Prefered Branch : KANDIVALI EAST LOKHANDWALA CIRCLE [MUMBAI-KANDIVALI-LOKHANDWALA-1434]

Customer Tracking ID: J S 0 5 8 5 5 5 6 9

CRN :
Account Number :
Account Type : Savings Account

Welcome to Kotak Mahindra Bank

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Welcome MR. ANIL GHENBAD

We thank you for choosing Kotak Mahindra Bank.

At Kotak Mahindra Bank it is our constant endeavour to enrich our customer's banking experience and to fulfill the emerging and changing banking & investment needs of
our customers.

Our account goes beyond the traditional role of savings, to provide a range of services from funds transfer options to attractive returns earned through a comprehensive
suite of investment options that can be booked through Internet or Phone Banking services.

This form has been designed for ease of completion, with simple instructions at relevant places to guide you along.

Should you face any difficulty in understanding the requirements, please do not hesitate to contact our staff who will be willing to assist / guide you.

It shall be our endeavour as always to provide you a truly satisfying service.

INDICATIVE LIST OF DOCUMENTS THAT CAN BE PROVIDED WHILE OPENING THE BANK ACCOUNT

Identification proof / Signature proof for each applicant

* Passport
* Driving License
* PAN (Income Tax) Card
* Valid Identity Documents with Photo issued by Govt. Org., PSU, Statutory/Regulatory Authority
* Voters ID Card
* NREGA Job Card
* Aadhar Card

Address proof for each applicant

* Passport
* Driving License
* Registered Leave & License Agreement (For Tenants)
* Utility Bill (Elec./Tele/Mobile/Piped Gas not more than 3 months)
* Voters ID Card
* NREGA Job Card
* Consumer Gas connection card/latest bill which is not more than 3 months old (only computer generated)
* Bank Statement (Active Account) - Last 3 months
* Aadhar Card

Please note:
* In case of non-availability of any of the above documents, please contact the Bank official for a detailed list of acceptable documents
* The original documents should be produced for verification
* Nomination facility is available
* Customer education brochure available on Bank's website provides you important information on Account opening and operations
* All service charges applicable to the product are available at the branch and on the Bank's website
* The Net Banking, Phone Banking and Payment Gateway access, if applied for, is applicable for all Deposit Accounts and Investment Accounts, existing or to be opened in future
* Transaction rights on Direct Channel for Investment Accounts are subject to the customer executing a mandate in favour of the Bank
* All account(s) existing or to be opened in future will be linked to the Debit Card/payment Gateway. Customer to give specific instructions if he/she wishes to de-link any account(s).
* Customer can avail SMS Banking Services to receive transaction details/information relating to your Bank account through SMS on the mobile number registered with the Bank
* “Jointly held” Accounts would not be given transaction rights through SMS Banking and Net Banking Services
* All accounts will be opened in the same combination as provided in the Account Opening Form by the Customer
* All account(s) existing or to be opened in future will get the account statement as per Account Statement Option chosen in this Account Opening Form / as per the Bank policy from time to time
* The age considered for Minor is Below 18 years; for Senior Citizens as 60 years & above
* Photo copies needs to be self-attested by the applicant
* All alerts, e-newsletter and promotional mails will be sent to the preferred mobile number and e-mail ID

Contact Us

Website : www.kotak.com Email : service.bank@kotak.com

Phone Banking : Letters : Kotak Mahindra Bank, P.O. Box – 16344, Mumbai 400 013.

Kotak Mahindra Bank | Account Opening Form for Resident Individuals 1

Location ( IP : 10.240.22.34 Country : India)
 Customer Tracking ID: J S 0 5 8 5 5 5 6 9

Primary Holder Details

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Please ensure you sign next to all changes you make on the form.

Personal Details
Name MR. ANIL KUNDLIK GHENBAD Date of Birth: 26-DEC-1988
Gender: Mother's maiden Name: MISS
Pan No.: Marital Status: SINGLE
Occupation: SERVICE Nationality:
Annual Income: LESS THAN INR 2 LACS Mobile: 9004316824
Email: GHEMBADAK1@GMAIL.COM
Company Name:

Residential Address (Communication Address)

Address Line1: RAM NAGAR NAVYUG CHAWL Address Line2: KANDIVALI

Address Line3: City: MUMBAI
Postal Code: 400101 State: MAHARASHTRA
Telephone: 000-00000000

Office Address
Address Line1: Address Line2:
Address Line3: City:
Postal Code: State:
Telephone: -

Other Details
Preferred Home Branch: KANDIVALI EAST LOKHANDWALA CIRCLE [MUMBAI-KANDIVALI-LOKHANDWALA-1434], City : MUMBAI
Do you have any other Kotak account? NO
Customer Relationship Number (CRN): _____________________________

NET001RISIGN

Primary Holders Signature

MR. ANIL KUNDLIK GHENBAD

Form reviewed and submitted online by MR. ANIL GHENBAD

Kotak Mahindra Bank | Account Opening Form for Resident Individuals 2

Location ( IP : 10.240.22.34 Country : India)
 Customer Tracking ID: J S 0 5 8 5 5 5 6 9

Joint Holder Details

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Yes No

Please ensure you sign next to all changes you make on the form.

Personal Details
Name: Date of Birth:
Gender: Mother's maiden Name:
Pan No.: Marital Status:
Occupation: Nationality:
Annual Income: Email:
Mobile: Company Name:

Residential Address
Address Line1: Address Line2:
Address Line3: City:
Postal Code: State:
Telephone: -

Office Address
Address Line1: Address Line2:
Address Line3: City:
Postal Code: State:
Telephone: -

Other Details
What type of access do you want for the Joint Holder? JOINT EITHER_OR_SURVIVOR Others

Do you have any other Kotak account? YES NO

Customer Relationship Number (CRN): _____________________________

NET001RISIGN

Joint Holders Signature

Form reviewed and submitted online by MR. ANIL GHENBAD

Kotak Mahindra Bank | Account Opening Form for Resident Individuals 3

Location ( IP : 10.240.22.34 Country : India)
 Customer Tracking ID: J S 0 5 8 5 5 5 6 9

SMS BANKING & ALERT FACILITY (Refer General Schedule of Features and Charges for Charges Applicable)
SMS Banking facility is available to all account holders for all products. Alert Facility enables you to receive alerts on your Email and / or Mobile regarding account
transactions and maintenances. New alerts may be added from time to time.

Alert Type 1st Applicant

SMS Email
a) Daily Balance + Transaction and Value Added Alerts

Please select either (a) or (b) as per your requirement

b) Weekly Balance + Transaction and Value Added
Alerts

** Bank will send all alerts to the preferred mobile number and E-mail address mentioned in this form. The Bank will also use these details for sending out transaction
information and updates about Product and Services.

In case you do not wish to receive information / updates, you can register yourself for Do Not Call on the Bank's website www.kotak.com

Alerts that have been mandated by RBI and such alerts as deemed appropriate by the Bank will be sent even if you have not subscribed for the facility.

* Transaction and Value Added Alerts will be sent to First Holder / Guardian for all Individual accounts where the mode of operation is "Singly" or "Either / Survivor" and to
all holders where mode of operation is "Jointly" for Non-Individual Accounts such alerts will be sent to allAuthorized Signatories, irrespective of the mode of operation

Primary Holders Signature

MR. ANIL KUNDLIK GHENBAD

Form reviewed and submitted online by MR. ANIL GHENBAD

Kotak Mahindra Bank | Account Opening Form for Resident Individuals 4

Location ( IP : 10.240.22.34 Country : India)
 Customer Tracking ID: J S 0 5 8 5 5 5 6 9

Nomination (Form DA1)

YES NO (Bank Use Only) Nomination under section 45ZA of the Banking Registration Act, 1949 and the rule 2(1)of
The Banking Companies (Nomination) Rules, 1985, in respect of bank deposits
I/We __________________________________________________ Address(es) ______________________________________________
nominate the following person to whom in the event of my /our /minor's death the amount of the deposit, particulars whereof are given below, may be returned by
Kotak Mahindra Bank Limited.

Nature of Deposit ___________ Distinguishing No ___________ Additional details, if any ____________

Nominee Name ________________________________________________________________
Address ___________________________________________________________________
Relationship with Depositor, if any _____________ Age ____ (if nominee is a minor, his/her date of birth)
As the nominee is minor on this date, I/We appoint Shri/Smt/Kum* ____________ Relation With Minor Nominee ___________
Address _______________________________________________________ Age ______
to recieve the amount of the deposit on behalf of the nominee,in the event of my/our/minor's death during the minority of the nominee.
Nominee Name to be printed on the Statements/Advices YES NO Date & Place __________________________

_________________ _________________ _________________

Signature(s)/Thumb impression*** Depositor Depositor Depositor

_________________ _________________
Signature Of First Witness*** Signature Of Second Witness***
*Strike out if nominee is not a minor ***Thumb impression(s) shall be attested by two witnesses and signature will be attested by one witness.
** where deposit is made in the name of minor, the nomination should be signed by a person lawfully entitled to act on behalf of the minor.

Applicable, If no nomination is provided in a Single Holder A/c For Bank Use Only

The Bank, through its authorized representative had explained to me the
advantages of nomination facility as per the extant guidlines of RBI. However, I
hereby decline to presently nominate any individual and understand the risks and
consequences of my failure to give nomination and am fully aware of the hardships
my legal heirs would face in the event of my death without nomination registered in
your Bank records.
I have clearly explained to the customer the advantage of nomination facility and
inspite of the same he/she still does not want to nominate and he/she also refused to
provide a specific letter to the effect that he/she does not want to make a
nomination.

__________________________ __________________________
Customers Signature Employees Signature & Code

Kotak Mahindra Bank | Account Opening Form for Resident Individuals 5

Location ( IP : 10.240.22.34 Country : India)
 Customer Tracking ID: J S 0 5 8 5 5 5 6 9

Decline Nomination (Form DA1) - <Kotak 811>

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Nomination under section 45Z A of the Banking Regulation Act, 1949, and the Rule 2 (1) of The Banking Companies (Nomination) Rules, 1985, in respect of bank deposits

If you have not appointed any nominee for Kotak 811 , then please fill the details below agreeing to the conditions.

The Bank, through its authorized representative had explained to me the
advantages of nomination facility as per the extant guidelines of RBI.
However, I hereby decline to presently nominate any individual and understand the
risks and consequences of my failure to give nomination and am fully aware of the
hardships my legal heirs would face in the event of my death without nomination
registered in your Bank records.
Primary Holders Signature
FOR BANK USE ONLY
I have clearly explained to the customer the advantages of nomination facility and
inspite of the same he / she still does not want to nominate and he / she also
refused to provide a specific letter to the effect that he / she does not want to make
a nomination
Employee Signature & Code

Form reviewed and submitted online by MR. ANIL GHENBAD

Kotak Mahindra Bank | Account Opening Form for Resident Individuals 6

Location ( IP : 10.240.22.34 Country : India)
 Customer Tracking ID: J S 0 5 8 5 5 5 6 9

“FORM NO. 60”

[See second proviso to rule 114B]
Form for declaration to be filed by an individual or a person (not being a company or firm) who does not have a permanent account number
and who enters into any transaction specified in rule 114B
1 First Name 2 Date of Birth / Incorporation of declarant
Middle Name D D M M Y Y Y Y
Surname
3 Father's Name (in First Name
case of individual)
Middle Name
Surname
4 Flat / Room No. 5 Floor No.
6 Name of premises 7 Block Name / No.
8 Road / Street / Lane 9 Area/ Locality
10 Town / City 11 District 12 State
13 Pin Code 14 Telephone Number (with STD code) 15 Mobile Number
16 Amount of transaction (Rs.) 18 In case of transaction in joint names,
number of persons involved in the
17 Date of transaction D D M M Y Y Y Y transaction

19 Mode of transaction: Cash Cheque Card Draft / Online Other

(Please tick appropriate box) Banker's Transfer
Cheque
20 Aadhaar Number issued by UIDAI (if available)
21 If applied for PAN and it is not yet generated enter D D M M Y Y Y Y Acknowledgment Number
date of application and acknowledgement number

22 If PAN not applied, fill estimated total income (including income of spouse, minor child etc. as per section 64 of Income-tax Act, 1961) for the financial year in
which the above transaction is held
A Agricultural income (Rs.)
B Other than agricultural income (Rs.)
23 Details of document being produced in Document code Document identification number Name and address of the authority
support of Identify in Column 1 (Refer issuing the document
Instruction overleaf)

24 Details of document being produced in Document code Document identification number Name and address of the authority
support of Address in Columns 4 to 13 (Refer issuing the document
Instruction overleaf)

25 Transaction code (Refer Instruction overleaf) Nature of Transaction (Refer

Instruction overleaf)

Verification
I, _______________________________________________ do hereby declare that what is stated above is true to the best of my knowledge and belief.I further declare
that I do not have a Permanent Account Number and my / our estimated total income (including income of spouse, minor child etc. as per section 64 of Income-tax Act,
1961) computed in accordance with the provisions of Income-tax Act, 1961 for the financial year in which the above transaction is held will be less than maximum amount
not chargeable to tax.

Verified today, the ______________ day of ______________ 20_____

Place: ___________________________
(Signature of declarant)

Note:
1. Before signing the declaration, the declarant should satisfy himself that the information furnished in this form is true, correct and complete in all respects.
Any person making a false statement in the declaration shall be liable to prosecution under section 277 of the Income-tax Act, 1961 and on conviction be
punishable,-
(i) in a case where tax sought to be evaded exceeds twenty-five lakh rupees, with rigorous imprisonment which shall not be less than six
months but which may extend to seven years and with fine;
(ii) in any other case, with rigorous imprisonment which shall not be less than three months but which may extend to two years and with fine.
2. The person accepting the declaration shall not accept the declaration where the amount of income of the nature referred to in item 22b exceeds the
maximum amount which is not chargeable to tax, unless PAN is applied for and column 21 is duly filled.

Kotak Mahindra Bank Ltd.CIN: L65110MH1985PLC038137

Registered Office:27 BKC, C 27, G Block, Bandra Kurla Complex, Bandra (E), Mumbai - 400 051.
www.kotak.com

Kotak Mahindra Bank | Account Opening Form for Resident Individuals 7

Location ( IP : 10.240.22.34 Country : India)
 Customer Tracking ID: J S 0 5 8 5 5 5 6 9

Instructions to the form:

1) Documents which can be produced in support of identity and address (not required if applied for PAN and item 20 is filled): -
Sl. Nature of Document Document Proof of Proof of
Code Identity Address
A For Individuals and HUF
1. AADHAR card 01 Yes Yes
2. Bank/Post office passbook bearing photograph of the person 02 Yes Yes
3. Elector’s photo identity card 03 Yes Yes
4. Ration/Public Distribution System card bearing photograph of the person 04 Yes Yes
5. Driving License 05 Yes Yes
6. Passport 06 Yes Yes
7. Pensioner Photo card 07 Yes Yes
8. National Rural Employment Guarantee Scheme (NREGS) Job card 08 Yes Yes
9. Caste or Domicile certificate bearing photo of the person 09 Yes Yes
10. Certificate of identity/address signed by a Member of Parliament or Member of Legislative Assembly or 10 Yes Yes
Municipal Councillor or a Gazetted Officer as per annexure A prescribed in Form 49A
11. Certificate from employer as per annexure B prescribed in Form 49A 11 Yes Yes
12. Kisan Passbook bearing photo 12 Yes No
13. Arm’s license 13 Yes No
14. Central Government Health Scheme /Ex-servicemen Contributory Health Scheme card 14 Yes No
15. Photo identity card issued by the government./ Public Sector Undertaking 15 Yes No
16. Electricity bill (Not more than 3 months old) 16 No Yes
17. Landline Telephone bill (Not more than 3 months old) 17 No Yes
18. Water bill (Not more than 3 months old) 18 No Yes
19. Consumer gas card/book or piped gas bill (Not more than 3 months old) 19 No Yes
20. Bank Account Statement (Not more than 3 months old) 20 No Yes
21. Credit Card statement (Not more than 3 months old) 21 No Yes
22. Depository Account Statement (Not more than 3 months old) 22 No Yes
23. Property registration document 23 No Yes
24. Allotment letter of accommodation from Government 24 No Yes
25. Passport of spouse bearing name of the person 25 No Yes
26. Property tax payment receipt (Not more than one year old) 26 No Yes
B For Association of persons (Trusts)
Copy of trust deed or copy of certificate of registration issued by Charity Commissioner 27 Yes Yes
C For Association of persons (other than Trusts) or Body of Individuals or Local authority or Artificial
Juridical Person)
Copy of Agreement or copy of certificate of registration issued by Charity commissioner or Registrar of 28 Yes Yes
Cooperative society or any other competent authority or any other document originating from any Central or
State Government Department establishing identity and address of such person.
2) In case of a transaction in the name of a Minor, any of the above mentioned documents as proof of Identity and Address of any of parents/guardians of
such minor shall be deemed to be the proof of identity and address for the minor declarant, and the declaration should be signed by the parent/guardian.
3) For HUF, any document in the name of Karta of HUF is required.
4) In case the transaction is in the name of more than one person the total number of persons should be mentioned in Sl. No. 18 and the total amount of
transaction is to be filled in Sl. No. 16.
5) In case the estimated total income in column 22b exceeds the maximum amount not chargeable to tax the person should apply for PAN, fill out item 21
and furnish proof of submission of application.

Kotak Mahindra Bank Ltd.CIN: L65110MH1985PLC038137

Registered Office:27 BKC, C 27, G Block, Bandra Kurla Complex, Bandra (E), Mumbai - 400 051.
www.kotak.com

Kotak Mahindra Bank | Account Opening Form for Resident Individuals 8

Location ( IP : 10.240.22.34 Country : India)
 Customer Tracking ID: J S 0 5 8 5 5 5 6 9

6) Transaction code and type should be selected from the below list only:

Permissible values are:

01-Sale of immovable property
02-Purchase of immovable property
03-Sale of motor vehicle
04-Purchase of motor vehicle
05-Investment in Time deposit
06-Deposit in cash
07-Sale of securities
08-Purchase of securities
09-Opening an account (other than savings and time deposit)
10-Account with balance exceeding Rs.50,000
Transaction Type 11-Purchase of bank drafts or pay orders
12-Application for issue of a credit or debit card
13-Payment to hotel
14-Payment in connection with travel to any foreign country
15-Payment for purchase, or remittance outside India,
16-Payment to Mutual Fund for purchase of its units
17-Payment for acquiring shares
18-Payment for acquiring debentures or bonds
19-Payment as life insurance premium
20-Sale of shares of a company
21-Purchase of shares of a company
22-Not classified above

Kotak Mahindra Bank Ltd.CIN: L65110MH1985PLC038137

Registered Office:27 BKC, C 27, G Block, Bandra Kurla Complex, Bandra (E), Mumbai - 400 051.
www.kotak.com

Kotak Mahindra Bank | Account Opening Form for Resident Individuals 9

Location ( IP : 10.240.22.34 Country : India)
 Customer Tracking ID: J S 0 5 8 5 5 5 6 9

Declarations

Please ensure you sign next to all changes you make on the form.

Customer Declaration
* I/ We would like to open a savings account with your bank.
* I/we have read through and understood the General schedule of fees and charges of the product.Download schedule
* I agree to bind by the banks Terms and conditions available in the link www.kotak.com/termsandconditions.
* I/we understand that 6% p.a. interest on savings account balance over Rs 1 lakh and up to Rs 5 crs. Earn 5% p.a. interest on savings account balance up to Rs 1 lakh and 5.5% p.a. interest on savings account balance above Rs 5 crs on
Resident Accounts only.
* The particulars contained here in shall be valid for all accounts opened by me / us or to be opened by me / us here after either singly or with other(s) and / or by me /us in any representative capacity with the Bank unless informed
otherwise.
* I /We have read,understood and agree the Terms and Conditions governing the opening of an account with Kotak Mahindra Bank Ltd. (the Bank), and those relating to various Services including but not limited to a) ATMs b) Phone
Banking c) Debit Card d) Net Banking e) Payment Gateway f)Kotak Bill Pay g) SMS Banking h) Alerts Service i)Term Deposits/Recurring Deposits, available at bank’s website www.kotak.com
* I/We understand and agree that Payment Gateway will be activated by default for the customers registered for Netbanking with unconditional transaction rights.
* I/We understand and agree that Net Banking, Phone Banking access, if applied for, is applicable to all Deposit accounts, existing or to be opened in the future. I/We understand and agree that existing/future accounts will be linked by
default to Debit Card/Payment Gateway and for delinking Debit Card/Payment Gateway from the account, I/We have to visit the nearest branch to place the request. I/We agree to be bound by the said Terms & Conditions including those
excluding/limiting the Bank liability. I/We understand that the Bank may at its absolute discretion, suspend any of the services completely or partially without any notice to me/us.
* Sweep-in Facility & Activmoney (Applicable only if opted for): I/We have been explained about the features and benefits of Sweep-in facility and ActivMoney (Auto Sweep-Out, Sweep-In) and I/We have understood and agree for the same.
* Statement of Account: I/We am/are aware that the Bank will share statements by Email on monthly basis to my/our registered Email ID. I/We agree that the Bank would be deemed to have delivered the statement to me/us, on Bank
sending the Email containing the Statement as an attachment to my/our registered Email ID. In case Email ID has not been provided by me/us, physical statements at quarterly intervals would be sent to my/our mailing address. I/We
am/are also aware that if I/We have provided my/our Emnil ID but still wish to opt for physical statements at quarterly intervals, I/We need to provide a specific request for the same. Any person resident in India collecting and
effecting/remitting payments directly/indirectly outside India in any form towards foreign exchange trading through electronic/internet trading portals would make himself/herself/themselves liable to be proceeded against with for
Contravention of the Foreign Exchange Management Act (FEMA) 1999, besides being liable for violation of regulations related to Know Your Customer (KYC) Norms/Anti Money Laudering (AML) standards.
* The bank will have a right to close the account in case of any incorrect representation, information given by the customer and the Customer acknowledges and agrees that Bank may at any time without notice as the circumstances in the
Bank's absolute discretion may require, discontinue /modify/cancel/terminate the services, if the Bank is of the opinion that continuation of services is prejudicial to Bank's interests. Bank shall not be made liable for any consequences
arising out of such closure of Account or termination of Services.
* The Customer shall indemnify and keep the Bank indemnified against any loss or damage that the Bank may suffer on account of dishonor of cheque after the closure of the Account.
* I/We agree that the Bank may debit my account for service charges as applicable from time to time.
* I/We hereby agree, declare & confirm that the funds routed by me/us in my/our account will be from my/our source of funds acquired legitimately and such funds are acquired not in contravention of any applicable laws or rules in force,
enacted/issued by Statutory or Regulatory Authority from time to time or funds so routed have not been on acquired by way of evasion of government levies/taxes. I/We shall advice the Bank immediately in the manner as agreed by me/us
and acceptable to the Bank, in case of any change in the above details and information given by me/us.
* I/We understand that the above account will be opened on the basis of the statements/declarations made by me/us in this application as well as on the supporting documents to be submitted with the applications.
* I/We also agree that if any of the statements/declarations made is found to be not correct in material particulars and/or the relevant supporting documents/proof is not provided by me in one month's time, you are not bound to pay any
interest on the deposit made by me/us.
* I/We have read & agreed to the following method of transaction point calculation (only applicable for JIFI Pro customers)
- Only online shopping and online bill payments are eligible for gaining transaction point. NEFT, IMPS, RTGS, PoS transactions are not eligible for transaction rewards.
- For every transaction in multiple of Rs. 1000, Bank will award 100 transaction points against every 1000 rupees. 50% additional transaction points will be awarded on using Kotak bank’s m-store for shopping.
- Maximum transaction points that will be awarded for one transaction are 500 points.
- 4 transaction points are equivalent to Re. 1. Bank may revise the conversion rate of transaction points to Rupee from time to time.
- Transaction Points can be redeemed on www.kotakjifi.com
* I/We understand that, in case I chose to open JIFI Neo Account type, then I/we will receive 5 free cheque leaves on account opening, & agree to pay for additional cheques/chequebook thereafter.
* I/We hereby declare the above information is true to the best of our knowledge.
* I/We shall advise the Bank immediately in the manner as agreed by me/us and in the form acceptable to the Bank, in case of any change in the above details and information given by me/us.
* I/We agree that the Bank may choose to close my account/s if I/ we do not submit the required documents or resolve discrepancies within 90 days from the date of initiation of online account opening process.
* I/We agree that in case of discrepancies in the details provided by me /us on the form, the Bank will consider details of actual proofs of documents submitted by me or funding received from me/ us as correct and final.
* I/we agree that in case the account opening form and/or introduction documents and/or remittance of funds that I / we submit or make in due course to the Bank are found by the Bank to be incomplete or discrepant or not as per
prescribed documentary requirements, therefore requiring my/our account to be closed, any funds remitted by me to Kotak Mahindra Bank may be returned by the Bank to me / us (without requiring my / our instructions) in the mode
deemed best by the Bank.
* I / we agree to bear any applicable expense or charges or exchange loss that may be incurred on returning of these funds.
* I/ we also agree that the return payment may be made by the Bank to the original remitting account number available to the Bank from my/ our original remittance and in case this information is not clear or unavailable, I / we agree to
provide the same.
* I / we also agree to bear any interest loss in the event my/ our funds are not credited to my/ our account and therefore lying with the Bank due to non-receipt of my/our account opening documents or due to discrepancies in funding or
documentation noted by the Bank or due to any other non-compliance with the Bank's prescribed policies or the laws of the land. In this context, I/ we agree that the Bank shall hold my/ our funds pending credit to my/ our account or
deposit for want of clearance of discrepancies for a period of at least one month from the date of receipt of funds and the Bank shall not be liable to pay any interest on the said funds during the said period.
* I/We do hereby authorise the bank to conduct my/our account for credit history verification with CIBIL or any other credit rating agency.
* I / We expressly consent and authorise the Bank to make Telephone Calls and Send SMS and / or Emails to inform me / us on any information or updates relating to Bank's existing / new Product / Services. The said consent is valid till
such time I / We withdraw the same in writing. This will overrule a National do Not Call if any.

Declaration for Channel Access

* I accept auto-registration for access to my account through various channels, namely Debit Card, Net Banking, Phone Banking, Payment Gateway. I have read and understood the Terms and Conditions relating to various services and
products, as also conditions prescribed herein, including, but not limited to (a) ATMs (b) Phone Banking (c) Debit Card (d) Net Banking (e) Payment Gateway. I accept and agree to be bound by the said Terms and Conditions including
those excluding/limiting the Bank Ãs liability. I understand that the Bank may at its absolute discretion, discontinue any of the services completely or partially without any notice to me. I agree that the Bank may debit my primary account
stated above for service charges as applicable from time to time. I agree that charges if applicable, will be recovered from this account or accessed through International and Domestic debit card respectively, on all Kotak Mahindra Bank
ATMs, this is the account that will be available on any VISA ATMs or merchant establishments. In case I /we do not specify any accounts, the first account I / we open with the bank will be treated primary account for each card respectively
and that Domestic Debit Cards issued can be used for transactions in India only.

I / We agree/ consent to the following

* The account number given to me/us to be in debit freeze, i.e the funds can be deposited, but the withdrawal can only be done once the account is regularized with proper documents. Incase for any reason the account cannot be
regularized, the funding done to the account will be returned back to the originating account without any payment of interest on the account.
* This application is available for opening account or TD booking by Resident Indian Individuals only.

Form reviewed and submitted online by MR. ANIL GHENBAD

Kotak Mahindra Bank | Account Opening Form for Resident Individuals 10

Location ( IP : 10.240.22.34 Country : India)
 Customer Tracking ID: J S 0 5 8 5 5 5 6 9

NET001RIIDVU

BRANCH USE

Source/Promo Code: DIGI LG Code: J N C L A S Category: D A B C S T G

Opty ID : 1-8274650179
LC Code: Customer Seg RL WM CB
CORP/GRP Co.Code
Emp Code * Risk Profile H M L
RM Code: N A V
Fulfillment Code: _________________ LOB: CRN _________________

Status: _________________ CHANL Code DIGITAL

A/C No. _________________
4 1 8 2 4 Product Kotak 811 Kotak 811 Edge
PBO Code:

IMPORTANT OTHER DETAILS

1434 ( KANDIVALI EAST LOKHANDWALA CIRCLE Passport No.
Branch Code: [MUMBAI-KANDIVALI-LOKHANDWALA-1434] )
Driving License No.
*Principal CRN:
Voter ID
*Principal A/c No.:
(*Applicable in case of Family Saving account)
SR No: _________________
Primary Ticket No: _________________

Child Ticket No: _________________

FUNDING DETAILS

Transaction Date : _________________ Transaction Amount (In Rs.) : _________________ Status : _________________
Mode Of Payment : _________________ Lead Generated Date : _________________ Transaction Id: _________________
For funding details , kindly refer to old tracking id ______________________

CPC/RPC USE ONLY

ONLY FOR TD Relation ___________________(MOP = Others)

V-Date OTHER DETAILS Tenure
Special Card Type ___________________
Tran.ID
(Intentionally left blank) ISG/15H Attached Yes No
No. of CRFs attached ___________________
Amount(Rs.) Tran.Srl.No.
Vernacular App1 App2 Both

Photo Card Yes No

Document Collected
Applicant 1: DL PASS ELE_ID PAN PHOTO_CR
ID_DOC L_L RATION EMP_AOF UTILITY
AADHAAR CARD PASSBOOK MID IP CHEQUE FORM 60
AFFIDAVIT VERDEC VC OTHERS ________________________
Applicant 2: DL PASS ELE_ID PAN PHOTO_CR
ID_DOC L_L RATION EMP_AOF UTILITY
AADHAAR CARD PASSBOOK MID IP CHEQUE FORM 60
AFFIDAVIT VERDEC VC OTHERS ________________________

Branch Stamps Operation Stamps Form Details

Approved by:Sales Official (Sign & Code)

Designation _____________

Branch Official (Sign & Code)

Designation _____________

Form reviewed and submitted online by MR. ANIL GHENBAD

Kotak Mahindra Bank | Account Opening Form for Resident Individuals 11

Location ( IP : 10.240.22.34 Country : India)
 Customer Tracking ID: J S 0 5 8 5 5 5 6 9

FATCA / CRS DECLARATION FOR INDIVIDUAL ACCOUNTS

Note - The information in this section is being collected because of enhancements to Kotak Mahindra Bank's new account on-boarding procedures in order to comply with
Foreign Account Tax Compliance Act (FATCA) requirements pursuant to amendments made to Income-tax Act,1961 read with Income-tax Rules, 1962.

For more information refer:

http://www.incometaxindia.gov.in/dtaa/other%20agreements/india_iga_final-_india_english.pdf

http://www.oecd.org/ctp/exchange-of-tax-information/automatic-exchange-financial-account-information-common-reporting-standard.pdf
(We are unable to provide advice about your tax residency. If you have any questions about your tax residency, please contact your tax advisor)

Office/Bank use only

OPTY ID/SR Number :_______________________

Part A (All fields are mandatory)

Section I Details of Account Holder
1 Customer Relationship Number (CRN)[if any]
2 Name of Account Holder MR. ANIL KUNDLIK GHENBAD
3 Address for Tax Residence (include City, State, Country and Pin
code)

4 Address Type(Tick whichever applicable) (a) Residential (b) Business (c) Registered Office
5 Do you satisfy any of the criteria mentioned below? YES NO

a. Citizen of any country other than India (dual /

multiple)[including Green card]

b. Country of birth is any country other than India

c. Tax resident of ANY country / ies other than India

d. POA or a mandate holder who has an address outside India

e. Address or telephone number outside India

If your answer to any of the above questions is a YES, please fill Section II of the form, else go to declaration & acknowledgment

Section II - Other information(Please fill in BLOCK LETTERS)

Father's name _________________________________ (If PAN not available, then mandatory)

Country of Birth * _______________________________ Place within the country of birth _______________________________

*(In case of Country of Birth is USA, however Nationality and Country of Tax Residency is other than USA , please provide documentary
evidence as mentioned in instruction 1)

Source of Wealth _________________________________________ Nationality ________________________________________

Please list below the details, confirming ALL countries of tax residency/ permanent residency/ citizenship and ALL Tax Identification Numbers
$
Country of Tax residency Tax Identification No Tax identification document (TIN or functional equivalent)

$
It is mandatory to supply a TIN or functional equivalent (in case TIN not available) if the country in which you are tax resident issues such identifiers. If no TIN/ functional

equivalent is yet available or has not yet been issued, please provide an explanation below:

___________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________

Kotak Mahindra Bank | Account Opening Form for Resident Individuals 12

Location ( IP : 10.240.22.34 Country : India)
 Customer Tracking ID: J S 0 5 8 5 5 5 6 9

Declaration & Acknowledgement I _________________________ being the beneficial owner of the account opened / to
be opened with Kotak Mahindra Bank Limited and the income credited therein, declare
that the above information and information in the submitted documents to be true,
correct and updated, and the submitted documents are genuine and duly executed.

I acknowledge that towards compliance with tax information sharing laws, such as
FATCA / CRS, the Bank may be required to seek additional personal, tax and beneficial
owner information and certain certifications and documentation from the account holder.
Such information may be sought either at the time of account opening or any time
subsequently. In certain circumstances (including if the Bank does not receive a valid
self-certification from me) the Bank may be obliged to share information on my account
with relevant tax authorities. Should there be any change in any information provided by
me I ensure that I will intimate the Bank promptly, i.e., within 30 days.

Towards compliance with such laws, the Bank may also be required to provide
information to any institutions such as withholding agents for the purpose of ensuring
appropriate withholding from the account or any proceeds in relation thereto. As may
be required by domestic or overseas regulators/ tax authorities, the Bank may also be
constrained to withhold and pay out any sums from my account or close or suspend my
account(s).

I also understand that the account will be reported if any one of the aforesaid FATCA /
CRS criteria for any of the account holders i.e. primary or joint are met.

Customer Signature
Date

Bank Use Section:

Signature Verified By Receiver's Stamp

Documents sent to CPC/RPC on

Kotak Mahindra Bank | Account Opening Form for Resident Individuals 13

Location ( IP : 10.240.22.34 Country : India)
 Customer Tracking ID: J S 0 5 8 5 5 5 6 9

Instructions to the Form

In case customer has the following Indicia pertaining to a foreign country and yet declares self to be non-tax resident in the respective country, customer to provide relevant
Curing Documents as mentioned below:

Sr no FATCA/ CRS Indicia observed (ticked) Documentation required for Cure of FATCA/ CRS indicia
1 U.S. place of birth 1. Self-certification(FATCA Declaration) that the account holder is neither a citizen of
United States of America nor a resident for tax purposes;
2. Non-US passport or any non-US government issued document evidencing
nationality or citizenship (refer list below); AND
3. Any one of the following documents:
- Certified Copy of Certificate of Loss of Nationality or
- Reasonable explanation of why the customer does not have such a certificate
despite renouncing US citizenship; or
- Reason the customer did not obtain U.S. citizenship at birth

2 Residence/mailing address in a country other than India
or
Telephone number in a country other than India
1. Self-certification that the account holder is neither a citizen of United States of America
nor a tax resident of any country other than India; and
2. Documentary evidence (refer list below)

3 Standing instructions to transfer funds to an account 1. Self-certification that the account holder is neither a citizen of United States of America
maintained in a country other than India (other than nor a tax resident of any country other than India; and
depository accounts)
2. Documentary evidence (refer list below)

4 POA granted to a person with an address in a country 1. Self-certification that the account holder is neither a citizen of United States of America
outside India nor a tax resident for tax purposes of any country other than India; OR
2. Documentary evidence (refer list below)

List of acceptable documentary evidence needed to establish the residence(s) for tax purposes:
1. Certificate of residence issued by an authorized government body*
2. Valid identification issued by an authorized government body* (e.g. Passport, National Identity card, etc.)
* Government or agency thereof or a municipality of the country or territory in which the payee claims to be a resident.

Kotak Mahindra Bank Ltd. CIN: L65110MH1985PLC038137.

Registered Office: 27 BKC, C 27, G Block, Bandra Kurla Complex, Bandra (E), Mumbai - 400 051. www.kotak.com

Kotak Mahindra Bank | Account Opening Form for Resident Individuals 14

Location ( IP : 10.240.22.34 Country : India)