CENTRAL KYC REGISTRY | Know Your Customer (KYC) Application Form | Individual

Important Instructions:
A) Fields marked with ‘P’ are mandatory fields. F) Please read section wise detailed guidelines / instructions at the end.
B) Tick ‘P’wherever applicable G) List of State / U.T code as per Indian Motor Vehicle Act, 1988 is available at the end.
C) Please fill the form in English and in BLOCK letters. H) List of two character ISO 3166 country codes is available at the end.
D) Please fill the date in DD-MM-YYYY format. I) KYC number of applicant is mandatory for update application.
E) For particular section update, please tick (’P’) in the box J) The ‘OTP based E-KYC’ check box is to be checked for accounts opened using
section number and strike off the sections not required to OTP based E-KYC in non-face to face mode.
be updated.

For office use only Application Type* New Update

(To be filled by financial institution) KYC Number (Mandatory for KYC update request)
Account Type* Normal Minor Aadhaar OTP based E-KYC (in non-face to face mode)

KYC Mode* : Please Tick (P)

Normal EKYC OTP EKYC Biometric Online KYC Offline KYC Digilocker

1. PERSONAL DETAILS* (Please refer instruction A at the end)

PAN* Form 60 furnished

Prefix First Name Middle Name Last Name
Name* (Same as ID proof)

Maiden Name

Father / Spouse Name*

Mother Name
Date of Birth* DD / MM / YYYY

Gender* M- Male F- Female T-Transgender

Nationality* Indian Others (Please specify)

Residential Status* Resident Individual Non Resident Indian Foreign National Person of Indian Origin
(Passport mandatory for NRIs, PIOs and Foreign Nationals)

Marital Status* Married Unmarried Others (Please specify)

2. PROOF OF IDENTITY AND PERMANENT ADDRESS* (Please refer instruction B at the end)

I. Certified copy of OVD or equivalent e-document of OVD or OVD obtained through digital KYC process needs to be submitted (anyone of the following OVDs)
A- Passport Number
PHOTO*
B- Voter ID Card

C- Driving Licence

D- NREGA Job Card Affix recent

passport size
E- National Population Register Letter photograph &
sign across
F- Proof of Possession of Aadhaar

Il E- KYC Authentication

Ill Offline verification of Aadhaar

Address
Line 1*
Line 2
Line 3 City I Town I Village*
District*
Pin/Post Code* State/U.T Code*
ISO 3166 Country Code*

Address Type* Residential / Business Residential Business Registered Office Unspecified

 3. CURRENT / CORRESPONDENCE ADDRESS DETAILS (Please refer instruction B at the end)
Same as above mentioned address (In such cases address details as below need not be provided)

I. Certified copy of OVD or equivalent e-document of OVD or OVD obtained through digital KYC process needs to be submitted (anyone of the following OVDs)
A- Passport Number

B- Voter ID Card

C- Driving Licence

D- NREGA Job Card

E- National Population Register Letter

F- Proof of Possession of Aadhaar

Il E- KYC Authentication

Ill Offline verification of Aadhaar

IV Deemed Proof of Address - Document Type code

V Self Declaration

Address
Line 1*
Line 2
Line 3 City I Town I Village*
District*
Pin/Post Code* State/U.T Code*
ISO 3166 Country Code*

Address Type* Residential / Business Residential Business Registered Office Unspecified

4. CONTACT DETAILS (All communications will be sent to Mobile number/ Email-ID provided) (Please refer instruction C at the end)

Tel. (Off) Tel. (Res) Mobile

Email ID

5. REMARKS (if any)

6. APPLICANT DECLARATION

"I/We hereby declare that the KYC details furnished by me are true and correct to the best of my/our knowledge and belief and I/We
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/We are aware that I/We may be held liable for it.

I/We hereby consent to receiving information from KRA & CKYCR through SMS / Email on the above registered number / Email
address.

I am/We are also aware that for Aadhaar OVD based KYC, my KYC request shall be validated against Aadhaar details. I/We hereby
consent to sharing my/our masked Aadhaar card with readable QR code or my Aadhar XML/Digilocker XML file, along with passcode
and as applicable, with KRA and other Intermediaries with whom I have a business relationship for KYC purposes only.

I/We accord my/our voluntary consent for sharing/fetching/verifying my/our records maintained in Central KYC Registry and KYC
Registration Agency.
(Signature / Thumb Impression)

Date : D D M M Y Y Y
Y Y Place: Signature / Thumb Impression of Applicant

7. ATTESTATION / FOR OFFICE USE ONLY

Documents Received Certified Copies E-KYC data received from UIDAI Data received from Offline verification Digital KYC Process

Equivalent e-document Video Based KYC

IPV DONE / KYC VERIFICATION CARRIED OUT BY INSTITUTION DETAILS

Date D D
_ M M
_ Y Y Y Y Name
Emp. Name Code
Emp. Code
Emp. Designation

Emp. Branch

(Institution Stamp)
(Employee Signature)
CENTRAL KYC REGISTRY | Instructions / Check list / Guidelines for filling Individual KYC Application Form

A Clarification / Guidelines on filling 'Personal Details' section

1 Name: The name should match the name as mentioned in the Proof of Identity submitted failing which the application is liable to be rejected.
2 One the following is mandatory : Mother's name, Spouse's name, Father's name.
B Clarification / Guidelines on filling 'Current Address details' section
1 In case of deemed PoA such as utility bill, the document need not be uploaded on CKYCR
2 PoA to be submitted only if the submitted Pol does not have current address or address as per Pol is invalid or not in force.
3 State / U.T. Code and Pin / Post Code will not be mandatory for Overseas addresses
4 In Section 2, one of I, II and III is to be selected. In case of online E-KYC authentication, II is to be selected.
5 In Section 3, on of I, II, III and IV is to be selected. In case of online E-KYC authentication, II isto be selected.
6 List of documents for 'Deemed Proof of Address':

Document Code Description

01 Utility bill which is not more than two months old of any service provider 9electricity, telephone, post-paid mobile phone, pipe gas, water bill)
02 Property or Municipal tax receipt.
03 Pension or family pension payment orders (PPOs) issued or retired employees by Government Department or Public Sector Undertakings, it they
contain the address.
04 Letter of allotment of accommodation from employer issued by State Government or Central Government Departments, statutory or regulatory
bodies, public sector Undertakings, scheduled commercial banks, financial institutions and listed companies and leave and licence agreements
with such employers allotting official accommodation.
7 Regulated Entity (RE) shall redact (first 8 digits) of the Aadhaar number from Aadhaar related data and documents such as proof of possession of Aadhaar, while
uploading on CKYCR.
8 "Equivalent e-document" means an electronic equivalent of a document, issued by the issuing authority of such document with its valid digital signature including
documents issued to the digital locker account of the client as per rule 9 of the Information Technology (Preservation and Retention of Information by Intermediaries
Provide Digital Locker Facilities) Rules, 2016.
9 "Digital KYC process" has to be carried out as stipulated in the PML Rules, 2005.
C Clarification / Guidelines on filling 'Contract details' section
1 Please mention two-digit country code and 10 digit mobile number (e.g. for Indian mobile number mention 91-9999999999).
2 Do not add '0' in the beginning of Mobile number.
D Clarification / Guidelines on filling 'Related Person details' section
1 Provide KYC number of related person, if available.
E Clarification on Minor
1 Guardian details are optional for minors above 10 years of age for opening of Bank account only.
2 However, in case guardian details are available for minor above 10 years of age, the same (or CKYCR number of guardian) is to be uploaded.
 List of two – digit state / U.T codes as per Indian Motor Vehicle Act, 1988

State / U.T Code State / U.T Code State / U.T Code

Andaman & Nicobar AN Himachal Pradesh HP Pondicherry PY
Andhra Pradesh AP Jammu & Kashmir JK Punjab PB
Arunachal Pradesh AR Jharkhand JH Rajasthan RJ
Assam AS Karnataka KA Sikkim SK
Bihar BR Kerala KL Tamil Nadu TN
Chandigarh CH Lakshadweep LD Telangana TS
Cha sgarh CG Madhya Pradesh MP Tripura TR
Dadra and Nagar Haveli DN Maharashtra MH Uttar Pradesh UP
Daman & Diu DD Manipur MN Uttarakhand UA
Delhi DL Meghalaya ML West Bengal WB
Goa GA Mizoram MZ Other XX
Gujarat GJ Nagaland NL
Haryana HR Orissa OR

List of ISO 3166 two- digit Country Code

Country Country Country Country Country Country Country Country
Code Code Code Code
Afghanistan AF Dominican Republic DO Libya LY Saint Pierre and Miquelon PM
Aland Islands AX Ecuador EC Liechtenstein LI Saint Vincent and the Grenadines VC
Albania AL Egypt EG Lithuania LT Samoa WS
Algeria DZ El Salvador SV Luxembourg LU San Marino SM
American Samoa AS Equatorial Guinea GQ Macao MO Sao Tome and Principe ST
Andorra AD Eritrea ER Macedonia, the former Yugoslav Republic MK Saudi Arabia SA
of
Angola AO Estonia EE Madagascar MG Senegal SN
Anguilla AI Ethiopia ET Malawi MW Serbia RS
Antarc ca AQ Falkland Islands (Malvinas) FK Malaysia MY Seychelles SC
An gua and Barbuda AG Faroe Islands FO Maldives MV Sierra Leone SL
Argen na AR Fiji FJ Mali ML Singapore SG
Armenia AM Finland FI Malta MT Sint Maarten (Dutch part) SX
Aruba AW France FR Marshall Islands MH Slovakia SK
Australia AU French Guiana GF Martinique MQ Slovenia SI
Austria AT French Polynesia PF Mauritania MR Solomon Islands SB
Azerbaijan AZ French Southern Territories TF Mauritius MU Somalia SO
Bahamas BS Gabon GA Mayotte YT South Africa ZA
Bahrain BH Gambia GM Mexico MX South Georgia and the South Sandwich GS
Islands
Bangladesh BD Georgia GE Micronesia, Federated States of FM South Sudan SS
Barbados BB Germany DE Moldova, Republic of MD Spain ES
Belarus BY Ghana GH Monaco MC Sri Lanka LK
Belgium BE Gibraltar GI Mongolia MN Sudan SD
Belize BZ Greece GR Montenegro ME Suriname SR
Benin BJ Greenland GL Montserrat MS Svalbard and Jan Mayen SJ
Bermuda BM Grenada GD Morocco MA Swaziland SZ
Bhutan BT Guadeloupe GP Mozambique MZ Sweden SE
Bolivia, Plurina onal State of BO Guam GU Myanmar MM Switzerland CH
Bonaire, Sint Eusta us and Saba BQ Guatemala GT Namibia NA Syrian Arab Republic SY
Bosnia and Herzegovina BA Guernsey GG Nauru NR Taiwan, Province of China TW
Botswana BW Guinea GN Nepal NP Tajikistan TJ
Bouvet Island BV Guinea-Bissau GW Netherlands NL Tanzania, United Republic of TZ
Brazil BR Guyana GY New Caledonia NC Thailand TH
Bri sh Indian Ocean Territory IO Haiti HT New Zealand NZ Timor-Leste TL
Brunei Darussalam BN Heard Island and McDonald Islands HM Nicaragua NI Togo TG
Bulgaria BG Holy See (Vatican City State) VA Niger NE Tokelau TK
Burkina Faso BF Honduras HN Nigeria NG Tonga TO
Burundi BI Hong Kong HK Niue NU Trinidad and Tobago TT
Cabo Verde CV Hungary HU Norfolk Island NF Tunisia TN
Cambodia KH Iceland IS Northern Mariana Islands MP Turkey TR
Cameroon CM India IN Norway NO Turkmenistan TM
Canada CA Indonesia ID Oman OM Turks and Caicos Islands TC
Cayman Islands KY Iran, Islamic Republic of IR Pakistan PK Tuvalu TV
Central African Republic CF Iraq IQ Palau PW Uganda UG
Chad TD Ireland IE Pales ne, State of PS Ukraine UA
Chile CL Isle of Man IM Panama PA United Arab Emirates AE
China CN Israel IL Papua New Guinea PG United Kingdom GB
Christmas Island CX Italy IT Paraguay PY United States US
Cocos (Keeling) Islands CC Jamaica JM Peru PE United States Minor Outlying Islands UM
Colombia CO Japan JP Philippines PH Uruguay UY
Comoros KM Jersey JE Pitcairn PN Uzbekistan UZ
Congo CG Jordan JO Poland PL Vanuatu VU
Congo, the Democra c Republic of CD Kazakhstan KZ Portugal PT Venezuela, Bolivarian Republic of VE
the
Cook Islands CK Kenya KE Puerto Rico PR Viet Nam VN
Costa Rica CR Kiribati KI Qatar QA Virgin Islands, British VG
Cote d'Ivoire !Côte d'Ivoire CI Korea, Democratic People's Republic KP Reunion !Réunion RE Virgin Islands, U.S. VI
of
Croa a HR Korea, Republic of KR Romania RO Wallis and Futuna WF
Cuba CU Kuwait KW Russian Federation RU Western Sahara EH
Curacao !Curaçao CW Kyrgyzstan KG Rwanda RW Yemen YE
Cyprus CY Lao People's Democra c Republic LA Saint Barthelemy !Saint Barthélemy BL Zambia ZM
Czech Republic CZ Latvia LV Saint Helena, Ascension and Tristan da SH Zimbabwe ZW
Cunha
Denmark DK Lebanon LB Saint Kitts and Nevis KN
Djibou DJ Lesotho LS Saint Lucia LC
Dominica DM Liberia LR Saint Mar n (French part) MF
 Regd. Office : 301, Centre Point, Dr. Babasaheb Ambedkar Road, Parel, Mumbai - 400 012.
Phone : 91-22-6177 9400 to 09 Fax: 91-22-6177 9058 Website : [Link] CIN : U67190MH1986GOI040506

FATCA/CRS Declaration for Individual

(Each account holder has to submit separate FATCA/CRS Declaration)
Section I

DP ID Client ID(s)
Name of the Client
Father Name / Spouse Name
Occupation Type Service Business
Occupation details
(Short Description)
PAN
Are you a Tax Resident (i.e. your Citizen/ Resident/ Green Cardholder /Tax
Resident in a country and accessed for Tax) in any country other than India? Y es* No
Are you US Person
(Yes means FATCA applicable. No means CRS applicable) Y es No

Section II
(Only applicable when Client select “Yes ” * for Tax Residence details other than India)
Correspondence Address Permanent
address

City/Town City/Town
State code State code
Postal Code Postal Code
Country Code Country code
Citizenship/Nationality Date of Birth
Country for Tax Resident Country for Tax Resident
Country of Birth Place of Birth
TAX Identication
Number (TIN) or
Equivalent
TIN is not available (A) The Country where the account holder is liable to pay tax does not issue TIN
to its residents.
(B) No TIN required (Select the reason only if the authorities of the respective
country of tax residence does not require TIN to be collected)
(C) Encircle relevant option - 1 Student / 2 Home-maker/ 3 House-Wife/ 4 Retired /
5 Diplomat/ 6 Other reason (Please Specify) _____________________

Section III
(Undertaking & consent)
I understand that SHCIL is relying on this information for the purpose of determining the status of the applicant named
above in compliance with FATCA/CRS. SHCIL is not able to offer any tax advice on CRS or FATCA or its impact on the
applicant. I/we shall seek advice from professional tax advisor for any tax questions. I also undertake to keep SHCIL informed
in writing about any changes / modication to the above information in future within 30 days and also undertake to provide
any other additional information as may be required at your / Fund’s end or by domestic or overseas regulators/ tax
authorities. I agree that as may be required by domestic regulators/tax authorities the SHCIL may also be required to report,
reportable details to CBDT or close or suspend my account. I certify that I/we provide the information on this form and to
the best of my knowledge and belief the certication is true, correct, and complete including the taxpayer identication
number of the applicant. I also conrm that I have read and understood the FATCA & CRS Terms and Conditions given
below and hereby accept the same.

I hereby agree to share / update my FATCA/CRS self-declaration with other products of StockHolding linked
with my aforesaid PAN. (Please strike off, if not required)

Client Signature
Notes:

A. Following supporting documents required alongwith aforesaid declaration:

1. Self attested PAN (Mandatory) documents requited alongwith self-certification

2. Self attested copy of TIN Card or Equivalent only if Client is US person or Tax Resident in any country other
than India
3. Self attested copy of Passport / Driving License / Election Card / UIDAI / NEREGA Card / Govt. Issued ID
Card only when Client is not US person or Tax Resident in India
4. Self attested copy of document related to Relinquishment of Citizen only in case Client is US Person but not
Citizen of US
5. Any other relevant documents in support of details mentioned in FATCA/CRS self -certication

FATCA & CRS Terms & Conditions

Details under FATCA & CRS: The Central Board of Direct Taxes has notied Rules 114F to 114H, as part of the
Income- tax Rules, 1962, which require Indian nancial institutions such as the Banks/other nanc ial entities to
seek additional personal, tax and benecial owner information and certain certications and documentation from all
our account holders. In relevant cases, information will have to be reported to tax authorities / appointed agencies.
Towards compliance, we 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.

Should there be any change in any information provided by you, please ensure you advise us promptly, i.e., within
30 days.

Please note that you may receive more than one request for information if you have multiple relationships with
(Insert FI's name) or its group entities. Therefore, it is important that you respond to our request, even if you believe
you have already supplied any previously requested information.

FATCA & CRS Instructions

If you have any questions about your tax residency, please contact your tax advisor. If you are a US citizen or resident
or green-card holder, please include United States in the foreign country information eld along with your US Tax
Identification Number.
$It is mandatory to supply a TIN or functional equivalent if the country in which you are tax resident issues such
identifiers. If no TIN is yet available or has not yet been issued, please provide an explanation and attach this 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:

FATCA & CRS Indicia observed (ticked) Documentation required for Cure of FATCA/ CRS indicia
U.S. place of birth 1. Self-certication 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:
Certied Copy of “Certicate of Loss of Nationality or
Reasonable explanation of why the customer does not have
such a certicate despite renouncing US citizenship; or
Reason the customer did not obtain U.S. citizenship at birth
Residence/mailing address in a country 1. Self-certication that the account holder is neither a citizen of
other than India United States of America nor a tax resident of any country other
than India; and
2. Documentary evidence (refer list below)
Telephone number in a country other than If no Indian telephone number is provided
India 1. Self-certication 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)
If Indian telephone number is provided along with a foreign country
telephone number
1. Self-certication that the account holder is neither a citizen of
United States of America nor a tax resident for tax purposes of
any country other than India;