CUSTOMER INFORMATION FORM (Individuals)

Customer General Staff Minor Senior Citizen

Constitution Share Holder NRI Others please state _____________________

Personal Details *Each Joint Applicant/Guardian should fill up separate Personal Information Sheet

Name Mr./Mrs./Ms. ________________________________________________________________________________

(First Name) (Middle Name) (Last Name)
Date of Birth: D D M M Y Y Y Y Gender: Gender: Male Female Others

Minor: Yes (Please provide guardian details) No

Senior Citizen: Yes (Age Proof) No Shareholder: Yes No
Religion: Hindu / Muslim / Christian / Sikh / Jain / Zorastrian / Buddhist / Others _________________________________
PAN No.: (if not please fill Form 60/61) Form 60/61(enclosed)

Aadhaar UIN No.: Nationality: _________________________________

Passport No.:

Date of Issue: D D M M Y Y Y Y Date of Expiry: D D M M Y Y Y Y

Marital Status: Married Single No. of Dependents: ____ Adults _____ Children
ADDRESS PERMANENT CORRESPONDENCE
Flat / Door / Block No.
Name of Premises / Building
/ House name
Road / Street / Lane / Post
Office
City and District
Pincode
State
Country

Phone No Mobile Fax

Other Details
Educational Qualification Non-matricualtion SSC/HSC Undergraduate Gradute
Postgraduate (General) Post Graduate (Professional)
Occupation Salaried Self Employed Professional Politician Housewife
Retired Student Dependent Others _____________________
If salaried, employed with Public Limited Company Private Limited Company Others ___________
Government Employee Bank Employee
Name of the company _______________________________________________________________________
Designation _______________________________________________________________________
If Self-employed, profession CA Engr. Doctor Trader Lawyer Consultant Other _______
If in business Public Limited Private Limited Proprietorship Partnership Others ____
Income Group (p.a.) <50,000 50,000-1,00,000 1,00,000-3,00,000
3,00,000-5,00,000 5,00,000-10,00,000 >10,00,000
Residence Ownership Rental Ancestral Company Provided Purchased against loan
Life Insurance Value upto 2 lakhs upto 5 lakhs above 5 lakhs
Existing loans Vehicle Home Personal Education Business
Assets Ownership
Consumer durable ownership: Computer Microwave LCD Television
Digital Camera DVD Player Home Theatre System
Projection Television Airconditioner
Vehicle Ownership: Car Two Wheeler None Both
Car Model & Make: ___________________________________________________________________________

Banking Relations with other Banks:

Name of the Bank _________________________ A/c No.
Name of the Bank _________________________ A/c No.
 Identification Details
Identification Details
Any one document from each of the undernoted two columns for a photo-identity and proof of address (Please tick the appropriate box)
Proof of identity Proof of address
a) Valid Passport a) Utility bill which is not more than 2 months old of any service provider
b) PAN Card (electricity, telephone, postpaid mobile phone, piped gas, water bill):
c) Voter’s Identity card b) Aadhar card/Valid passport with same address/valid driving license/
d) Valid Driving License voter Id card
e) identity card with applicant’s photograph issued c) Identity card with applicant’s Photograph issued by Central/
by Central/State Government Departments, State Government Departments Statutory/Regulatory Authorities,
Statutory/Regulatory Authorities, Public Sector Public Sector Undertakings, Scheduled Commercial Banks and
Undertakings, Scheduled Commercial Banks and Public Financial institutions.
Public Financial d) Letter issued by a gazetted officer, with a duly attested photograph
f) Job cards issued by NREGA duly signed by an of the person
officer of the State Government e) Property or Municipal Tax receipt.
g) Aadhar Card f) Bank A/c or Post office savings bank A/c statement
g) Pension or family pension payment orders (PPOs) issued to retired
employees by Government Departments or Public Sector
Undertakings, if they contain the address.
h) Letter of allotment of accommodation from employer issued by
State or Central Government departments, statutory or regulatory
bodies, public sector undertakings, scheduled commercial banks,
financial institutions and listed companies. Similarly, leave and
license agreements with such employers allotting official
accommodation.
I) Documents issued by Government departments of foreign
jurisdictions and letter issued by Foreign Embassy or Mission in
India.

Identification Details

Photograph

Signature of applicant Place :.................................................

Guardian in case of minor Date :..........................................
For Bank Use Only
Date : D D M M Y Y Y Y Customer ID : Signatures

1 Details Input By Name :

2 Details Verified By Name :

3 Branch Head Name :

KYC AND RISK PROFILE CERTIFICATION

Name of the Issuing Place of Expiry date
No Proof Type Number Date of issue
document authority issue
1 Identity

Address

2 Identity

Address

KYC Certification
We have perused the Original Documents and as per KYC norms all are correct. Further to know about the customer we have enquired locally and/or we
personally visited the places of addresses given by the customer, to ascertain the correctness. All the signatories have signed before m. I authorize opening of
the account. Also we certify that according to the nature of Business/activity, this account may be treated under the below selected risk category.
RISK LEVEL LOW MEDIUM HIGH
I also confirm that the form has been signed by the applicant in my presence.
Name of Bank Official: _________________________________________________ ______________________________
Place: _______________________________ Date: _____________________ Signature of Bank Official