Know Your Client (KYC) Application Form
{For individuals Only)
Please fill n ENGUSH and in BLOCK LETTERS ‘Application N
‘A. entity Detals (please see guidelines overleaf)
4. Name of Applicants apoearng in supertin ientfatin document,
Name |
sabes
—
ees
Son
ewe Hee Je Cris Gb aot bh oman
3. Nationality Dinan
4 Status Pee Uk (v} [nen hesert Coren National (Papert Copy Mandy fr Nis & Foreign Nanas)
Please ence 2 dy ated copy of you AN Cort
fang
sulted for PAN exempt cases ese Tk)
Pasoot Cte Deng cence homes (ease see guide 0’ ove
“ee guidelines overleaf)
PinGake
cola
Sat County [
5. Proof af address to be provided by Applicant. Please submit ANY ONE ofthe follwing valid documents & tick (V) against the document attached,
Passoor Cikation Cond CiReiere Lease Agreement of Residence CIDrving Leense Cote Went Coa Cates Bank Ae StatemensPastbok
statest Bephone i fon Land Line) Catest Bec Bil CsLatest as Bll Coches lense see
‘ot mare tan 3 Mars id Vahdlyapey date f prot of addres submited fv | fs
DECLARATION
I hereby deciare thatthe deals [urnished above are true and correct othe best of
‘yf knowledge and belie and | undertake to inform you of any changes therein,
Immediately. In ease any of the above Information 's found tobe fase of untrue oF
‘misleacing Gr misrepresenting, lam/veareaware hat Ie maybe held able ort
ae: |
FOR OFFICE USE ONLY PV Donec on 1 Js
_ANClnemaday rare OR code Sealstamp ofthe intermediary shoud contain
Sia Name
besgnaion
1 tse Tur capes of documents eeved ee in
Nan inemedin, a
(otras vet se Cert Decent copies esasINSTRUCTIONS / CHECK LIST FOR FILLING KYC FORM
‘A. IMPORTANT POINTS:
1. Self attested copy of PAN cards mandatory oral len
2. Copies of al the documents submitted by the polcant should be
safatesed and accompanied by ariginls for verification. I case
‘the orginal of ary document i not produced for verfcation, then
the copies shoulé be propel atested by entes authorized for
attesting the documents, asperthebelow mentioned ist.
If any prof of identity or address i in a foreign language, then
‘ranslation nto English is required,
Name &addressof the applicant mentioned on the KYC form should
match with the documertary proof submited,
Hfcorespondence& permanent address are citferen, then proofs for
bothhaveto be submited
Sole proptoter must make the application in his individual name &
capaci,
For non-residents ad foreign nationals alowed to ade subject to
Bl and FEMA guidlines), copy of passporvPlOCardiOCICard and
overseas adores proctismandatory.
For foreign ents, IN is optional ann the absence of DIN no. fo
‘the directors, ther psspor copy should be giver
In case of Merchant Navy NR's, Maine’ declaration or ceried
‘copy of CDC (Continuous Discharge Ceticae is tobe submited
10. For opening a acount with Depository patipant or Mul Fund,
for amie hotecopy ofthe School Leaving Cricate/Mark sheet
issued by Higher Seconday BoardPasspot. of MinocBith
Confcate mustbeprovided
11Polcaly Exposed Persons (PEP) are defined as individuals who are
“orhavebeen entrusted with prominent publicfunctions ina foreign
county, eg, Heads of States or of Governments, senior
poitiians, senior Governmensjuccaimitary officers, senior
‘executives of state owned corprations, important politcal party
officials ete
Proof of Identity( POH): List of documents admissible as Proof
of Identity:
1. PAN card with photograph. Tis is a mandatory requtement forall
applicants excep those who are spectcally exempt rom obtaining
PAN (lstedin Secon),
Unique denificaion Number (UID (Aadnear / Passport! Voter ID
card Dring cans,
Identity car document with applicant’ Photo, sued by any of the
following: ContalSate Government and its Departments,
StatutoryRegulatoy Authorities, Public Secor Undertakings,
Scheduled Commercial Banks, Pubic Francia Institutions Colleges
affliated to Uivests, Profesional Bodies suchas ICA, ICAL,
ICSI Ba Cound et, to thei Members and Creat cardiDebit cards
issuedby Banks
Proof of Address (POA): List of documents admissible as Proof
of Address: “Documents having an expiry date should be
valid onthe date of submission)
1. Passponoters deny Cardaton Card Regiered (ease o Sale
Agreement of Resdence/Driving Licenseflat Maintenance
billinsurance Copy
sly ils ike Telephone Bl (only landline) Flector Gas bill
Not more than3 months old
Bank Account StatemertUPassbook- Not more than 3 months ld
Sef declaration by High Court and Supreme Court judges, giving he
‘new adress in respect ther own accounts.
Proof fades issued by any ofthe ellowing: Bank Managers of
Scheduled Commercial Barks!Scheduled Co-Operative
SoneMutinatona Feeign SanklGazeted —OficerNoxary
publfeced —represenaties tothe Legislative
AssemblyPatlameriDocumens issued by any Got or Statutory
Author
Ientty arddocament ih aces sued by any ofthe flowing
CenraSate Goverment ands Departments,
SiattoyReguatoy Authorities, Pubic Sector Underakns,
Scheduled Commercial Bans, Public Financial stuns, Calleges
affiated to Universes and Profesional Boies such as 1A,
IGWA, IS Bar Counlet, tothe Members
For Flisub account, Power of Attomey given by Flisub-account to
the Custodians (which are duly notarzed andor apostied or
. Exemptions/ clarifications to PAN
(*Sufficient documentary evidence in support of such claims
tobe collected.)
1. Incase of vansactons undertaken on behalf of Central Government
andlor State Government and by officials eppoited by Courts eg
Official iquidatr, Cour receiver et
Investors residingin he state of Sikkim.
UNentties/multlateal agencies exempt rom paying taxesiling tax
retumsinindi,
‘1 of Mutual Funds upto Rs $0,0001-p.
In case of institutional clients, namely, Fls, Ms, VCS, FVK\s,
Scheduled Commercial Banks, Mutlateral and Bilateral
Development Financial Instutions, State Indus Development
poration, Insurance Compares registered wthIRDA and Public
Financial Insttuon as defined under section 4A ofthe Companies
Act, 1956, Custodians shall vey the PAN card deta with the
ctginal PAN card and provide duly certified copes of such verified
PAN detalstothe intermedia,
- Listof people authorized to attest the documer
1. Notary Publ, Gazeted Office, Manager of 2 Scheduled
‘CommercallCo-operatve Bark or Multinational Foreign Banks
(Wame, Designation & Seal shouldbe afixedon the copy),
2. In case of NR, authorized officials of overseas branches of
Scheduled Commercial Banks registered in Inca, Notary Public
‘Court Magistrate Judge, Irian EmbassyConsulate General nthe
county where the dient resides are permitted to attest the
documents.
Pensa Subt the KYC Decameron Sze Paper Only.