CIF No

I 111D KYC DETAILS UPDATION KYC ANNEXURE 'B

STATE BANK OF INDIA: Branch
1. PERSONAL DETAILS
Last Name
Prefix First Name Middle Name
Name (Same as proo O U I I IIIIIDIIIIII0
PHOTO
Account No

Residential Status: Resident Individual Non Resident Indian

Foreign National Person of Indian Origin
Occupation Type: S-Service ( Private Sector Public Sector Government Sector)
0-Others (Professional Self Employed Retired Housewife Student)
B-Business
X-Not Categorised Please Specify.. **********ooss**.

Annual Income/Tumover.
2. 1DENTIFICATION INFORMATION
PAN No L E L t PAN not available FORM 60 to be submitted)
MANDATORY:
(certified copy of any one of the folowing documents to be submitted)
OVD: Passport Voter ID Driving Licence NREGA Job Card Letter issued By National
Population Register
DOCUMENT No: III
| 1 I | I 1 IIAADHAR
I NO (Voluntary) 1 |
3. CURRENT/PERMANENT/OVERSEAS ADDRESS DETAILS

OVD:Passport Voter ID Driving LicenceNREGA Job Card Letterissued By National

Population Register
DOCUMENT No: II
I submit my Aadhar number and voluntarily give my consent(Please a tick mark)

Aadhar No:
3.1 Current/LOCAL ADDRESS DETAILS
Line 1

Line 2

Line 3
City/Town/Village
Pin/Post Code State/U.T
District
4. CONTACT DETAILS
Tel (Off) |IILITel(Re Mo Moble D 111
Email 1D
5. APPLICATION DECLARATION
I submit my Aadhar copy and voluntarily give my consent to use the same 1D/Address proof document (Strike of
Aadhaar not submitted). I hereby declare that the details furnished are true and correct to the best of my knowledge and
belief. I undertake to inform you of any changes therein, immediately. In case the above information is found to be false
untrue or misleading or misrepresenting, I am aware that I may be held liable for it.

Date mOOM1 Place:

(0D-MM-Ymm LIID
Signature/Thumb Impression of customer
6 ATTESTATION/FOR OFFICE USE ONLY
Documents Received Proof of identify Proof of Address
KYC VERIFICATION CARRIED OUT & ENTERED IN cBS ON -BY

Maker Checker
Thisform along with the KYC Documents be sent to LCPC for storage.
ldentity/Address details to be verified with bank records
AcknOMdadaor t to