(Kyc) Application Form For Individuals

ADVERTISEMENT

KNOW YOUR CLIENT (KYC) APPLICATION FORM – FOR INDIVIDUALS
(Please fill this form in ENGLISH and in BLOCK LETTERS)
A. IDENTITY DETAILS
1. Name of the Applicant: _______________________________________________________
Please affix your
2. Father’s/ Spouse Name: ______________________________________________________
recent passport
3.
a. Gender:
Male/ Female
b. Marital status: Single/ Married
size photograph
c. Date of birth:
d
d
m m y
y
y
y
and sign across it
4.
a. Nationality: ___________________________
b. Status: Resident Individual/ Non Resident/ Foreign National
5.
a. PAN: __________________
b. Unique Identification Number (UID)/ Aadhaar, if any:_______________________
6. Specify the proof of Identity submitted: _________________________________________________
B. ADDRESS DETAILS
Address for correspondence
Permanent Address
(if different from correspondence address OR Overseas
address ( mandatory ) for Non-Resident Applicant)
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
City/town/village: ___________ Pin Code: __________
City/town/village: ___________ Pin Code: __________ ___
State: ______________ Country: ______________
State: ______________ Country: ______________
2. Contact Details:
Tel. (Off.) ____________ Tel. (Res.) ________ _______
Fax: ____________
Mobile No.: ________
Email id: __________
3. Specify the proof of address submitted for correspondence address:___________________________________
4. Specify the proof of address submitted for permanent address: __________________________
C. OTHER DETAILS
1. Gross Annual Income Details (please specify):
Income Range per annum:
Below Rs. 1 Lakh
Between Rs.1 to Rs.5 Lakhs
Between Rs.5 to 10 Lakhs
Between Rs.10 to Rs.25 Lakhs
Above Rs.25 Lakhs OR
Net-worth as on (Net worth should not be older than 1 year)
d
d
m
m
y
y
y
y
Rs.
2. Occupation (please tick any one): Private Sector / Public Sector / Government Service / Business / Professional /
Agriculturist / Retired / Housewife / Student / Others _________________________
3. Please tick, if applicable:
Politically Exposed Person (PEP)
Related to Politically Exposed Person (PEP)
4. Any other information:___________________________
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.
__________________
d
d
m
m
y
y
y
y
Signature of Applicant
Date:
(Self-Attested) Self Certified Document copies received
True copies of documents received (Originals verified)
Signature
In person verification done by
Relationship with the Intermediary / Designation
Date of
IPV Details
IPV
………………………………………..
………………………………
……………………………………
Signature of the Authorized Signatory
Name of the Intermediary
Seal/Stamp of the intermediary
Date
d
d
m
m
y
y
y
y

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go