Know Your Client (KYC) Application Form (For Individuals Only) Application No, Please fil in ENGLISH and in BLOCK LETTERS ‘A Identity Details (please see guidelines overleaf) 4. Name of Applicants apoearng in supertin ientfatin document, Name | sabes — , Sar ewe Hee Pe ae 3. Nationality Dinan 4 Status Pee Uk (v} [iventesert foreign National Papert Copy Madi fr Nis & Foreign Nanas) Please ence 2 dy ated copy of your AN Cot exempt cases ese Tike (4 Tie i> Cho wag uence Cotes (ease see guide 0’ ove “ee guidelines overleaf) PinGake yo age Sate Gonty 5. Proof af address to be provided by Applicant Please submit ANY ONE ofthe follwing valid documents & tick (V) against the document attached, Passport CiRaton Cand. CiReitere Lease Agreement of Residence C2Drving License voter lety Card [atest Bank Ae SttemensPasbook statest Bephone Bi fon Land Line) Catest Bec Bil CsLatest Gas Bll othe Please soe ‘hot mare an 3 Marth id Vahdlyapy dat f prot of addres submited fff 6. Any other information: >» DECLARATION Inereby declare tha the detais fused above are rue ancscorect the bes’ of my/our knowledge and beet and |Undertake to inform you ot any changes tren, immediately Incase any ofthe above information found tobe {alge oruntruearmiseading orm stepresenting,lamfve are aware thet Wwemay beheld able fort FOR OFFICE USE ONLY IPVDonecion 8 J ft ce ate “ANChntrmedany name OM code Seal'Stamp of the intermediary shot ‘Seal/Stamp of the intermediary should contain Cr AAtested) Te copes of documents recened vee “ “ Name of rome ton taney re oS (otras vet se Cert Docent cis esasINSTRUCTIONS / 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 BarMutinatonal Foreign BanksGazered —OficerNoxary publfected —represenaties tothe —_—Legisatie 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.