Account Opening Supplement–CKYCR (Central KYC Records Registry) Additional Data Capture

This form must be completed by any individual who wishes to open a banking account. This form is supplemental
to the account opening form and all information provided in this supplemental account opening form and the
account opening form are true and accurate. Please use separate form for each individual account holder. Please
fill in Block Letters.
The Government of India has authorised the Central Registry of Securitisation Asset Reconstruction and Security
Interest of India (CERSAI), to act as, and to perform the functions of the CKYCR. Standard Chartered Bank shall
share your KYC data by uploading the same with CERSAI in accordance with the operational guidelines.

For Office Use Only Application Type New Update BAR Code
CKYC Number

Personal Details
Mr Sandeep Kumar Ramesh Jain
Full Name
Prefix First Name Middle Name Last Name
Maiden Name (If Any)

Ms PRIYANKA
Spouse's name
Prefix First Name Middle Name Last Name
Mrs OMMA DEVI
Mother’
s Name
Prefix First Name Middle Name Last Name
Citizenship IN –India Others Country of Residence India

Gender Male Female Others

Country of Birth
District –
Residence Address
Residential Status
Place/City of Birth
India
(For NR clients)
District –
CHENNAI Chennai
Permanent Address
Resident Individual Non Resident Indian Foreign National Person of Indian Origin

Service Please tick [ Private / Public / Government ]

Occupation Type Others Please tick [ Professional / Self Employed / Retired / Housewife / Student ]

Business Not Categorised

Passport Voter ID PAN Driving License

Proof of Identity
UID (Aadhaar) NREGA Job Card Others

Document Number XXXXXXXX6155 Document Expiry

Passport Voter ID Driving License
Proof of Address
UID (Aadhaar) NREGA Job Card Others

Document Number XXXXXXXX6155 Document Expiry

Tax identification
Number (For NR Mortgage)

Applicant's Signature For Office Use

Sales ID 2075006
Signature

Referral ID 2092944
Date 07/10/2023
The application is sourced electronically, hence does not need the signature of a Bank Representative.
By performing mobile OTP check successfully, I/We accept and agree to the aforesaid terms, client terms,
product terms and most important document and this acceptance shall have the same validity, admissibility and
enforceability as if signed by you in physical form and you agree not to challenge the validity, admissibility and
enforceability of such terms and conditions only on the basis that they are in electronic form.

Applicant Name : Sandeep Kumar Ramesh Jain

Date : 07/10/2023
Time :17:47:51 IST
Mobile Number:+91-7652940900

Printed