| (mus Res | omy REGISTRATION DETAILS ( ») mall Address fee CUSTOMER INFORMATION ~ hy First Name idole Notre LastName Mother's Name pate orsien: [B TPE Gender: Mate Ferrale Nationality ———ESSS Ade tine 1 Add Line 2 city state Iss \ |As per prevailing reguatory guidelines an Know Your Customer, you ar hereby requested to ensure that a valid Photo identity Proof and an A proofs submitted aiong with the tmw KYC Form, Please refer tothe staf documents Below acceptable for identity & Address prool. Ensure [AVESTED" copyies of ene same ie submitted slong wth the tmw KY for agiee to abide by the terms and co net limted to Privacy Policy Refund Pe Please courier the duly flea tmw KYC Form with documents to our address: lations and othe Rete tutor requirements as specified in Terms & Consitions, Policies including but 2 and mobie spp. ‘tmw Operations Department. The MobileWallt Pvt.Ltd, Tower 3, Thid Floor, Equinox Business Park, Off Bandra Kurla Complex, LBS Road, Kurla West). Mumps’ - 40 ar any queries cal US on 75 Proof of identity: Document No Li Pancard EQ UIDAI care wadhar) [J Passport [] Voters'O Card [] Driving License [] NREGA Job Cara Proof of Address: Document No: [—] [1 win card (aadnar} [2] Passport [J Voters iD Card [] Drving License [] NREGA Job Card CUSTOWER NAME ‘CUSTOVER SIGNATURE DATE Bianca errosusimccad 5 Custorner Nome Date PIP MELEE SIGNATURE & STAMP