KYC Updation form for Individuals

Ref No:

Date:
To,
Standard Chartere Bank,
KYC Cell, No 19, Rajaji Salai, Chennai
Dear Sir/Madam

Ref: Account / Loan / Credit Card Numbers

I undersigned Account Holder / Power of Attorney of above mentioned account/s hereby declare that the information given below, in respect of the
above mentioned bank account/s is true and correct

Full Name* GOPAL CHANDRA SAMANTA

C
Residence Address* / O S A N D I P D E Y
2, H A T G A C H I A, D H A P A R O A D, N E A R
S C I E N C E C I T Y District K O L K A T A
City K O L K A T A State W E S T - B E N G A L
Country I N D I A PIN 7 0 0 1 0 5

Aadhaar Number^ Mobile* + 9 1 - 9 8 3 0 4 9 5 0 6 9

PAN Number* B H I P S 9 5 4 2 R Residence -

Date of Birth* 02-01-1981 Office -
Nationality* INDIA
Please fill above if any changes. Also provide valid document supporting the same

Email* g o p a l c h s a m a n t a @ y a h o o . c o m

Salaried Professional Self Employed Retired Housewife Student Unemployed

Occupation*
(Please tick as appropriate)
Business McNally Bharat Enginnering Company Limited
Employer / Business Entity Name* _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Manufacturing Trading Export/Import Service Retailing Wholesaler

Nature of Business* Engineering Procurement and Commissioning (EPC)

Other _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(Please tick as appropriate)
Industry in which the client’s Business entity or Employer Operates (e.g. Jewellery, diamond, textile, chemicals, law/accounting firm etc) * _ _ _ _
_________________________________________________________________________________________

In the event of change in address due to relocation or any other reason, I shall intimate the new address to the Bank within two weeks of such a change.

Account Holder Signature*

Note:
1. For joint accounts or accounts operated under a power of attorney, a separate declaration should be completed for each joint account holder or
constituted attorney.
2. ^Please submit self attested copy of Aadhaar card to update the same in banks record
3. The details mentioned above will be applicable to all relationships / accounts that you hold with the bank
4. * Mandatory fields
5. “I/we hereby give my/our consent to Standard Chartered Bank to authenticate my/our Aadhaar number, Identification details and Fingerprint with
UIDAI. I/we agree and authorize Standard Chartered Bank to obtain my personal details from UIDAI