Know Your Customer (Kyc) Application Form - Central Kyc Registry printable pdf download

CENTRAL KYC REGISTRY | Instructions / Check list / Guidelines for filling Know Your Customer (KYC) Application Form

4.3 ADDRESS IN THE JURISDICTION DETAILS WHERE APPLICANT IS RESIDENT OUTSIDE INDIA FOR TAX PURPOSES* (Applicable if Section 2 is ticked

)

Annexure B1

Same as Current / Permanent / Overseas Address details (In case of multiple correspondence / local addresses, please fill ‘Annexure A1’)

General Instructions:

CENTRAL KYC REGISTRY | Know Your Customer (KYC) Application Form | Individual | Related Person

1 Fields marked with ‘*’are mandatory fields.

Line 1*

2 Tick ( ) wherever applicable.

Important Instructions:

Line 2

3 Self-Certification form is mandatory.

A) Fields marked with ‘*’ are mandatory fields.

E) List of State / U.T code as per Indian Motor Vehicle Act, 1988 is available at the end.

4 Please fill the form in English and in BLOCK Letters.

Line 3

City / Town / Village*

F) List of two character ISO 3166 country codes is available at the end.

5 Please fill all dates in DD-MM-YYYY format.

B) Please fill the form in English and in BLOCK letters.

State / U.T Code*

ISO 3166 Country Code*

Pin / Post Code*

6 Wherever state code and country code is to be furnished, the same should be the two-digit code as per Indian Motor Vehicle, 1988 and ISO 3166 country code respectively.

G) KYC number of applicant is mandatory for update application.

C) Please fill the date in DD-MM-YYYY format.

7 List of State/U.T code as per Indian Motor Vehicle Act 1988 is available at the end

H) For particular section update, please tick ( ) in the box available before the

D) Please read section wise detailed guidelines / instructions

5. CONTACT DETAILS

(All communications will be sent on provided Mobile no. \ Email-ID) (Please refer instruction F at the end))

8 List of two character ISO-3166 country codes is available at the end.

section number and strike o the sections not required to be updated.

at the end.

9 KYC number of applicant is mandatory for update application at the end.

Tel. (Off)

Tel. (Res)

Mobile

10 For particular section update, please tick ( ) in the box available before the section number and strike off the sections not required to be updated.

11 In case of ‘Small Account type’ only personal details at section number 1 and 2, photograph, signature and self-certification required.

FAX

Email ID

Application Type*

New

Update

For office use only

KYC Number

(Mandatory for KYC update request)

(To be filled by financial institution)

A. Clarification/guidelines on filling ‘Personal Details’ section

9. APPLICANT DECLARATION

1 Name: Please state the name with Prefix (Mr/Mrs/Ms/Dr/etc.). The name should match the name as mentioned in the Proof of Identity submitted failing which the application is liable to

be rejected.

I hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I undertake to inform you of any changes therein, immediately.

1. DETAILS OF RELATED PERSON

(Please refer instruction G at the end)

2 Either father’s name or spouse’s name is to be mandatorily furnished. In case PAN is not available father’s name is mandatory.

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.

Addition of Related Person

Deletion of Related Person

KYC Number of Related Person (if available*)

I would like to share my personal / KYC details with Central KYC Registry

B. Clarification/guidelines on filling details if applicant residence for tax purposes in jurisdiction(s) outside India

Guardian of Minor

Assignee

Authorized Representative

Related Person Type*

I hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/email address

1 Jurisdiction (s) of Residence: It may be mentioned that since US taxes the global income of its citizen, every US citizen if whatever nationality, is also a resident for tax purpose in USA.

Prefix

First Name

Middle Name

Last Name

2 Tax identification Number (TIN): In the footnote it may be mentioned that TIN need not be reported if it has not been issued by the jurisdiction. However, if the said jurisdiction has issued

Date :

Name*

D D

M M

Y Y Y

[Signature / Thumb Impression]

by high integrity number with an equivalent level of identification (a “Functional equivalent”), the same may be reported. Examples of that type of number for individual include, a social

security/insurance number, citizen/personal identification/services code/number, and resident registration number)

(If KYC number and name are provided, below details of section 1 are optional)

Place :

Signature / thumb Impression of Applicant

PROOF OF IDENTITY (PoI) OF RELATED PERSON* (Please see instruction (H) at the end)

C.Clarification/guidelines on filling ‘Proof of Identity’ section

10. ATTESTATION / FOR OFFICE USE ONLY

1 If driving license number or passport is provided as proof of identity then Expiry date is to be mandatorily furnished.

A- Passport Number

Passport Expiry Date

D D

M M

Y Y Y

2 Mention identification / reference number if ‘Z- Others (any document notified by the central government)’ is ticked.

Documents Received

Self-Certified

True Copies

Notary

B- Voter ID Card

Risk Category

High

Medium

Low

D. Clarification/guidelines on filling ‘Proof of Address [PoA] - Current / Permanent / Overseas Address details’ section

C- PAN Card

1. PoA to be submitted in only if the submitted PoI does not have an address or address as per PoI is invalid or not in force.

D- Driving Licence

IN PERSON VERIFICATON DETAILS

Driving Licence Expiry Date

D D

M M

Y Y Y

E. Clarification/guidelines on filling ‘Proof of Address [PoA] - Correspondence / Local Address details’ section

E- UID (Aadhaar)

1 To be filled in only in case the PoA is not the local address or address where the customer is currently residing. No separate PoA is required to be submitted.

Identity Verification

Done

Name

2 In case of multiple correspondence / local addresses, Please fill ‘Annexure A1’

F- NREGA Job Card

Date

Code

F. Clarification/guidelines on filling ‘Contact details’ section

Z- Others

Identification Number

Emp. Name

(any document notified by the central government)

1 Please mention two- digit country code and 10 digit mobile number (e.g. for Indian mobile number mention 91-9999999999).

Emp. Code

S- Simplified Measures Account - Document Type code

Identification Number

2 Do not add ‘0’ in the beginning of Mobile number.

Emp. Designation

2. APPLICANT DECLARATION

G. Clarification/guidelines on filling ‘Related Person details section

Emp. Branch

1 Provide KYC number of related person if available.

[Institution Stamp]

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

H. Clarification/guidelines on filling ‘Related Person details – Proof of Identity [PoI] section

liable for it.

[Signature / Thumb Impression]

1 In case of nominees, proof of identity is not required.

[Employee Signature]

2 Mention identification / reference number if ‘Z- Others (any document notified by the central government)’ is ticked.

Date :

Place :

D D

M M

Y Y Y

Signature / Thumb Impression of Applicant