (including reasonable attorney fees) suffered and/or incurred by RKSV Securities India Pvt. Ltd. / RKSVSignature as per our records4upstox COMMODITIES ACCOUNT OPENING FORM MANDATORY DOCUMENTS DOCUMENT SIGNIFICANCE | _ PAGES) Account Opening Form a) KYC form - Document captures the basic information about the 3 constituent and an instruction/check list: b) Document captures the additional information about the constituent relevant to trading account and an instruction/check list. Rights and Obligations Provided to client Risk Disclosure Document (ROD) Provided to client Guidance Note Provided to client Policies and Procedures | Provided to client Tariff Sheet Details the rate/amount of brokerage and other charges levied ° (on the client for trading on the stock exchange(s) FATCA CRS Declaration | Client's self declaration on holding of overseas asset if any 2 VOLUNTARY CLAUSE DOCUMENT SIGNIFICANCE PAGE(S) ‘Authorization for Letter of Authorization for Electronic Contract Notes. 10 Electronic Contract Notes Authorization of running | _ Letter or authority/request to RKSV Commodities India Pvt. Ltd 10 account/request letter REGISTERED OFFICE ADDRESS RKSV Commodities India Private Limited £807, New Delhi House, Barakhamba Road Connaught Place, New Delhi, 110011 Telephone: #91-22-6130-9999 Fax: #91-22.6710-7492 Email: contact@upstox.com, wuw.upstox.com CEO (BSE/NSE) Mr Ravi Kumar Telephone: +91-22-6130-9999 Emall: compliance@upstox.com, www.upstox.com COMPLIANCE OFFICER (BSE/NSE) Mr, Amit Lalan Telephone: +31-22-6130:9999 Email: compliance@upstox.com, wwvw.upstox.com COMPLIANCE OFFICER (OP) Mr, Amit Lalan Telephone: +31-22-6130-9999 Email: compliance@upstox.com, vwvw.upstox.com KC PROCESSING OFFICE ADDRESS RSV Commodities India Private Limited Salasar Business Park, Off 150 Feet Flyover Road, Bhayander West, Thane, Maharashtra 401101 Telephone: +91-22-6130-9999 Fax: +91-22-6710-7492 Email: contact@upstox.com, www-upstox.com ‘SEBI REGISTRATION NUMBERS ‘SEBI Regn. No. INZ000015837 IMCX: MCx/TM/CORP/2034 Registration Date: Jan 22, 2016 Clearing Member: RKSV Commodities India Private Limited Forany grevance/ dispute plate contact R&SY Commmodites nda Pt. td atthe above adress and/or eval No, 18152-61309, In cae you ae not satisfied ith te feszonse, pled 491-22.673L-abae,Proceduretofle cor plainton SEE SCORES: Rei Number €-mall net ld complaints@risvin and complaints mex@rhscin ao Prene ontat the cancers exchange) a MC grevenie@mand om and Phone No ‘on SCORES portal, Mandatory deta fling omplints on SCORES: Name, PAN, Ades, Mable PAGE1INSTRUCTIONS / CHECK LIST FOR FILLING KYC FORM (A) IMPORTANT POINTS: 1. Self attested copy of PAN card is mandatory for all clients. 2. Copiesofallthe documents submitted bythe applicant should be cell-attested and accompanied by original for verification. Incatethecriginal of any document snot produced for verification, then the copies shouldbe properly attested by entities authorized for attestin the documents, spe the below mentioned ist. 3. If any proof of identity or address is in a foreign language, then translation into English is required. 44. Name & address of tne applicant mentioned on the KYC form, should match with the documentary proof submitted. 5 __Ifeorrespondence & permanent address are diferent, then proofs for beth have to be submitted 6. Sole proprietor must make the application in his individual name & capacity 7. Fornon-residents and foreign nationals allowedto rade subject toRBI and FEMA guidelines),copy of passport/PIOCard/OCICardand overseas address proo is mandatory. 8, For foreign entities, CIN is optional and inthe absence of DIN no. forthe directors, their passport copy should be given. 9. Incase of Merchant Navy NR’, Marine's declaration or certified copy of CDC (Cotinuous Discharge Certificate) i to be submitted 10, For opening an account with Depository participant or Mutual Fund, fra minor, photocopy of the School Leaving Certificate/Mark sheet isued by Higher Secondary Board/Passport of Minor/arth Certificate must be provided. 11, PoltieallyExoosed Persons (PEP) are deinecasindviduals who are orhave been entrusted with prominent publicfunctionsina foreign country, leg, Heads of States or of Governments, senior politicians, senior Government/judiclal/miltary officer, senior executives of state owned corporations, important politcal party officials ete (B) PROOF OF IDENTITY( PON) List of documents admissible as Proof of Identity: 1. PANcard with photograph. Thisisamandatory requirement forallappicants except those who.arespeciicallyexempt fromobtaining PAN CIisted In Section D). 2 Unique identification Number (UID) (Aachaan / Passport / Voter ID card / Orving license 3 Identity card/ document with epplicant’s Phot, issued by any ofthe following: Central/State Government and its Departments, tatutory/ Regulatory Autherties, PubieSector Undertakings, Scheduled Commercial Bales Pubic Financialinsttuions, Coleges afilatedto Universities, Professional Bodles such as ICAl,ICWAl, ICSI, Bar Council etc. to thelr Members’ and Crecit cards/Debit cards issued by Bank. (©) PROOF OF ADDRESS (POA): List of documents admissible submission) Passport/Voters identity Card/Ration Card/Registered Lease or Sale Agreement of Residence/Driving License/Fiat Maintenance bil/Insurance Copy. Utility bil lke Telephone Bil only landline), Electricity bill or Gas bill Not more than 3 months old BankAccount Statement/Passbook - Not more than 3 months ol. Sell-delaration by High Court and Supreme Court judges. giving the new address in respect of thelr wn accounts. Proof of address issued by any ofthe folowing: Bank Managers of Scheduled Commercial Banks/Schedtled Co-Operative Bank/Multinational Foreign Banks/Gazetted Officey/Notary public/ Elected representativesto the Legislative Assembly/Parllament/Documents ksuedby any Govt. or Statutory Authority. 6. Identity card/document with address ssued by any of the following: Central/State Government and its Departments, Statutory/Regulatory Authorities, Public Sector Undertakings, Scheduled Commercial Banks, Public Financia institutions, Colleges afiieted to Universities and Professional Bodies sun as ICAI, ICWal, ICS, Bar Counc ste-to their Members. root of Address: ("Documents having an expiry date should be Vad onthe date of 7 ForFll/subaccount, Power of Attorney given by FM/sub-account to the Custodians (which are duly notarized and/or apostle or consularised) that gives the recistered address should be taken 8, Theproof of adatess inthe name ofthe spouse may be accepted, (0) EXEMPTIONS/CLARIFICATIONS TO PAN (‘Sufficiont documentary evidence in support of such claims tobe collected.) 1. Incase of transactions undertaken on behalf of Central Government and/or State Government and by officials appointed by Courts e.g. Oficial iqudator, Court receiver ete 2. Investors residing inthe stat of Sikkim. 3. _UNentties / multiateral agencies exernpt from paying taxes/fiing tax returns in inca, 4. SIPof Mutual Funds upto Rs 50, 000/- pa 5 Incase of institutional cients, namely, Fils, Ms, VCFs, FUCIs, Scheduled Commercial Banks, Multiteral and Sateral Development Financial Institutons, State Industrial Development Corporations, insurance Companies registered with IRDA and Public Financial institution as defined Under section 4A of the Companies Act, 1956, Custocias shal verify the PAN card details withthe eriginal PAN card and provide duly certified ‘pies of such verifieg PAN details to the intermediary. (E)UST OF PEOPLE AUTHORIZED TO ATTEST THE DOCUMENTS: 1. Notary Public, Gazetted Officer, Manager of a Scheduled Commercil/Co-operative Bank or Multinational Foreign Banks (Name, Designation & Seal shouldbe stixed onthe copy). 2. Imease of NRIs, authorized officials of overseas branches of Scheduled Commercial Banks registered in inci, Notary Public, Court Magistrate, Judge, Indian Embassy/Consulate Genera inthe country where the cllent resides are permited to attest the documents ADDITIONAL DOCUMENTS IN CASE OF TRADING IN DERIVATIVES SEGMENTS - ILLUSTRATIVE LIST In respect of ather cients, documents as per risk management policy ofthe Trading Member need to be provided by the cient from time to time Copy of ITR Acknowledgement Copy of Annual Accounts Incase of Salary Income - Salary lip, Copy of Form 16, Net Worth Certificate Copy of demat account holding taternent. Bank account statement fr last 6 months Self declaration with relevant supporting documents. ‘Any other relevant documents substantiating ownership of Assets. 1 2 5 4 5. 6 2 a RSV PAGE