1. Gross Annual Income Details Please tick () Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs >25 Lacs
[OR]
Net-worth in v as on (date)
Know Your Client (KYC)
Application Form (For Individuals Only) Application No. :
Ver. 02-2012
1. Name of Applicant (As appearing in supporting identifi cation document)
DECLARATION
I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake
to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or
misleading or misrepresenting, I am aware that I may be held liable for it. I hereby authorise sharing of the information
furnished on this form with all SEBI registered KYC Registration Agencies.
Place : Date :
Name
Father's /
Spouse's Name
A. Identity Details (please see guidelines overleaf)
SIGNATURE OF APPLICANT
I
5. PAN Please enclose a duly attested copy of your PAN Card.
Unique Identifi cation Number (UID)/Aadhaar, if any
4. Status Please tick () Resident Individual Non Resident Foreign National (Passport copy mandatory for NRIs and Foreign Nationals)
6. Proof of Identity submitted for PAN exempt cases Please tick ()
UID (Aadhaar) Passport Voter ID Driving License Others (please see guideline 'D' overleaf)
2a. Gender Please tick () Male Female 2b. Marital Status Please tick () Single Married
2c. Date of Birth D D / M M / Y Y Y Y
D D / M M / Y Y Y Y
D D / M M / Y Y Y Y
3. Nationality Please tick () Indian Others Please specify
B. Address Details (please see guidelines overleaf)
2. Contact Details
4. Permanent Address of Resident Applicant if different from B1 above OR Overseas Address (Mandatory) for Non-Resident Applicant
1. Address for Correspondence
City / Town / Village Postal Code
State Country
E-Mail Id.
Tel. (Off.) (ISD) (STD) Tel. (Res.) (ISD) (STD)
Mobile (ISD) (STD) Fax (ISD) (STD)
City / Town / Village Postal Code
State Country
2. Occupation Details (Please tick () any one and give brief details)
Private Sector Service Public Sector Government Service Business Professional Agriculturist Retired Housewife
Student Forex Dealer Others (Please specify)
3. Please tick if applicable: Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP) For defi nition of PEP, please refer guideline overleaf
4. Any other information:
C. Other Details (please see guidelines overleaf)
Please specify
3. Proof of address to be provided by Applicant. Please submit ANY ONE of the following valid documents & tick () against the document attached.
Passport Ration Card Registered Lease / Sale Agreement of Residence Driving License Voter Identity Card *Latest Bank Account Statement/Passbook
*Latest Telephone Bill (only Land Line) *Latest Electricity Bill *Latest Gas Bill Others Please specify *Not more than 3 months old.
5. Proof of address to be provided by Applicant. Please submit ANY ONE of the following valid documents & tick () against the document attached.
Passport Ration Card Registered Lease / Sale Agreement of Residence Driving License Voter Identity Card *Latest Bank Account Statement/Passbook
*Latest Telephone Bill (only Land Line) *Latest Electricity Bill *Latest Gas Bill Others Please specify *Not more than 3 months old.
(* Net worth should not be older than 1 year)
PHOTOGRAPH
Please affix
a recent passport
size photograph and
sign across it
Seal/Stamp of the intermediary should contain
Staff Name
Designation
Name of the Organization
Signature
In Person Verifi cation
AMC/Intermediary name OR code
(Originals Verifi ed) Self Certifi ed Document copies received
(Attested) True copies of documents received
FOR OFFICE USE ONLY IPV Done on
Please fill this form in ENGLISH and in BLOCK LETTERS.
Seal/Stamp of the intermediary should contain
Staff Name
Designation
Name of the Organization
Signature
Date
Documents Attestation
A. IMPORTANT POINTS:
1. Self attested copy of PAN card is mandatory.
2. Copies of all documents that are submitted need to be
compulsorily self-attested by the applicant and accompanied by
originals for verifi cation. In case the original of any document is
not produced for verifi cation, then the copies should be properly
attested by entities authorized for attesting the documents,as
per the list mentioned under [E].
3. If any proof of identity or address is in a foreign language, then
translation into English is required.
4. Name & address of the applicant mentioned on the KYC
form,should match with the documentary proof submitted.
5. If correspondence & permanent addresses are different, then
proofs for both have to be submitted.
6. Sole proprietor must make the application in his individual name
& capacity.
7. For non-residents and foreign nationals,(allowed to trade subject
to RBI and FEMA guidelines), copy of passport/PIOCard/OCICard
and overseas address proof is mandatory.
8. In case of Merchant Navy NRI’s, Mariner’s declaration or certifi ed
copy of CDC (Continuous Discharge Certifi cate) is to be submitted.
9. For opening an account with Depository participant or Mutual
Fund, for a minor, photocopy of the School Leaving Certifi cate/
Mark sheet issued by Higher Secondary Board/Passport of Minor/
Birth Certifi cate must be provided.
10. Politically Exposed Persons (PEP) are defi ned as individuals who
are or have been entrusted with prominent public functions
in a foreign country, e.g., Heads of States or of Governments,
senior politicians, senior Government/judicial/military offi cers,
senior executives of state owned corporations, important political
party offi cials,etc.
B. Proof of Identity (POI): List of documents admissible as
Proof of Identity (*Documents having an expiry date
should be valid on the date of submission.):
1. PAN card with photograph. This is a mandatory requirement
for all applicants except those who are specifi cally exempt from
obtaining PAN (listed in Section D).
2. Unique Identifi cation Number (UID) (Aadhaar)/Passport/Voter ID
card/Driving license.
3. Identity card/ document with applicant’s Photo, issued by any of
the following: Central/State Government and its Departments,
Statutory/Regulatory Authorities, Public Sector Undertakings,
Scheduled Commercial Banks, Public Financial Institutions,
Colleges affi liated to Universities, Professional Bodies such as
ICAI, ICWAI, ICSI, Bar Council etc., to their Members; and Credit
cards/Debit cards issued by Banks.
C. Proof of Address (POA): List of documents admissible as
Proof of Address: (*Documents having an expiry date
should be valid on the date of submission.)
1. Passport/Voters Identity Card/Ration Card/Registered Lease or
Sale Agreement of Residence/Driving License/Flat Maintenance
bill/Insurance Copy.
2. Utility bills like Telephone Bill (only land line),Electricity bill or
Gas bill -Not more than 3 months old.
3. Bank Account Statement/Passbook -Not more than 3 months
old.
4. Self-declaration by High Court and Supreme Court judges, giving
the new address in respect of their own accounts.
5. Proof of address issued by any of the following: Bank Managers
of Scheduled Commercial Banks/Scheduled Co-operative Bank/
Multinational Foreign Banks/Gazetted Offi cer/Notary public/
Elected representatives to the Legislative Assembly or Parliament/
Documents issued by any Govt. or Statutory Authority.
6. Identity card/document with address, issued by any of the
following: Central/State Government and its Departments,
Statutory/Regulatory Authorities, Public Sector Undertakings,
Scheduled Commercial Banks, Public Financial Institutions,
Colleges affi liated to Universities and Professional Bodies such
as ICAI, ICWAI,ICSI,Bar Council etc.,to their Members.
7. The proof of address in the name of the spouse may be accepted.
D. Exemptions/clarifications to PAN (*Sufficient documentary
evidence in support of such claims to be collected.)
1. In case of transactions undertaken on behalf of Central
Government and/or State Government and by offi cials appointed
by Courts e.g. Offi cial liquidator,Court receiver etc.
2. Investors residing in the state of Sikkim.
3. UN entities/multilateral agencies exempt from paying taxes/fi ling
tax returns in India.
4. Micro schemes such as Systematic Investment Plan (SIP), where
aggregate of installments in a rolling 12 month period or in a
fi nancial year i.e. April to March does not exceed Rs 50,000.
E. List of people authorized to attest the documents after
verification with the originals:
1. Authorised offi cials of Asset Management Companies (AMC).
2. Authorised offi cials of Registrar & Transfer Agent (R&T) acting
on behalf of the AMC.
3. KYD compliant mutual fund distributors.
4. Notary Public, Gazetted Offi cer, Manager of a Scheduled
Commercial/Co-operative Bank or Multinational Foreign Banks
(Name,Designation & Seal should be affi xed on the copy).
5. In case of NRIs, authorized offi cials of overseas branches of
Scheduled Commercial Banks registered in India, Notary Public,
Court Magistrate, Judge, Indian Embassy/Consulate General in
the country where the client resides are permitted to attest the
documents.
6. Government authorised offi cials who are empowered to issue
Apostille Certifi cates.
F. List of people authorized to perform In Person Verification
(IPV):
1. Authorised offi cials of Asset Management Companies (AMC).
2. Authorised offi cials of Registrar & Transfer Agent (R&T) acting
on behalf of the AMC.
3. KYD compliant mutual fund distributors.
4. Manager of a Scheduled Commercial/Co-operative Bank or
Multinational Foreign Banks (for investors investing directly).
5. In case of NRI applicants, a person permitted to attest documents in
E(5) above, may also conduct the In Person Verifi cation and confi rm
this in the KYC Form.
INSTRUCTIONS / CHECK LIST FOR FILLING KYC FORM
alok
graphics
Please Submit the KYC Documents on A4 Size Paper Only.