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SBI FASTag Application Form - Legal Entity
SBI FASTag Application Form - Legal Entity
Passport size
photograph of
Authorised
Person
Date: /……/…………, Application Number…………………….., Account Type- A-Limited KYC, B- Full KYC, SBI FASTag Number………………………………………………………
1. ENTITY DETAILS
Entity Constitution*
Name*
PAN* Number of controlling person(s) resident outside India for Tax purposes
Account Detail* a) Within SBI - Account Number………………………………………………………….
b) Outside SBI –Bank Name…………………………………IFSC Code………………………….Account Number…………………………………
(Please provide details of each controlling person resident outside India for Tax Purposes separately in Annexure C2)
2. PROOF OF IDENTITY (POI)* (Certified copy of anyone of the following Proof of Identity (PoI) needs to be submitted), Please tick one POI
A-Certificate of Incorporation/Formation, B-Registration Certificate, C-Resolution of Board/Managing Committee, D-Memorandum and article
of association/Partnership Deed/Trust Deed, E- Officially Valid document(s) in respect of person authorized to transact, F- Activity proof ( For
Sole Proprietorship only)
* Please obtain KYC of Entity as per list mentioned in Annexure II.
3. PROOF OF ADDRESS (POA)* (Certified copy of anyone of the following Proof of Address (PoA) needs to be submitted)
3.1 Current/Permanent/Overseas address* (Please tick one address type and one proof of address)
Address Type* A- Residential/Business, B- Residential, C- Business, D- Registered Office, E- Unspecified (tick one)
PoA* I-Certificate of Incorporation/ Formation, II- Registration Certificate
Line 1*……………………………………………………………………………………………………………………………………………………………………………………………….
Line 2…………………………………………………………………………………………………………………………………………………………………………………………………
Line 3…….………………………………………………………………………………………………………………City/Town/Village*…………………………………………..……
State/U.T Code*………………Pin/Post Code*………………………..Country Code*(IN)/other country, please refer list of country codes………………….
Address Type* A- Residential/Business, B- Residential, C- Business, D- Registered Office, E- Unspecified (tick one)
PoA* I-Certificate of Incorporation/ Formation, II- Registration Certificate
Line 1*……………………………………………………………………………………………………………………………………………………………………………………………….
Line 2…………………………………………………………………………………………………………………………………………………………………………………………………
Line 3…….………………………………………………………………………………………………………………City/Town/Village*…………………………………………..……
State/U.T Code*………………Pin/Post Code*………………………Country Code*(IN)/other country, please refer list of country codes……………………
4. Contact Details* (All communications will be sent on Provided Mobile no. /Email-ID)
(Please tick one option) A-Addition of Related Person, B- Deletion of Related Person, C-Update related person details
KYC Number of Related Person (if available*)………………………………………………………………………………………
(Please Tick One option) Related Person Type- A- Director, B- Promoter, C- Karta, D- Trustee, E- Partner, F- Authorised Signatory, G- Court
Appointed official, H- Beneficiary
5.1 PERSONAL DETAILS of Related Person for each person
Name* (same as ID Proof)
Date of Birth* D D M M Y Y Y y
5.2 Tick if Applicable Residence for Tax purposes in Jurisdiction(s) outside India
Address Type* A- Residential/Business, B- Residential, C- Business, D- Registered Office, E- Unspecified (tick one)
PoA* I- Passport, II- Driving License, III-Voter Identity Card, IV- NAREGA Job Card, V- Letter Issued by National Population
Register containing details of name & address
Address*
Line 1*……………………………………………………………………………………………………………………………………………………………………………………………..
Line 2……………………………………………………………………………………………………………………………………………………………………………………………….
Line 3……………………………………………………………………………………………………………………………………………………………………………………………….
City/Town/Village*…………………………………………..………………………………………………………………………………………………………………………………..
Pin/Post Code*………………………………………State/U.TCode*……….Country Code*(IN)/other country, please refer list of country codes…………
7. Transaction Details
Payment Mode: (Cash, Debit/Credit card, others)
FasTag Issuance Fees
Security Deposit of the FASTag account
Load amount in the FASTag account
Total:
Applicant Declaration:
I/We hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I/we undertake to
inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or
misrepresenting, I/we am/are aware that I/we may be held liable for it. My/Our personal KYC details may be shared with Central KYC
Registry. I/We hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/email
address.
I/We declare that, I/We am/are eligible to apply for SBI FASTag(s). I/we have read the terms and conditions applicable to SBI FASTag, and
I/we understand that SBI is entitled at its discretion to accept or reject this application without assigning any reason whatsoever. I/we agree
to be bound by all the terms and conditions in force from time to time. I/we also understand that upon any usage of State Bank FASTag at
any Toll Plazas and Top ups of the FASTag via point-of-sale / online portals, the amount in the FASTag account will result in decrease/
increase as per the transactions/case type. The Bank/third party will levy all the applicable charges/taxes as per the service types availed by
me/us.
[ ] I have read and agree to the terms and condition attached with this form.
Optional:
I/we hereby authorize State Bank to debit my/our SBI Current/savings/etc. account Number
at Branch by Rs………………….(In Words:…………………………………........................................................................),
once the minimum balance falls below the prescribed amount as defined by SBI from time to time.
Documents Received (Tick any one) – A- Self Certified, B- True Copies, C-Notary,
Risk Category (Tick one) - High, Medium, Low. In person Verification Carried out by (name of the person)………………………………………………..
POS Name …………………………………….…..POS Code………………………………… PoS Authorised Person Signature and Seal
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Annexure -II iv. (a) OVD as defined by RBI from time to time; and (b) Permanent Account
Number or Form 60 as defined in the Income-tax Rules, 1962
A) For Individual customers :
i. The passport Other documents
ii. The driving License
iii. The Voter's Identity Card issued by Election Commission of India, v. A declaration containing the names of all the beneficial owners together
iv. Job card issued by NREGA duly signed by an officer of the State with their shareholding / controlling interest / stake duly signed by the
Government, authorized signatory.
v. The letter issued by the National Population Register containing details of vi. Mode of operation in case of Partnership to be indicated clearly in AOF
name, address, or any other document as notified by the Central (Viz. All Partners jointly/severally (singly), Partner 1 & 2 jointly/severally
Government in consultation with the Regulator. (singly) etc.)
vii. Partnership letter dated……………and No. ……………obtained on Cos 37.
B) Where the customer is a Proprietorship Firm: Signed by all partners. (To be compulsorily obtained in case of
Minimum two documents issued in the name of Proprietary Concern from partnership firms)
the following list of documents along with any OVD and PAN of the viii. Addresses of the Power of Attorney holders
Proprietor must be taken. ix. PoA granted to a partner or employee of the firm to transact business on
i) Proof of the name, address and activity of the concern like registration its behalf
certificate (in case of a registered concern) x. OVD as defined by RBI from time to time and PAN of all partners &
ii) Certificate/ License issued by Municipal Authorities under Shop and beneficial owners
Establishment Act.
iii) Sales and Income Tax returns
iv) GST/CST certificate, Certificate / registration document issued by sales
E) Where the customer is Societies/Association/Clubs:
tax / Service tax/ Professional tax authorities.
i. Copy of the Memorandum of Association registered on………and Articles of
v) License / Certificate of Practice issued in the name of proprietary concern
Association dated …………….Obtained.
by any professional body incorporated under statue (e g Certificate of
ii. Resolution of managing body for opening the account
Practice issued by Institute of Chartered Accountants of India, Institute of
iii. Copy of the By Laws dated …………………and resolution dated……………Of
Cost Accountants of India, Institute of Company Secretaries of India, etc)
the Society, regarding the conduct of the account, obtained.
vi) IEC (Import / Export code) issued to the Proprietary concern by the Office
iv. Government / Military Order dated………………obtained (whichever
of Director General of Foreign Trade (DGFT) in the name of Proprietary
applicable).
Concern.
v. OVD as defined by RBI from time to time and PAN of Chairman/ MD/
vii) The complete Income tax return (not just acknowledgement) in the name
Chief Promoter/Secretary etc. of all Related persons or Beneficial owners.
of sole proprietor where the Firm’s Income is reflected duly
authenticated/acknowledged by the Income tax authorities.
viii) Utility bills such as electricity, water and landline telephone bills in the
name of the proprietary concern.
[Any one document above can also be taken as activity of proof. In such
case a contact point verification has to be undertaken which will establish (F) Where the customer is Hindu Undivided Family(HUF):
the existence of such Firm and that business activity has been verified i. Joint Hindu Family Letter dated ………………………And No. …………Obtained
from the address. The record of such contact point verification should be on Cos 38, signed by all the adult coparceners Family (HUF)
placed along with AOF]. ii. Declaration from the Karta
iii. OVD as defined by RBI from time to time and PAN of Karta
iv. OVD as defined by RBI from time to time and PAN of adult coparceners
C) Where the customer is a limited company: v. PAN Card of Joint Hindu Family
i. Certificate of incorporation vi. On death of a coparcener, birth of a coparcener and a minor coparcener
ii. Memorandum and Articles of Association attaining majority (18 years), a fresh JHF letter (COS 38) has to be
iii. A resolution from the Board of Directors and power of attorney granted to executed Declaration that a) the depositor is the Karta of the Joint
its managers, officers or employees to transact on its behalf Family, b) the deposit belongs to JHF
iv. PAN of the Company