Know Your Customer (Kyc) Application Form printable pdf download

Know Your Client (KYC)

Application

Application Form (For Individuals Only)

No. :

Please fill this form in ENGLISH and in BLOCK LETTERS (All Information as applicable in Sections A, B and C below is mandatory)

This information is sought under the Prevention of Money Laundering Act, 2002, the rules notified thereunder and SEBI’s guidelines on Anti Money Laundering.

For existing Mutual Fund investors, the address(es) furnished herein will be replaced in the records of the Mutual Fund / Authorised Agent. (Refer Notes / Guidelines overleaf)

A. Identity Details (Please see guidelines A1 to A6 overleaf)

Please specify

1. Name of Applicant (As appearing in supporting identification document) Title

Mr.

Ms.

Others

Gender

Male

Female

Name

Father's Name

Please affix

2. Date of Birth

most recent

colour photograph

Indian

Others

3. Nationality

Please specify

30 mm x 40 mm

4. Status Please tick ( )

Resident Individual

Non Resident: Passport / PIO Card / OCI card No.___________________________

Sign across the photograph

(Passport copy & overseas address proof mandatory for NRI)

5. Proof of Identity

Permanent Account Number (PAN) (MANDATORY)

Please tick ( )

Copy of PAN Card attached

B. Address Details (Please see guidelines B1 to B4 overleaf)

1. Address for Correspondence

City / Town / Village

Postal Code

State

Country

2. Contact Details

Tel. (Off.)

(ISD)

(STD)

Tel. (Res.)

(ISD)

(STD)

Mobile

(ISD)

(STD)

Fax

(ISD)

(STD)

E-Mail Id.

3. Proof of address to be provided by Applicant.

Please submit ANY ONE of the following valid documents & tick ( ) against the document attached.

Latest Land Line Telephone Bill

Latest Electricity Bill

Passport

Driving License

Latest Bank Passbook

Latest Bank Account Statement

Latest Demat Account statement

Voter Identity Card

Ration Card

Registered Lease / Sale Agreement of residence

Any other proof of address document (as listed overleaf)

4. Permanent Address of Resident Applicant if different from B1 above OR Overseas Address (Mandatory) for Non-Resident Applicant

City / Town / Village

Postal Code

State

Country

5. Proof of address to be provided by Applicant.

Please submit ANY ONE of the following valid documents & tick ( ) against the document attached.

Latest Land Line Telephone Bill

Latest Electricity Bill

Passport

Driving License

Latest Bank Passbook

Latest Bank Account Statement

Latest Demat Account statement

Voter Identity Card

Ration Card

Registered Lease / Sale Agreement of residence

For NRIs - Any other document attested by local authority.

C. Other Details

(Please see guidelines C1 and C2 overleaf)

1. Gross Annual Income Details Please tick ( )

Upto Rs. 5,00,000

Rs. 5,00,001 to Rs. 25,00,000

Rs. 25,00,001 to Rs. 1,00,00,000

Rs. 1,00,00,001 to Rs. 5,00,00,000

Rs. 5,00,00,001 and above.

2. a. Occupation Details Please tick ( ) any one

Private Sector Service

Public Sector / Government Service

Business

Professional

Agriculturist

Retired

Housewife

Student

Forex Dealer

Others (Please specify) _______________________________________

b. If the following is additionally applicable to you Please tick ( ) as applicable

Politically Exposed Person (PEP)

Related to a Politically Exposed Person (PEP)

For definition of PEP, please refer guideline C3 overleaf

DECLARATION

SIGNATURE OF APPLICANT

I hereby confirm that I have read and understood the Instructions mentioned overleaf and apply to CDSL Ventures Limited ('CVL') or other agent of the mutual

fund registered under the SEBI (Mutual Funds) Regulations, 1996 for compliance of Know Your Client (KYC) procedure for transacting in units issued by Mutual

Funds and I agree to abide by the terms, conditions, rules, regulations and other statutory requirements applicable to the respective Mutual Funds. I hereby declare

that the particulars given herein are true, correct and complete to the best of my knowledge and belief, the documents submitted along with this application are

genuine and I am not making this application for the purpose of contravention of any Act, Rules, Regulations or any statute or legislation or any Notifications,

Directions issued by any governmental or statutory authority from time to time. I hereby undertake to promptly inform CVL / the mutual fund agent of any changes

to the information provided hereinabove and agree and accept that CVL, the respective Mutual Funds, their authorised agents and representatives ('the Authorised

Parties') are not liable or responsible for any losses, costs, damages arising out of any actions undertaken or activities performed by them on the basis of the information

provided by me as also due to my not intimating / delay in intimating such changes. I hereby authorize CVL / the mutual fund agent to disclose, share, remit in

any form, mode or manner, all / any of the information provided by me to the respective Mutual Funds in which I may transact / have transacted and / or to their

Place :

authorised agents and representatives including all changes, updates to such information as and when provided by me. I hereby agree to provide any additional

information / documentation that may be required by the Authorised Parties, in connection with this application. I hereby confirm that this is a unique KYC application

Date :

and I have not applied for KYC in the past.

For

Name and Employee Number of Receiver

Stamp of POS

Office

(Name & Location)

Use

(Originals Verified) Self Certified Document copies received

& Receiver's Signature

Only

(Attested) True copies of documents received