“Account Opening Form (For Indviduals Ony)
Know Your Gliont(KYC)
Pease fil in ENGUSH and in LOCK LETTERS
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3 Vor. 4 gyINSTRUCTIONS / CHECK LIST FOR FILLING KYC FORM
| impontan poms:
1, Selarecopy of ANcastsmandaeryeralen.
2 Copies ofa the docs submited bythe appa souk be
seated ad accomparied by agin for veatn. nase
the egal of any doce ot produce for vertexion the
the copies shoul be popelyateed by ents authorzed for
estingthe documents asper the bebe mentioned.
1 ary poo af idem rads sna foreign guage then
atonal i eques,
4 Name wadtessofte appllantmentnedontte KYCfom sous
match ith thedoanentyprotsubrited
5 eanegondene pemarendcs ardent then proctor
ott have tobe submited
6 Soleporetormastmae te aplation nhs iva name &
cape
For nonresidents and forign naa allowedt tate sujet to
Foland FEMA guidelines, copy of apertPIOCa OCs ns
vescaatesprofismandan.
1.
{8 Fafareg ents CINisopiona and inthe absence of DIN nn for
‘hedrecorshepasoat copy sou begin.
In ase of Merchant Navy Nl Mares dedaation orcad
‘copy of CC (Coninuous Dichare Crate) ta besubite,
10.frperng an acrunt wth Depestoy paricpant or Mutual Fun,
foramioc photocapyofthe School eaing Cent Man sest
sued by Higher Secondary BaorPasipor of Minar
Conca musto paises
"Plc Exposed Persons (PP) are dfn as neve bo re
rhe beenentused ith prominent pbcfunctos ina frig
county, 69, Hate of Stes of of Goverment, senor
polis, senor Govermemjudilktany ofces senor
ecb of sate ouned coparatons impoantpoical pany
afeak et
Proof of Kentity Pom: Us of documents admissible as Proof
of Identity:
1, PAN cad with photograph Tiss a manda requement for a
applans xcept thae who ae speccaly exempt a caiing
FaNiedinseconD},
2. Unique Mefton Nonbe (WD) Aad Paso Voter
ardiDivrglcense
3, erty card documet wth apa Phota,suedbyanyofhe
‘owing: CentlStte Goverment and. Depriment,
StamtoyRepibzoy Autonies Puble Secor Underabnes
Schesuled Commercial Banks Pu Fnancllsituns Cleges
fate to Unestes Profesional Bodies such 3, KAA
Test Barcauncete, tthe Members and Crd aD cad
sued Barc,
. Proof of Address (PON): List of documents admissibleasProot
of Address: ‘Documents having an expiry date should be
valid onthe date of submission)
1. Pagers deny CaRatonCariReisteed ease or Sole
Ageament of Resdnceriing Leesa aitnance
besos Cops,
2, Ushi bisBeTelephone ono lee bilo Gas
Netmoethon3 months
4 Sankcount StatemenuPesbook- Natt han 3manbs ok
4, Setclaratin by hghCourandSupeme Cou spe ging te
ew assim espe er own accu.
5. Prof of ates ised by ayo te fallovng Bonk Manages of
Scheied Conmercal BankScheduks —Co-perve
BankNMabinatoraForignBarksGazeted —OfcerNetay
publoteted —rresentaives tothe Legbtve
PezenbhyPalamertDacaret ues by any Govt or Son
aon,
6, Wenty cardlscament with aes, suedby ay ofthe flowing
CentalSiie Government and IS eparments,
StaunyRegdstay Autortes Pale Sear Underabgs,
Sched Conmrc dans at Finencal tits Cllges
fled to Unites and Poeional Seles sch o¢ KA
WALICS ar Counce tothe Menbes.
2, For sub acount, Power of Atemey gen by sub-account to
the Cusedars (whch ae duly notarized andor apes or
conse that gives terested adtess shouldbe ale,
Te profofadtes inthe namecftespousemaybe acted,
xemprionscaritcationsto PAN
(Sufficient documentary evidence in support of such aims
tobe collected)
1, Incase ofransactonsunderalen on behalf Cental Goverment
dor State Government andy ofl spoilt Courts
Oficallqudst, Coutreceneet,
2, storsresdingin testator,
3, UNenttesntistealagecs exempt tompayngtaesfing tax
retunsinin
4, sPor wal Funds ups 0000+ pa
5. case of insttional dens, nary, Ni, VCR FUCK,
Scheduled Conmerial Banks Mutbtesl and Sloteal
DeveprentFrancid Inttuton, Sut Indust Delopnent
Copoatns Insuance Companies registered ith ROA ad Fue
Financ stato defied under secon 48 athe Companies
‘Ac, 1956, Castodans shal very the PAN card deta withthe
‘gal PAN car and prove ul ceri copes of such eid
Pv detaletteintemasian.
LUstof people authorized tates the documents:
1, Notay Puke, Gaetied Ofiet Manager of 2 Scheduled
ConmercaVCoeperatte Bank or Mubiatenal Frign Barks
(ame Deighton eaehouldbe aiedon becom,
2. In ce of NR, autoed ofc of eves branches of
Schedles Commercial Banks rested in India, Noiay Pub
our Magsvate, ue, Idan EmbasConute Gener the
county whee te dent resides ae perited % atest the
oeurens
he Ste RY Bom nM Se Poe OoEATCA-CRS Declaration & Supplementary KYC Information
(Deciaration Form for individuals)
1. PAN No: -
2. Trading Account No: -
3, Name:
4, Gross Annual Income: [<1 Lac []< 1-5 Lac] <5-10 Lac [1< 10-25 Lac [> 25 Lac
oR
Net Worth in INR Net worth As On.
5. Occupation CTprivate Sertor Service [7] Public SecrorL] Government Servicel] Business
Lorrotessione! Retired [EE] housewite [2] student []settemptoyed []Not categorized.
6. Politically Exposed Person (PEP){_] Yes ]Related to PEP Not Applicable
7. Are you a US Person [] Yes [1] No
8, Country of Birth: [] India [U.S Other
9. Citizenship: C1 india Clu.s other
10. Place (City/Town) of Birth (if other than India) :
11. Primary Source of Wealth (choose any one from following)
Ciselary Coausiness E]cit LJ Ancestral “operty
CG Rental Income [J Prize Money [1] Royalty [Others
12. Whether Tax Resident in any country other than India:[] Yes] No
13, If for any of the above fields, the country mentioned by you is not India or if your US
person status is "Yes’ or you are an NAl or Foreign National, then please provide following
details:
Country of Tax Identification No. | Type of No. Please specify FE
Residence for Tax _| (TIN) or functional Type/ Name (Not
Purpose (other than_| equivalent (FE) of TIN applicable if TIN
India) / TIN issuing provided)
country
0 ow Ore
OW oOFfe
14. Address in the foreign country of which you are a tax resident (Other than India):
City/Town Village. State
Pin Code, Country,15, If you satisfy the criteria as mentioned in point 7 above but do not have TIN / FE,
please fill the following details:
Country No. other than TIN/ Type of No.
Name FE
Tvs Dy Resident no. ] Work permit no.
Cdependent visa LI student visa
D1 Seafarer status [1 Going to the country
of residence for first time*
{_ Under penalty of perjury, I certify that:
1The applicant is (i) an applicant taxable as @ US person under the laws of the United States of America
(US.1 or any state oF politcal subdivision thereof or therein, including the District of Columbia or any other
states of the U.S. {i) an estate the income of which is subject to U.S. federal income tax regardless of the
source thereof. (This clause is applicable only ifthe account holder is identified as a US person) or
2. The applicant is taxable as a tax resident under the laws of country outside India. (This clause is applicable
only ifthe account holder is a tax resident outside of India)
{il) | hereby declare that the details furnished above are true, correct and complete to the best of my
knowledge and belief including my/our taxpayer identification number. In case of any change in the above
siven status on a future date, | undertake to inform |= Sec the same within 30 days.
{il) | agree that if | am a U.S. Person oF tax resident of a reportable foreign jurisdiction (other than U.S.)
requiring reporting under FATCAICRS or any other laws, my account details, as required under Inter
Governmental Agreement (IGA)/ Multilateral Competent Authority Agreement (MCA) signed by Indian
Government, would be reported by |-Sec to the relevant tax authority,
{IVI [hereby confirm thet details 8s provided by me above can be shared by I-Sec with the concerned Asset
‘Management Companies (AMCs) or such other product providers, to whom FATCAICRS norms are applicable,
in whose schemes! products I may invesVransact in future through lSec.
Following clause applicable only if any of th
since not resident for tax purpose outside |
No’ in point no.1:
iia parameters is outside India and TIN/ FE is not available
(OR Country of Birth is US and US person is mentioned as
| hereby confirm that | am not a US Person ora resident for tax purpose in any country other than India,
though my Country of Birth suggests my relation with US or one or more parameters suggest my relation with
the country outside india. | am providing / already provided copy of my PAN card to Sec and now providing a
cortficate of relinquishment of US citizenship (loss of nationality} OR reasons for not having such a certificate
despite relinquishing US citizenship OR for not obtaining US citizenship at birth (only if born in US)
Please specify reason
Please select any one of the below option- | am signing this document as,
1 First Holder [J] Bank Joint Holder] DP Co Holder [] MF Joint Holder
Name: Signature:
Date: