CKYC & KRA KYC Form
LOGO
Know Your Client
New
Application Form (For Individuals only) Application
Type* Update KYC Number*
(Please fill the form in English and in BLOCK Letters)
Fields marked with ‘*’ are mandatory fields
KYC Type* Normal (PAN is mandatory) PAN Exempt Investors (Refer instruction K)
1. Identity Details (Please refer instruction A at the end)
PAN Please enclose a duly attested copy of your PAN Card
Prefix First Name Middle Name Last Name
Name* (same as ID proof)
Maiden Name (If any*)
Father / Spouse Name*
Mother Name*
Date of Birth* DDD
D - MM
M M - YYYY
Y Y Y Y Photo
Gender* M- Male F- Female T-Transgender
Marital Status* Married Unmarried Others
Citizenship* IN- Indian Others – Country Country Code
Residential Status* Resident Individual Non Resident Indian
Foreign National Person of Indian Origin
Occupation Type* S-Service Private Sector Public Sector Government Sector
O-Others Professional Self Employed Retired Housewife Student Signature/
Thumb Impression
B-Business X-Not Categorised
2. Proof of Identity (PoI)* (for PAN exempt Investor or if PAN card copy not provided) (Please refer instruction C & K at the end)
(Certified copy of any one of the following Proof of Identity [PoI] needs to be submitted)
A- Passport Number Passport Expiry Date D DD
D - MMM
M - YYYYY
Y Y Y
B- Voter ID Card
D- Driving Licence Driving Licence Expiry Date D DD
D - MMM
M - YYYYY
Y Y Y
E- Aadhaar Card
F- NREGA Job Card
Z- Others (any document notified by the central government) Identification Number
3. Proof of Address (PoA)*
3.1 Current / Permanent / Overseas Address Details (Please see instruction D at the end)
Address
Line 1*
Line 2
Line 3 City / Town / Village*
District* Zip / Post Code* State/UT Code as per Indian Motor Vehicle Act, 1988
State/UT* Country* Country Code as per ISO 3166
Address Type* Residential / Business Residential Business Registered Office Unspecified
(Certified copy of any one of the following Proof of Address [PoA] needs to be submitted)
Proof of Address*
Passport Number Passport Expiry Date D DDD -M MM
M -Y YYYY
Y Y Y
Voter ID Card
Driving Licence Driving Licence Expiry Date D DDD M
- MM
M -Y YYYY
Y Y Y
Aadhaar Card
NREGA Job Card
Others (any document notified by the central government) Identification Number
3.2 Correspondence / Local Address Details* (Please see instruction E at the end)
Same as Current / Permanent / Overseas Address details (In case of mult iple correspondence / local addresses, please ‘Annexure A1’, Submit relevant document ary proof)
Line 1*
Line 2
Line 3 City / Town / Village*
District* Zip / Post Code* State/UT Code as per Indian Motor Vehicle Act, 1988
State/UT* Country* Country Code as per ISO 3166
Version 1.6 Page 1
4. Contact Details (All communications will be sent on provided Mobile no. / Email-ID) (Please refer instruction F at the end)
Email ID
Mobile Tel. (Off) Tel. (Res)
5. FATCA/CRS Information (Tick if Applicable) Residence for Tax Purposes in Jurisdiction(s) Outside India (Please refer instruction B at the end)
Additional Details Required* (Mandatory only if above option (5) is ticked)
Country of Jurisdiction of Residence* Country Code of Jurisdiction of Residence as per ISO 3166
Tax Identification Number or equivalent (If issued by jurisdiction)*
Place / City of Birth* Country
Countryof
of Birth*
Birth Country Code as per ISO 3166
Address
Line 1*
Line 2
Line 3 City / Town / Village*
District* Zip / Post Code* State/UT Code as per Indian Motor Vehicle Act, 1988
State/UT* Country* Country Code as per ISO 3166
6. Details of Related Person (Optional) (please refer instruction G at the end) (in case of additional related persons, please fill ‘Annexure B1’)
Related Person Deletion of Related Person KYC Number of Related Person (if available*)
Related Person Type* Guardian of Minor Assignee Authorized Representative
Prefix First Name Middle Name Last Name
Name*
(If KYC number and name are provided, below details of section 6 are optional)
Proof of Identity [PoI] of Related Person* (Please see instruction (H) at the end)
(Certified copy of any one of the following Proof of Identity[PoI] needs to be submitted)
A- Passport Number Passport Expiry Date D D
DD M M
- MM -Y YYYY
Y Y Y
B- Voter ID Card
C- PAN Card
D- Driving Licence Driving Licence Expiry Date D DD
D -M MM
M - Y YYYYY
Y Y Y
E- Aadhaar Card
F- NREGA Job Card
Z- Others (any document notified by the central government) Identification Number
7. Remarks (If any)
8. Applicant Declaration
• I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes
therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held
liable for it. I hereby declare that I am not making this application for the purpose of contravention of any Act, Rules, Regulations or any statute of
[Signature / Thumb Impression]
legislation or any notifications/directions issued by any governmental or statutory authority from time to time.
• I hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/email address.
Date: D DD
D M
- MMM - YYYYY
Y Y Y Place : Signature / Thumb Impression of Applicant
9. Attestation / For Office Use Only
Documents Received Certified Copies
KYC Verification Carried Out by (Refer Instruction I) Institution Details
Date D D M M Y Y Y Y Name
Emp. Name Code
Emp. Code Emp. Branch
Emp. Designation
[Institution Stamp]
[Employee Signature]
In-Person Verification (IPV) Carried Out by (Refer Instruction J) Institution Details
Date D D M M Y Y Y Y Name
Emp. Name Code
Emp. Code Emp. Branch
Emp. Designation
[Institution Stamp]
[Employee Signature]
Version 1.6 Page 2
