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Please affix most recent Color Photograph 30mm*40mm Signacross the Photograph

Affix Recent Passport size photograph of the Applicant

Instructions: Please fill in the form in BLOCK LETTERS in English only. 1. NAME OF THE APPLICANT (As required in the Done Card)

(Please ensure that the name as it appears in the Identity Proof matches with the name mentioned below) 2. RESIDENTIAL ADDRESS

3.TOWN/CITY/DISTRICT

4.STATE/UNION TERRITORY

5.PINCODE

6.TELEPHONE NO

7.MOBILE PHONE

8.DATE OF BIRTH [DD/MM/YYYY]

9.EMAIL ADDRESS

10.IDENTIFICATION DETAILS[Please Tick and ANY One] Passport No Votes ID PAN no Driving Lic Ration Card No PF Ac

HOME DELIVERY DETAILS:-

*Get home delivery of Done Card from Done Card Utility Limited offices across the country. *you can make DD/CHEQUE in the name of OSS Retails Pvt. Ltd. payable at Mumbai and send it to our office *For any Queries Call our Customer Support 022 6684 6684 / 4238 4238

OFFICE ADDRESS:

Done Card Utility Limited,


301, Linkway Estate, New Link Road,

Malad West, Mumbai 400 064, Maharashtra


PAYMENT DETAILS DDNO/ CHEQUE NO: BANK NAME BRANCH NAME DATE

DONE CARD DETAILS Denominations (Any one)

1,000/5,000/10,000/-

TOTAL AMOUNT PAID

Done Card Utility Limited,


301, Linkway Estate, New Link Road, Malad West, Mumbai 400 064, Maharashtra.

DOCUMENTS REQUIRED AND SUBMITTED BY THE APPLICANT DOCUMENTS REQUIRED FOR VERIFICATION Attach the Copy of any one:-[Please Tick the One Submitted]

PASSPORT DRIVING License Voters ID PAN Card

Attach the Copy of any one:[Please Tick the one Submitted]

Latest Telephone bill (Landline/Mobile No] Latest Electricity bill LIC Receipt [If LIC policy is taken by Applicant] Ration Card

Note:Card will be issued to the Customer within one week after the date of receiving the KYC form.

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