Scribd
Upload
130 views1 page

Know Your Customer (KYC) Form: C-9 T V K Industrial Estate, Guindy Chennai - 600 032

This document contains a Know Your Customer (KYC) form for GI Technology (P) Limited. The form collects identity details like name, address, date of birth, photo, and identity proof from applicants. It also lists address proof documents that can be submitted like ration card, passport, driving license or utility bills. The document outlines terms and conditions for the ICashCard including that redemption is not allowed, misuse can lead to legal action, and the card remains the property of GI Technology.

Uploaded by

whiterup
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
130 views1 page

Know Your Customer (KYC) Form: C-9 T V K Industrial Estate, Guindy Chennai - 600 032

This document contains a Know Your Customer (KYC) form for GI Technology (P) Limited. The form collects identity details like name, address, date of birth, photo, and identity proof from applicants. It also lists address proof documents that can be submitted like ration card, passport, driving license or utility bills. The document outlines terms and conditions for the ICashCard including that redemption is not allowed, misuse can lead to legal action, and the card remains the property of GI Technology.

Uploaded by

whiterup
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

GI TECHNOLOGY (P) LIMITED C-9 T V K Industrial Estate, Guindy Chennai - 600 032

Know Your Customer (KYC) Form

INSTRUCTIONS : Please fill the form in BLOCK LETTERS in English only.


IDENTITY DETAILS 1. NAME OF THE APPLICANT 2. MOTHERS MAIDEN NAME
PHOTO

3. RESIDENTIAL ADDRESS

4. TOWN/CITY/DISTRICT

[Link]/UNION/TERRITORY 6. PINCODE 8. MOBILE NO 9.D.O.B 11. IDENTITY DETAILS [PLEASE TICK ANY ONE] Passport No/Voter ID/PAN No/Driving LIC/Ration Card No/ PF A/C [Link] PROOF FOR VERIFICATION Driving License Passport PAN Card Latest Electricity bill Voter ID Attach the copy of any one [Please Tick which one is submitted] Latest Telephone bill(Land line/Mobile No) LIC Receipt (If LIC policy taken by Applicant) Ration Card [Link] NO 14. NATIONALITY Indian Others (Please Specify) 10. EMAIL 7. TELEPHONE NO

Note: Card will be issued to the customer with in one week after the date of receiving the customer details form. Verification I______________________________________________ do hereby declare that what I stated above is true to the best of my knowledge and belief.
Terms and conditions

1. Redemption of ICashCard is not allowed as per RBI guidelines 2. For any misuse or fraudulent activity using the card will lead to severe legal action. 3. These terms &conditions as well as any amendments there of are part of a contract between you and GI Technology Private Limited and govern the use of ICashCard. 4. ICashCard should not be used for any cross border transactions. 5. ICashCard once submitted for purchase will not be cancelled. 6. GI Technology Private Limited shall not be liable / responsible for any defect in the product/merchandise/goods or services availed using ICashCard. GI Technology does not warranty against any damage or defect for the above mentioned transactions. 7. ICashCard is the exclusive property of GI Technology Private Limited. You hereby unconditionally agree to destroy the card on its cancellation or if required to do so under our instructions. 8. You agree to pay the full amount of the value of this ICashCard. 9. GI Technology is not responsible for any misuse of the ICashCard. 10. GI Technology reserves the right to amend or withdraw the ICashCard without any prior notice.
Date ___________________ Verified By ______________________ Place __________________ Signature(Seal) __________________

Instructions Documents which can be produced in support of the address are: (A) Ration Card (B) Passport (C) Driving License (D) Copy of the electricity bill or telephone bill showing residential address

You might also like