CENTRAL RYE REGISTRY | Know Important instructions: 15) eave nw oem in aie ans BLOCK ter stot wo eect 80 3188 coy oa i ave te rit ‘Pee eae wes ese guns nasone Far paral secon gi lene ex te bon vate alee ne steno secton suber en ake ofthe scion al rere ob ud For office use only Application Type" CINow Update (7000 nies tyrone nateten) KE Number (ianaatany or KYO ups r34098) Account Type" Cj Normal [Simplified (forlow risk customers) Small (11. PERSONAL DETAILS (Peate reterinsructon A atthe ond) = Maiden Name (fry Father / Spouse Name" Date cit conser SMe Mate IF Female Transgender Marta! Statist > Mrs Uemaries Others Cczensnigt IN Incian others (80 9168 County Code! |) Foren Netora! [Peron ot ieban Orin Cceupaten'ype’ «=< SServee ( IPtvate Sector C)Puble Sector (Goverment Sector) = Ooters ( “Profesional Set Employed TRetred Hewsewie Student e-business (2. Tick iF APPLICABLE [RESIDENCE FOR TAX PURPOSES IN JURISDIGTION(S) OUTSIDE INDIA (Peste refer insiucionB sted) ADDITIONAL DETAILS REQUIRED (Mansator only secon 2s trea) 180 3168 Country Code of Jurisdiction of Residence” “Tax lentiicavon Number oF equivalent tissues by jicton* Prace / Cy of Btn 180 3166 County Code of Bit (1s. PROOF OF IDENTITY (Pol) (Piease ree instruction € at end (Cones copy of anxene of he flowing Prot a eenttyPal neesee be submitee) ‘A Passport Number Voter ID Cara CPAN Cara Driving Licence Driving Licence Expiry Date 2 E-UID (Radar) F-NREGA Job Cars 2: Otver (any document nts bythe conral goverment ‘donticstion Number Simplifies Messures Account - Document Type code Identieaton Number 4. PROOF OF ADDRESS (PoA}* = z 114: CURRENT PERMANENT /OVERSEAS ADDRESS DETAILS (Pest se nerucson Dat he enc) (Certo copy ef arven ofr fowing Proto Accs [PoA] pees ob submited) ‘Adress Type" ——-TResidentia!/ Business) Residentia!. eusiness CDRegistered Offce —ZUnspecied Proof of Address” passport Doriving cence UD /Aadhaar) ‘Divoter entity Care IREGA Job Cad 0 Others )Simpities Measures Account - Document Type coe Addross Line 1" Line 2 Line 3 iy /Towe / Vilage” Disticr Pin / Post Code" State / UT Code 180 2166 County Code"[1142 CORRESPONDENCE / LOCAL ADORESS DETAILS (less se hsiructn E atthe ons) 1D Same as carer Parmanert/ Overseas Aas ts In caso of mull corespondece eal adresses. please #1 Annexure At) Line 2 Line 3 Cy Town / Vilage” Distrit™ in Post Code ‘State UT Coast 180.3168 Country Code* (C142AD0RESS INTHE JURISDICTION DETAILS VERE APPLICANT IS RESIDENT OUTSIDE INDIA FOR TAX PURPOSES" (oplcabe secon 2 eked) ‘Same ae Curert/ Permanent Overtas Aon Stain Same as Corespondenca Loca Acree Une 1" Line 2 Line 3 ty Town / Vilage” ‘tater ZIP | Post Code* 180 2166 Country Code" Es. CONTACT DETAILS i conmnicaton wt crton odes bie no, / Ena} eater istucon Fat tes) Tel (09, Tol. (Res) obie FAK Ema 10 C16. DETAILS OF RELATED PERSON nse cf etiton ted pons, ae ft Anene 1 elas fr cshucion Gt hard) ClAdten a Rea Peven [Devon of Relate Peon NYC Nurerat Rested Peon (ian) Related Person Typet —_“] Guardian of Minor ‘Assign |Authorized Representative Name" (YC number and name are proved, now deaf acon ae open) PROOF OF IENTITY Pell OF RELATED PERSON" (esse coe netucton the ad) 1) A: Passport Number Passport Expiry Date DB Voter 10 care 1 © PAN Card 1 B- Driving Licence Driving Licence Expiry Date 5 E-Uio(aacnaen) 1 F-NREGA Job Cara 5) Z Others (any soeuren notes by he canea goverment Idonticaton Number LL &-Simpiied Measures Account - Document Type code entiicaton Number (17. REMARKS (tary) 8, APPLICANT DECLARATION ate Place: Stee Tams ineuain eat ‘9. ATTESTATION / FOR OFFICE USE ONLY Documents Received Cetied Copies YG VERIFICATION CARRIED OUT BY INSTTUTONDETALS: te Name Emp. Name cose Emp. Cose Emp. Designation Emp. 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