I SVC CO.

OPERATIVE
BANK LTD. r11;:"'"****,

For office use only Application Type'

CENTRAL KYC REGISTRY
Know Your Customer (l(YC) Application Form I lndividual & Related person
[To be filled by Account

New update Delete

Holder]

lfexisting, CBS lD:

CKYC_I

KYC Number (Mandatory for KYC update request) Doc. No.:

Account Type' Normal Minor Aadhaar OTP based EKYC (non lace to face mode)
l. INDIVIDUAL DETAILS (Eitherfalhefs name or spouses name is to be mandatorily lu.nished. ln case PAN is not avaitabte. taiher's name is mandatory)

Purpose Savings Cunent Oeposits Others, specify

Role Type lndividual Related Person ( Guardian for Minor Director Promoter Karta Trustee Parher Propdetor
Beneliciary Benelicial owner Court Appoinlmeot olf icial
Auhorised Signatory Power of Atlomey Holder 0lher {Pl€ase specify)
Name ol Applicanl
Name* (as Der lD Proofl PHOTOGRAPH

Maiden Namer
Fathel's/SDouse Namei Pleas€ alfix
lra$e6 Nam. mailirory n aDseie ol PAll a recenl passpon
size phologrdph
Mother's Name*

Genderi Maie Female Transgender Date ot Birthr

Marital Status Single Married Divorce Widow Others
Statusr Resident lndividual Non Resident Foreign National (PrssM copv mardab.v ror NRh & ro.ie{fl alioials
SIGNATURE
Nationality* lndian Other (Please specify)
(Please enclose a sell dested copy ol your PAI'I cafllIfim60 only in cas€
PANi Form 60
€ligible under income tax act 1962 Buh No. 1l4B)

Ouslification llliterate Non Matric Undergraduate Graduate Poslcraduate Other

Occupalion lyper S-Service( Private Sector Public Sector Govemmert Sectgr)

O-Others ( Professional Self Employed Retlred Housewiie Student)

B - Business

X- Not Categoris€d

Profession

Rellgion Caste

Annual lncome (ln O Nil 1to <60,000 60,001 to < 1,20,000 1,20,001 to <6,m,ooo 6,00,001 to < 12,00,000 > 12'm'000
ol
Political Exposure: Yes No Disabillty: Yes, Type ot Disability
(Medical cenincaE mqulmd incase
drf emnty/Sepcially a!bd)

the totlowlng detalts aHnandalory in case nesidence tot,at Putpoies in lu sdictlon(s) outside lndla
Country ot Juridiclion ol Residence*
TIN issuing country
TIN (tf issued byiuridiction)*.
Place/City of Birth*
Country of Birth

(Illl): TIN n ( ii hiqh

2. Address

Permanenl Address (Oversea8 Eddresa incase ol NRI)

Type Resident / Business / Overseas Residential Business Registered ofice Unspecmed
Address

Linel*
Une2
City/Iown/r'illage*
Uneg
state/u.T codei ISO 3166 Code
District* ZplPin Coder
be sent to this address)
marked.as account address and all deliverables lor account will
Current Addless oglails (cufient add.ess of primary hotder wil be in correspondence address For NRI - local address is mandatory
permanent will be taken as comriulll"ii6n ir no address is meniioned
address
Type Resident / Business /
"00r,""",
Overseas Residential Business Registered offce Unspecified
Address

Linel*
Une2
City/townlr'ilhge*
Line3
stat6/u.T coder ISO 3166 Code
Districf' ziplPin Code*

contacrtoetails(Allcommunicationswillbesenttocontactdetailsofprimaryholder)
Mobile*
Tet.: (ofD Tel (Ros)

Email lD*
You may convey promotional inlormation through Calls/SMs/Letters
 CENTRAL KYC REGISTRY cKYC-1
Know Your Customer (KYC) Applicarion Form I lndividual
/;xt':,-",9i:53:l"v* [to be filled by Account Holder]

3. Applicant Declaration
t. l^,ve hereby declare that the details fumished are kue and corecl lo the best of my
knowledge and belief and Iundenake to iniorm you ol any changos th€rein.
immediately- ln cas€ any o, the above informatjon is lound to be false oa untrue or
misbading or misropresonting , l,^ivo ar6 aware that lAVe may be held liabls tor it.
2. lAVe hereby confirm lhat my/our latest photograph has been alfxed and ly'fle have
submitled a self attested photocopy l(YC document in suppon of POI & POA. The
iniormation provided by us/me on this Form is true, corect, and complete. l/w€ also
confrm lhat l/vve are aware of the FATCA / CRS Terms and Conditions and hereby
accept lh€ sam€,
3. ll re cartify that tho informalion provided by mo/us in the Form, its supponing
Annexures as well as in the documenlary evidenc€ provrded by me/us are, to the best
my/our knowledg€ and belief, fue, conect and complete and that l/we have not
withheld any matedal iniormation that may allect the assessmont / categodzalion ol
the account as a Reportable Account or olherwise.
4. l,4l/€ pormivauthoris€
ihe Bank to collect, store, communicale and process
con{irmingthe intormation provided by me lo lhe Bank-
7. Should there be any change in inlormation/inconect provided by me/us, l/we declare
and undertake the responsibility to intimaie the bank within 30 days the date o,
change with supporling documentary evidence.
8. lt shall be my/our respons,bilities lo educate mysolf/ours€ll and to comply at alltimes
with allrelevanl lawsrolatingto rcpo.ting undersection2S5BAoltheAct read withthe
rulestheaeunder,
9. l,/vve also agree to fumish such inlormation and/or documents as the Bank may
require lrom time to time on account of any change in law eith€r in lndia or atroad in
ths subject matter herean,
10- l/We shall indemnily lhe Bank lor any loss that may arise to the Bank on account of
providing incorrector incomplete inrormation.
11- Thedetails provided by me/ us in lhe lorm isas perthe notifed rules 114G to 114H ol
the income tax acl 962,
1

intormation relating to the Account and all tansactions ther€in, by the Bank and any
of fts atfrliates wherever situatod including sharinO, transler and disclosur€ between
lhem and to lhe authoritigs in and/or oulside lndia of any conidential iniomatbn lor
compliance wilh any hw or regulation whether domestic or foreign.
5. l/We also agroe that my/our tailure to disdose any material facl known to me/us. now
or in loture, may invalldate my/our application and the Bank would be within its rights
to put restrictions in the operations ol my/our accoum or c1o6e it or report to afly
re{ulator and/or any aulhority des(lnated by lh6 Govemment ol lndia (cot) / BBt for
the purpose or take any olher aclion as may be deemed appropriate by the Bank itthe
deficiency is not remedied by me/us within the stipulated period.
6. l/We hereby accopt and acknowledge that the Bank shalt have the right and authorily
to carry out investigations ftom the informaton available in pubtic dornain for
12. l/We have rcad, understood and hereby accept & agree to the Terms & Conditions
given for all the producls & services lAVe have requested.
13. l/We hereby consent to receiving inrormation trom Central KYC Registry th.ough
SMS/Email on the above registered number/email address.
14. l/We have been explained about the naiure ot inlomation that may be shared upon
authenlication. l,ryve havo been given to undersland lhat my information submitted to
the bank, herewith, shallnot be used for any other purposethan mentioned above, or
as per requirements of law-
15. lMe hereby declare thal allthe abov6 infomation votuntarityturnished by me is true,
corect and complele_

Date
Place Signatur€ / Thumb lmpr'ssion ol ApDlicsnt

ATTESTATION / FOR OFFICE USE ONLY

KYC Verification carried out by: Documents Certified Copies EKYC Data received from ulDAl
Date Received
Equivalent E-Document Digitat t(yc process
Emp. Name
Oata Received From Omine Verirication
Emp. Code p A. No
Emp. Designation Documenl Name lD Address
proof proof
Emp. Branch
Passport Number
CBIS ID:
Passport Expiry Date
lf politically exposed, approval obtained
Voter ID Card
Zero day calling done
Driving Licenso
AML UN match list verification done and no match found
Driving License Expiry Date
Branch Offcer Signatlre with
Branch Round Stamp NREGA Job Cad

Nalonal Poputation
Regisler Lefter
Proof of oossession
For CAO Use
ofAadhaar XXXXXXXX
Biometric ref. no
AOF details verifed wth
l(YC docurhents: E-KYC Authentic€lion XXXXXXXX
Offline Verification of
Aadhaar
XXXXXXXX
Deemed POA

Self Declaralion for Mailing Address

Cust lD Customer detaits
ve.ifi ed and authoriz€d:

REMARKS (/fa,y)
 Annexure 25 -Aadhaar Consent

Date:
RRN ol' tisc tn c0se eKYC on
Lost 4 d its o Aadhaar
d h (l al h o d 0 ,l o t, istobes ned b ren uardian
co SE the 5

Ltd. to open a savings/current Account for self/minor

This is to confirm that I have approached svc co.operative Bank
(strike off whichever option is inapplicable)'
's'";tL that ds per rhe existrng PMLA Guidelines submission of Proof of ldentity and Proof of
I am given to understand tron,, tn"
Aclclre-ss are mandatory reqttirements for opening ofthe account'

lamalsogiventounderstandbytheBankthataspertheguidelinesmentionedabove,anyofthefollowingofnciallyValid
of availing any subsidy
Documents (ovD) are accepted ty tt in lleu of ihe Aadhiar, in case, the constituent is not desirous
"-o"rt
from the Central/ State Government:

OVD: Voter's lD or Driving License or Passport or NREGA

Card

However, I am submitting my Aadhaar details [check

relevant box' only)

Voluntarily 0R am Desirous of Availing SubsidY

I would also like to (check relevant box, onlyl

ndertake eKYC Provided bY UIDAI OR t Physical Document

Agencv), to fetch my Demographic details and

#*-*ffffi.ized by urDAr to underrake the eKyc as a KUA (Kyc user
photograph from the CIDR rnrint"inJ by UIDAI for the purposes mentioned
U"L*.-tt mode of authentication' in order to
"
fetch tire details shall be,

OR OTP
FingerPrint
to
VID will be entered by me in the application and the Bank is authorized
The full 12-digit Aadhaar number or the 16-digit defined bY UlDAl The
per the guideline"s issued bv.u.lDAl with necessary securitv meas ures as
;;;;;;"-ilf,;J;;mber as
not sent bacl( Dy u luAr'
biomel ri(s are not stored by the Bank and be submitted.
ln case of eKyc, I am gir"n to ,naJ.rir"J it ri,r'" tria ."py of the Aadhaar card need not
"rro
onlv and the last four disits is alreadv
manner
##:ftXffi;be shared by me ro rhe Bank in a redacred
mentioned above

Purposes:

l.TheAadhaardetailsaresharedforthepurposeofcreatingadepositand/orborroweraccountandtocomplywith
the PMLA aspects related to KYC
ll. Sharing with the external bodies

same will be shared -rhe

by c;;;;i;;p"?
a.TheAadhaar(Iast4digits)alrdtherelateddemographicinfolma^tionincludingname,DoBandaddr€ssshallbesharedwith
pr"rLa guidetines
vo* cur,or"i i.g,ri;;i;riy;j-;r"ir"i,,"d generated from
cenrrar Know
card
rhe Aadhaar ."r" oiir"g" rnl."J; uttu it o"put
tin
PDF/,PEG
"
elecrronically as well as the image-of
the UIDAI site
Agencv) as
,"f".r:;;r,;:;"i'^, ,aa..rr"*i,i, ""y or tn" xne (KYc. Registration
b.lntheeventlwishtoopenadepositoryaccountwiththeBank,theBankshallsharet}relast4digitsofAadhaarandthe
,jo, for the purpose
related demograph,. "ra,ue rill-ea uv *" 6"nt '"itt' tt'e
""rr",snatt atro R and T Agent
uy tne rRe r"grraii'i;.'il;';;;;"m;;"
stiDutated
resulatio.n act Financial lnrormation
to
in lndia rrom time to rime as per crc
. :i$il?H:*:,:""1""t;X"jfr'::.".porared t" trt"'lr,i,ilp"ii (other than the last four digits of
rnformatronuti[t,", ,n"orpol"uill"r.""- n^i"'i, i ,n" ""a "'ir""ti"
Aadhaar numberJ

j.2-disit J".oe;hi. ;","ih rhull be shared with NHB/HUDco

d.lncase,lwouldliketoavailthesubsidyunderPMAYPradhanMantriAwaSYolana(Urban)CreditLinkedSubsidySchemes
A"dh'j:;'"lr;;; ""i ,n"'."i","a
craim then, the
30
 1z-digit Aadhaar number will be
e. In case, I am desirous of receiving direct benefit from Government to this account, the
to map my account with NPCI as defined by the
shared with Npcl and am aware I will have to fill a separate application
regulations
entity, other than those mentioned
i t a'm atso informed Uy the Bank that they will not share the information with any other
is mandated by law like the lncome Tax
above, whatsoever, without my explicit;ermission, except where the disclosure
Garnishee order etc.
I understand English Yes: No:

or if Illiterate or Visually Challenged.

The below table is to be filled only if the constituent does not understand E nglish*
*Witnessr
*[should write in his/her known language, that Iother than Branch o fficial)
content is understood and is acceptable ) Have read and explained the contents ofthis consent

Name of the Witness:-

Signature of the witness:

I, hereby, confirm and declare that I have understood and accepted the terms stated above'
-
Signature ofthe Applicant:
Name of the Applicant: