Know Your Client (KYC) Application Form (For Individuals Only) ‘Application No.: Please fill in ENGLISH and in BLOCK LETTERS ‘LMlame of Applicant (is apoeainginsupparingcefcaton document, ame Fathers Spouse Pree afc the ant psspet ‘ie photograph and 2Gender Oh status CJsnale C]Mavies Date of Bh) || fo |v | sores 3.Natonalty indian 4 Status Fes tek (7) [ven Resdert Coton National Pasprt Copy Madey fr Ns &Frsign Natonal) Please eros a dy ated copy of you AN Cat exempt cass Pease Tek ¢) ting tiene Chote Pease sce quid Fone (tan Sc Contact Details [ety (a Wie a fa aid) Proof of address to be provided by Applicant. Please submit ANY ONE ofthe following val Passport CoRatin Card Citeistred Leal Agreement of Residence CI (C-tatestelephone ail (ony Land Line) Catet Elect ae C>Latest Gas Bl “it mote tan 3 Months Vaktyxpry dat of prot of addres submited Permanent Address of Resident Applicant if different f (yn Pn ot Se curty 5. Proof of address to be provided by Applicant. Please submit ANY ONE ofthe following valid documents & tick () aginst the document attached. asso: CiRation Card Citegitered LeaseSale Agreement of Residence []Dsiing License Cote identity Cad [Latest Bank A SaterenvPasbook [Di “Lates lephone ail (nly Land Line) atest Eletety Be C]*Latest Gas Bll JOthers Pz ost “it more tan 3 Maths Vatyapy dat of prot of ads submited | || | | | 6. Any other information: ‘hereby decare that the deta furisned above are true and correct tothe best of mylour knowledge an belief and undertake to inform you of any changes therein, mediately Incase ary of the above informations found tobe false oruntrueormiseadingor misrepresenting lamfve are aware that Uwe may beheld able fort rc | / [aS FORIOFFIGELUSEONLYCN IV 0oner3 on) 17D DL ANCHntermediny name OR code SealStamp ofthe intermediary should conti SeaStanp ofthe intermediary should contain Staff Name Staff Nare (otis verti se Certified Document copies recived Designation Designation Name of the Organzation Name of the Organization AAs tue copes of documents ecved Soe ce Main intermedia, ate ‘bateA. IMPORTANTPOINTS: 1. Seffaested copy of PAN card ismandatrforalcents, 2. Copies of al the documents submitted by the applicant should be salf-atested and accompanied by ariginal for verification In case ‘the original of any document is nat produced for vetfication, then the copes should be propery attested by entes authorized for attesting the documents a per the below mentioned ist. If any prof of identity or adress is in a foreign language, then translation int English requied Named adéress ofthe applicant mentioned on the KYC form, should match with the documentary proof submitted, Hfcortespondence & permanent address are ciferent, then proosfor bbatnhave to besubmite. Sole proprietor must make the application in his individual name & capaci. For non-esidens and foreign nationals (allowed to trade subject to Rl and FEMA guidelines), copy of passpor!PIOCardOCCard and ‘overseas adress proofs mandatoy, Far foreign ents, INis optional andin the absence of DIN, for the directors, their passport copy shouldbe given. Incase of Merchant Nay NR's Marines dedaration or cated copyof DC (ContinuousDscharge Cerificate) sto be submited, 10.For opening an acount with Depository participant or Mutual Fund, fora minor, photocopy ofthe School Leaving Crtfcate/Mark sheet issued by Higher Secondary BoardPasspot of MinorBith entficate mustbe provided, 11 Potically Exposed Persons (PEP) are defined as individuals who are ‘orhave been entrusted with preminent public functions ina foreign county, eg, Heads of States or of Governments, senior poltcians, senior Governmentjudidalimiitary ofces, senior exeaitves of state onned corporations, important political party officials et. Proof of Identity PON): List of documents admissible as Proof of Identity 1 PAN card with photograph. This is a mandatory requirement for al applicants except those who are specifically exempt fom obtaining PAN (istedinSecon D). Unique lentifcation Number (ID) (Aadhaay)/asspo Voter 1D card Divinglicense Identity card? document with applicant's Pho, sued by any ofthe following: CenraliState Government and its Deparment, Statutay/Reguatoy Authors, Public Sector” Undertakings, Scheduled Commercial Banks, Publi Financial nstutions, Colleges afffated to Universes, Profesional Bodies such as ICAI, ICWAL ICSI, Bar Counc et, to thei Members; and Credit cardDebit cards ‘sued byBanks. Proof of Address (POA):Listof documents admissible as roof of Address: (*Documents having an expiry date should be valid on the date of submission) 1. PassportVoters Identity CarRation CardRegitred Lease or Sale ‘Ageement of Residence/riving LiceselFlat Maintenance billnsurance Copy. silty bils ke Telephone Bl ony landing), Elec bil or Gas bil Notmerethan 3 monthsold Bank Account Statement/Passbock Not more than 3 months ld Sel declaration by High Cour and Supreme Court judges, giving the newaderessinrespectoftherown accounts. Proof of address issued by any ofthe following: Bank Manages of Scheduled Commercial BanksScheduled Co-Operative Bank/Mutinatona Foreign BanksGazeted officerNotary publiftected representatives tothe -—_—Legslative ‘AssemblyParlamenv/Dacuments issued by any Govt. or Statutory Authority Idontty cardtdacumert with adress, issued by any ofthe folowing CenvalState Goverment and its Deparment, StatutoryRegulatoy Authorities, Public Sector” Undertakings, ‘Scheduled Commercial Banks, Pubic Financial Insitutions, Colleges aflated to Univesties and Professional Bodies such as ICAL, CWAI ICS Bar Counelete,totheirMembers. For Fs account, Power of Any given by Fsubaccout 1 the Custodians (wtch are duly notarized andor apostled or consiased) that ives theregsered address shouldbe taken 8, Theproof of adsressin enamel thespousemaybe accepted Exemptions/carifcations to PAN ("Sufficient documentary evidence in support of such claims tobe collected.) 1. Incaseof transactions undertaken on behalf of Cental Government andlor State Government an by officials appointed by Cours eg, Offcialiquidatr Courtrecever et. Investorstesidngin thestateof Sikkim, UNentitesimufilateralagences exempt fam paying taxesfling ax returns india, SP of Mutual Funds uptoRs$0,000'-pa. In case of institutional cients, namely, Fs, Mis, VCFS, PVC, Scheduled Commercial anks, Multlateral and Bilateral Development Financial Insitutions, State Industial Development Corporations, Insurance Companies registered with IRDA and Public Financial Insttion as defined unde section 4 of the Companies ‘at, 1956, Custodians shall verify the PAN card details with the cxiginal PAN card and prevde duly certified copies of such verified PAN etal to the intermedia . List of people authorized to attest the documen 1. Notay Public, Gazeted Office, Manager of a Scheduled CommerialCo-operative Bank of Multinational Foreign Banks (Wame, Designation & Seal shouldbe affixed onthe copy 2. In case of NR, authorized ofcals of overseas branches of Scheduled Commercial Banks regitered in India, Notary Public, Court Magistrate, udge, Indian Embassy/Consulate General inthe county where the client resides are permined to attest the documents ‘ease Sub the KE Docaments on At Si Paper Oly.