Serial No:
GOVERNMENT OF PAKISTAN
MINISTRY OF FINANCE
NATIONAL SAVINGS CENTRE
KNOW YOUR CUSTOMER("KYC")/CUSTOMER DUE DELIGENCE("CDD')
FORM-NATURAL PERSON
For Photo Account
only
Any natural person who wants to invest in National Savings Scheme ("NSS") is
required to provide all the information duly supported by
documentary evidence, as prescribed in this form under the national Savings (AML
and CFT) Regulations,2020.
PASTE PICTURE
Name and Code of For Official Use Only
National Saving Center: 2129-Saving House ﺻﺮﻑ ﺩﻓﺘﺮﯼ ﺍﺳﺘﻌﻤﺎﻝ ﮐﯿﻠﺌﮯ Date of Application:
(i.e
1. Type of Customer: ✓ Adult Minor Photo 2. Purpose of Certificate/ Account: investment,pledge,court
3. Existing Relationship: Yes ✓ No 4. Bio-Metric Verification: Verisys Bio-Metric
Details of Applicant/ Guardian(Minor*) ﺩﺭﺧﻮﺍﺳﺖ ﺩﮨﻨﺪﮦ ﮐﯽ ﺗﻔﺼﯿﻼﺕ
1. Name of Applicant(as per cnic):
RAFAT NASREEN
(ﺩﺭﺧﻮﺍﺳﺖ ﺩﮨﻨﺪﮦ ﮐﺎ ﻧﺎﻡ )ﮐﻤﭙﯿﻮﭨﺮﺍﺋﺰﮈ ﻗﻮﻣﯽ ﺷﻨﺎﺧﺘﯽ ﮐﺎﺭﮈ
2. Father's/Husband Name: ZAHEER UDDIN QURESHI 3. Mother's Name:
ﺷﻮﮨﺮ ﮐﺎ ﻧﺎﻡ/ ﻭﺍﻟﺪ ﻭﺍﻟﺪﮦ ﮐﺎ ﻧﺎﻡ
4. CNIC/SCNIC/NICOP/POC: ﮐﻤﭙﯿﻮﭨﺮﺍﺋﺰﮈ ﻗﻮﻣﯽ ﺷﻨﺎﺧﺘﯽ ﮐﺎﺭﮈ ﻧﻤﺒﺮ 5. CNIC Expiry Date:
ﺷﻨﺎﺧﺘﯽ ﮐﺎﺭﮈ ﻧﻤﺒﺮ ﮐﯽ ﻣﯿﻌﺎﺩ ﺧﺘﻢ ﮨﻮﻧﮯ ﮐﯽ 01-01-2048
4 2 2 0 1 - 6 1 1 8 8 7 8 - 0
ﺗﺎﺭﯾﺦ
6. Gender: Male: ﻣﺮﺩFemale: ﻋﻮﺭﺕTransgender:ﻣﺨﻨﺚ 7. Date of Birth:
✓ 1 5 - 0 2 - 1 9 5 7
ﺟﻨﺲ ﭘﯿﺪﺍﺋﺶ ﮐﯽ ﺗﺎﺭﯾﺦ
8. Current Residential Address: ﻣﻮﺟﻮﺩﮦ ﺭﮨﺎﺋﺸﯽ ﭘﺘﮧ
City: ﺷﮩﺮ District:ﺿﻠﻊ Province:ﺻﻮﺑﮧ
Attach Evidence in case of different from CNIC ()ﮐﻤﭙﯿﻮﭨﺮﺍﺋﺰﮈ ﻗﻮﻣﯽ ﺷﻨﺎﺧﺘﯽ ﮐﺎﺭﮈ ﻧﻤﺒﺮ ﺳﮯ ﻣﺨﺘﻠﻒ ﮨﻮﻧﮯ ﮐﯽ ﺻﻮﺭﺕ ﻣﯿﮟ ﺛﺒﻮﺕ ﺟﻮﮌﯾﮟ
9. Permanent Address: ﻣﺴﺘﻘﻞ ﭘﺘﮧ80/2 G CLAYFON QTR JAHANGIR RO
City: ﺷﮩﺮ District:ﺿﻠﻊ Province:ﺻﻮﺑﮧ
10. Resident Telephone: ﺭﮨﺎﺋﺸﯽ ﭨﯿﻠﯿﻔﻮﻥ 11. Email Address:
ﺍﯼ ﻣﯿﻞ ﺍﮈﺭﯾﺲ
12. Mobile Number(Registered on Applicant's Name): 13. Alternate Contact Number:
0336-2473348
(ﻣﻮﺑﺎﺋﻞ ﻧﻤﺒﺮ )ﺩﮨﻨﺪﮦ ﮐﮯ ﻧﺎﻡ ﭘﺮ ﺭﺟﺴﭩﺮﮈ ﻣﺘﺒﺎﺩﻝ ﻣﻮﺑﺎﺋﻞ ﻧﻤﺒﺮ
14.Place of Birth : 15. Marital Status: Married Unmarried Widow Other
ﻣﻘﺎﻡ ﭘﯿﺪﺍﺋﺶ ﺍﺯﺩﻭﺍﺟﯽ ﺣﯿﺜﯿﺖ ﺷﺎﺩﯼ ﺷﺪﮦ ﻏﯿﺮ ﺷﺎﺩﯼ ﺷﺪﮦ ﺑﯿﻮﮦ ﺩﯾﮕﺮ
✓
16. Education: Ph.D Masters Bachelors Intermediate Matric Primary Illiterate 17. Religion:Muslim Non Muslim
ﺗﻌﻠﯿﻢ ﭘﯽ ﺍﯾﭻ ﮈﯼ ﻣﺎﺳﭩﺮﺯ ﺑﯿﭽﻠﺮﺯ ﺍﻧﭩﺮﻣﯿﮉﯾﭧ ﻣﯿﭩﺮﮎ ﺑﻨﯿﺎﺩﯼ ﻣﺬﮨﺐ ﻏﯿﺮ ﺗﻌﻠﯿﻢ ﯾﺎﻓﺘﮧ ﻏﯿﺮ ﻣﺴﻠﻢ ✓ ﻣﺴﻠﻢ
18. Residence Status:Owned Rented With Parents Govt. House Other please Mention
ﺭﮨﺎﺋﺶ ﺣﯿﺜﯿﺖ ﻣﻠﮑﯿﺖ ﮐﺮﺍﯾﮧ ﺩﺍﺭ ﻭﺍﻟﺪﯾﻦ ﮐﮯ ﺳﺎﺗﮫ ﺳﺮﮐﺎﺭﯼ ﻣﮑﺎﻥ (ﺩﯾﮕﺮ)ﻭﺿﺎﺣﺖ -
19. Non-Resident Pakistani: Yes No Dual National If Yes/Dual National,then Country of Residence
ﻏﯿﺮ ﻣﻘﺎﻣﯽ ﭘﺎﮐﺴﺘﺎﻧﯽ ﮨﺎﮞ ﻧﮩﯿﮟ ﺩﻭﮨﺮﯼ ﻗﻮﻣﯽ ﻣﻠﮏ ﮐﺎ ﺭﮨﺎﺋﺸﯽ ﻧﺎﻡ، ﺍﮔﺮ ﮨﺎﮞ ﺗﻮ -
20. Tax Filer Status:ﭨﯿﮑﺲ ﻓﺎﺋﻠﺮ Filer Non-Filer 21. NTN No.:ﺍﯾﻦ ﭨﯽ ﺍﯾﻦ ﻧﻤﺒﺮ
ﺣﯿﺜﯿﺖ ﻓﺎﺋﻠﺮ ﻧﺎﻥ ﻓﺎﺋﻠﺮ ✓
.In case of joint investment use separate KYC form for each applicant*
ﺟﻮﺍﺋﻨﭧ ﺍﻧﻮﯾﺴﭩﻤﻨﭧ ﮐﯽ ﺻﻮﺭﺕ ﻣﯿﮟ ﮨﺮ ﺩﺭ ﺧﻮﺍﺳﺖ ﺩﮨﻨﺪﮦ ﮐﮯ ﻟﯿﮯ ﺍﻟﮓ ﮐﮯ ﻭﺍﺋﯽ ﺳﯽ ﻓﺎﺭﻡ ﺍﺳﺘﻌﻤﺎﻝ ﮐﺮ ﯾﮟ
Details of Minor Applicant ﻧﺎﺑﺎﻟﻎ ﺩﺭﺧﻮﺍﺳﺖ ﺩﮨﻨﺪﮦ ﮐﯽ ﺗﻔﺼﯿﻼﺕ
1. Name of Minor: ﻧﺎﺑﺎﻟﻎ ﮐﺎ ﻧﺎﻡ- 2. Father's Name: ﻭﺍﻟﺪ ﮐﺎ ﻧﺎﻡ
4. Date of Birth ﭘﯿﺪﺍﺋﺶ ﮐﯽ ﺗﺎﺭﯾﺦ:
3. Relationship with Guardian:ﮔﺎﺭﮈﯾﻦ ﮐﮯ ﺳﺎﺗﮫ ﺗﻌﻠﻖ۔
5. Registration Number as per B-Form:
ﺏ ﻓﺎﺭﻡ ﮐﮯ ﻣﻄﺎﺑﻖ ﺭﺟﺴﭩﺮﯾﺸﻦ ﻧﻤﺒﺮ - -
6. Current Residential Address: ﻣﻮﺟﻮﺩﮦ ﺭﮨﺎﺋﺸﯽ ﭘﺘﮧ
City: ﺷﮩﺮ District:ﺿﻠﻊ Province:ﺻﻮﺑﮧ
Details of Source of Income and Occupation ﺫﺭﺍﺋﻊ ﺁﻣﺪﻥ ﺍﻭﺭ ﭘﯿﺸﮧ ﮐﯽ ﺗﻔﺼﯿﻼﺕ
1. Occupation ﭘﯿﺸﮧ 2. Source of income ﺫﺭﺍﺋﻊ ﺁﻣﺪﻥ
Salary ﺗﻨﺨﻮﺍﮦ Pension ﭘﯿﻨﺸﻦ
Employee(Govt./ SemiGovt/Autonomous/bodies) Business ﮐﺎﺭﻭﺑﺎﺭ Property Rent ﺟﺎﺋﯿﺪﺍﺩ ﮐﺎ ﮐﺮﺍﯾﮧ
ﺳﺮﮐﺎﺭﯼ ﻣﻼﺯﻡ ﭘﺮﺍﻭﯾﮉﻧﭧ ﻓﻨﮉ
Provident Fund EOBI ﺍﺩﺍﺭﮦِ ﻣﺮﺍﻋﺎﺕِ ﻣﻌﻤّﺮ ﻣﻼﺯﻣﯿﻦ
House Wife
Agriculturist ﮔﮭﺮ ﯾﻠﻮ ﺧﺎﺗﻮﻥ ﻭﺭﺍﺛﺖ
ﺯﺭﺍﻋﺖ Lottery ﻻﭨﺮﯼ Inheritance
Employee(Private Sector) Receipts from Relative Profit on Investment
ﻧﺠﯽ ﺍﺩﺍﺭﮮ ﮐﺎ ﻣﻼﺯﻡ Student ﻃﺎﻟﺐ ﻋﻠﻢ
ﺭﺷﺘﮧ ﺩﺍﺭﻭﮞ ﺳﮯ ﺭﺳﯿﺪﯾﮟ ﺳﺮﻣﺎﯾﮧ ﮐﺎﺭﯼ ﭘﺮ ﻣﻨﺎﻓﻊ
Self Employed
Business ﮐﺎﺭﻭﺑﺎﺭ ﺫﺍﺗﯽ ﻣﻼﺯﻣﺖ
Sale of Asset ﺍﺛﺎﺛﮧ ﮐﯽ ﻓﺮﻭﺧﺖ Gift Deed ﺗﺤﻔﮧ ﻋﻤﻞ
Retired ﺭﯾﭩﺎﺋﺮﮈ Unemployed ﺑﮯ ﺭﻭﺯﮔﺎﺭ Dowry ﺟﮩﯿﺰ Spouse ﺷﺮﯾﮏ ﺣﯿﺎﺕ
Other (please Mention): )ﺩﯾﮕﺮ)ﻭﺿﺎﺣﺖ ﮐﺮﯾﮟ ﭘﺮﺍﺋﺰ ﺑﺎﻧﮉ ﮐﯽ
Gratuity ﮔﺮﯾﺠﻮﯾﭩﯽ Prize Bond Money ﺭﻗﻢ
(Other (please Mention
(ﺩﯾﮕﺮ)ﻭﺿﺎﺣﺖ ﮐﺮﯾﮟ
.(In case the applicant is House-wife/Student, mention details of sponsor (husband/father/brother etc*
( ﺑﮭﺎﺋﯽ/ ﻭﺍﻟﺪ/ ﺍﮔﺮ ﺩﺭ ﺧﻮﺍﺳﺖ ﺩﮨﻨﺪﮦ ﮔﮭﺮ ﯾﻠﻮ ﺧﺎﺗﻮﻥ ﻃﺎﻟﺒﻌﻠﻢ ﻣﯿﮟ ﺗﻮ ﮐﻔﯿﻞ ﮐﯽ ﺗﻔﺼﯿﻼﺕ ﻣﯿﮟ ) ﺷﻮﮨﺮ
3. Name of Employer/Business/
4. Designation/ID/Code etc: ﻋﮩﺪﮦ
Institution: ﺍﺩﺍﺭﮮ ﮐﺎ ﻧﺎﻡ/ ﮐﺎﺭﻭﺑﺎﺭ/ﺩﻓﺘﺮ
5. Employer/Business Contact Address:
ﺍﺩﺍﺭﮮ ﮐﺎ ﻣﮑﻤﻞ ﭘﺘﮧ/ ﮐﺎﺭﻭﺑﺎﺭ/ﺩﻓﺘﺮ
City: ﺷﮩﺮ District:ﺿﻠﻊ Province:ﺻﻮﺑﮧ
6. Employer/Business contact: ﺭﺍﺑﻄﮧ ﻧﻤﺒﺮ Email :ﺍﯼ ﻣﯿﻞ
8. Current Deposit(PKR):
7. Recurring Income:(PKR) ﻣﺴﻠﺴﻞ ﺁﻣﺪﻧﯽ ﻣﻮﺟﻮﺩﮦ ﮈﭘﺎﺯﭦ
9. One time Income 10. Existing NSS investment
ﺍﯾﮏ ﺑﺎﺭ ﮐﯽ ﺁﻣﺪﻧﯽ ﻣﻮﺟﻮﺩﮦ ﺍﯾﻦ ﺍﯾﺲ ﺍﯾﺲ ﺳﺮﻣﺎﯾﮧ
11. Total Source of income (Recurring + one time ) 12. Total (Existing+new)
ﺁﻣﺪﻧﯽ ﮐﺎ ﮐﻞ ﺫﺭﯾﻌﮧ ﻧﺌﯽ(ﮐﻞ ﺭﻗﻢ+ )ﻣﻮﺟﻮﺩﮦ
Details of Beneficial Owner ﺣﺘﯽ ﻓﺎﺋﺪﮦ ﯾﺎ ﻣﻔﺎﺩ ﻟﯿﻨﮯ ﻭﺍﻟﮯ ﮐﯽ ﺗﻔﺼﯿﻼﺕ
Self ﺧﻮﺩ ✓ Other ﺩﯾﮕﺮ
If others, please provide following details of Beneficial Owner "ﺩﯾﮕﺮ" ﮐﯽ ﺻﻮﺭﺕ ﻣﯿﮟ ﻧﯿﭽﮯ ﺩﯼ ﮔﺌﯽ ﻣﻌﻠﻮﻣﺎﺕ ﻣﮩﯿﺎ ﮐﺮﯾﮟ
1. Name : ﻧﺎﻡ 2. Father's Name: ﻭﺍﻟﺪ ﮐﺎ ﻧﺎﻡ
4. Date of Birth ﭘﯿﺪﺍﺋﺶ ﮐﯽ ﺗﺎﺭﯾﺦ:
3. CNIC NO. :ﺷﻨﺎﺧﺘﯽ ﮐﺎﺭﮈ ﻧﻤﺒﺮ - -
5. Residential Address: ﺭﮨﺎﺋﺸﯽ ﭘﺘﮧ 6. Beneficial Relationship:
ﻓﺎﺋﺪﮦ ﻣﻨﺪ ﮐﮯ ﺳﺎﺗﮫ ﺗﻌﻠﻖ
7. Source of Income: ﺫﺭﺍﺋﻊ ﺁﻣﺪﻥ 8. Employer Business Address:
-
ﮐﺎﺭﻭﺑﺎﺭ ﮐﺎ ﭘﺘﮧ/ ﺩﻓﺘﺮ
Declaration by Applicant ﺩﺭ ﺧﻮﺍﺳﺖ ﺩﮨﻨﺪﮦ ﮐﺎ ﺍﻗﺮﺍﺭ ﻧﺎﻣﮫ
I hereby undertake and confirm that
1. Information provided above is true and correct in all aspects
2. Any changes in the provided information shall be notified immediatly
3. All applicable Regulations,laws,Rules,Procedures, Guidelines and instructions as amended from time to time shall be adhered to
Signature/ thumb impression of primary Applicant
ﺩﺭ ﺧﻮﺍﺳﺖ ﻭ ﮨﻨﺪﮦ ﮐﮯ ﺩﺳﺘﺨﻂ ﻧﺸﺎﻥ ﺍﻧﮕﻮﭨﮭﺎ
Signature & stamp 2nd Officer Signature & stamp Officer Incharge
Reference of Account/Certificate linked with KYC/CDD form
S.NO Registration/Account Number Name of NSS
1 212900020024899 REGISTRATION 2129 Saving House
