(Kyc) Application Form For Individuals - Sebi printable pdf download

(Kyc) Application Form For Individuals - Sebi

KNOW YOUR CLIENT (KYC) APPLICATION FORM

For Individuals

PHOTOGRAPH

Please fill this form in ENGLISH and in BLOCK LETTERS.

Please affix your

recent passport

A. IDENTITY DETAILS

size photograph

and sign across it

1. Name of the Applicant: ________________________________________________________________

2. Father’s/ Spouse Name: _______________________________________________________________

3. a. Gender: Male/ Female

b. Marital status: Single/ Married

c. Date of birth: ____________(dd/mm/yyyy)

4. a. Nationality: ___________________________

b. Status: Resident Individual/ Non Resident/ Foreign National

5. a. PAN: ____________________ b. Aadhaar Number, if any: ______________________________________________

6. Specify the proof of Identity submitted: _______________________________________________________________

B. ADDRESS DETAILS

1. Residence Address: ________________________________________________________________________________

________ City/town/village: ___________ Pin Code: __________ State: ______________ Country: _________________

2. Contact Details: Tel. (Off.) _______ Tel. (Res.) ________ Mobile No.: _________ Fax: _________ Email id: __________

3. Specify the proof of address submitted for residence address:_______________________________________

4. Permanent Address (if different from above or overseas address, mandatory for Non-Resident Applicant): ____________

________ City/town/village: ___________ Pin Code: _________ State: ______________ Country: __________________

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. In case 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.

__________________

Signature of the Applicant

Date: ___________ (dd/mm/yyyy)

FOR OFFICE USE ONLY

Originals verified and Self-Attested Document copies received

(………………………………………..)

Name & Signature of the Authorised Signatory

Date ………………….

Seal/Stamp of the intermediary

(Kyc) Application Form For Individuals - Sebi