“som had nt be prt a ek & ARN-69583 $ AXXPD3020F ¥y Wealth India Financial Services Pvt. Ltd. ‘App. No : 456209 | 1 om Enriching india, one investor at a time Ref. No: 901298 -1 Sanesnccct ines chaeni) Nameof Applicant: Mr. Amab Das ateof inn: 1708/1962 pao. AXXPD3020F PAN Proofénciored KY Compan Please (7) [_]es [w/]No Ocevpation [Jeuines EE] Protessional [7}sewice J rete student [J Houewite Joiners A) ncividuot (ur — Efsociety net Lcomponyitedy comet [Joiners Status [ratinership Fim [J minor 1] aor ysor [rust ‘Name of Guardian Incase of Minot /: (Contact person Designation in case of non-individual investors) Guardian PAN No. PAN Proof Enclosed, KYC Comptant Please (7) [] ves []No- Relation with Minor / Designation: Permanent Address 2 ‘Address 1; Belakoba ‘Address2; College Para city; Jalpaiguri State: _West Bengal Country : India Pincode: 735133 Overseas Addess* (Mandatory for NR /Fll Applicant) (Please provide our complete address. P.O, Box alone isnot adequate) Address 1 Address 2 ty: State: Country Postal code Contact details of Sole First applicant Tel. No. Office: Residence: Mobile: 7585800909 mailto; @Mabmail.16@gmai.com BANKACCOUNT OETALS recoup: [7S] [Jammer] [mo i roa] [Taras count; 2054608121 nk; Sato Bark a ‘11 DigitiFSC Code; _SBINO000095___epigitmicrcode: 735002095 Branch city: alpaigurl Branch Address: _SalpaiguriW.B.-735101 Puncture da tare a teen enor ee er eee [ caneeted cheque Enosed NOMBUTNRETALS Nominee Name: Anil Kumar Das, DateofBirth; 04/04/1055 Name of Parent/Guardian in case of Minor: Father Investor's relation with nominee