(Kyc) Application Form For Individuals - Sebi (Page 2 of 2) in pdf

KNOW YOUR CLIENT (KYC) APPLICATION FORM

For Non-Individuals

PHOTOGRAPH

Please fill this form in ENGLISH and in BLOCK LETTERS.

Please affix the

recent passport

A. IDENTITY DETAILS

size photographs

1. Name of the Applicant: ________________________________________________________________

and sign across it

2. Date of incorporation: _______________(dd/mm/yyyy) & Place of incorporation: ________________

3. Date of commencement of business: ______________________________________________________ (dd/mm/yyyy)

4. a. PAN: _______________________________ b. Registration No. (e.g. CIN): _________________________________

5. Status (please tick any one):

Private Limited Co./Public Ltd. Co./Body Corporate/Partnership/Trust/Charities/NGO’s/FI/ FII/HUF/AOP/ Bank/Government

Body/Non-Government Organization/Defense Establishment/BOI/Society/LLP/ Others (please specify) _______________

B. ADDRESS DETAILS

1. Address for correspondence: ________________________________________________________________________

_________ 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 correspondence address: ______________________________________

4. Registered Address (if different from above): ____________________________________________________________

_________ City/town/village: _____________ Pin Code: _________ State: _____________ Country: ________________

C. OTHER DETAILS

1. Name, PAN, residential address and photographs of Promoters/Partners/Karta/Trustees and whole time directors:

_________________________________________________________________________________________________

2. a) DIN of whole time directors: _______________________________________________________________________

b) Aadhaar number of Promoters/Partners/Karta:______________________________________________

DECLARATION

I/We hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I/we

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/we are aware that I/we may be held liable for it.

_____________________________________

Name & Signature of the Authorised Signatory

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 Page 2