Geojit Annual KYC Updation Form - Individual

Name of the Client Location Code Trade Code

DP Ids NSDL : IN300239 IN301637 CDSL : 12048900 Demat Id : PAN NO.

Address* * If there is any change in the address registered with us, please contact the nearest branch with a valid address proof (self attested)

Financial Details. (Please fill the below details in order to update our records.)

Annual Income (tick Below Rs 1 Lakh 1 -5 Lakh 5-10 Lakh 10-25 Lakh 25–50 Lakh
one)
50 Lakh –1 Crore 1–5 Crore 5–10 Crore Above 10 Crore
OR
Net worth as on (date) D D M M Y Y Y Y (Net worth should not be older than 1 year)
1) Source of Funds Salary Income Professional Income
Business Income Rental Income
(Please ensure to select at least one)
Fixed Deposits Agricultural Income
Sale of Assets Dividend Income
Loans Gifts
Ancestral Property Others: (pls specify) …………………………….
2) Professionals /Business Details* 1. Profession/Business Name : ……………………………
(applicable if professional Income/Business Income above 2. If Business, type of Business Activity: …………………………..
is selected)

Please tick, if applicable Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP)

I declare that I don’t have (In the case of trading account holder) Mobile Email
(In case there is a change/update in email or mobile number, please contact branch or HO)

Derivative (F&O, CDS and Commodities) clients should mandatorily attach any ONE of the below listed documents along with this form.

1. Copy of ITR Acknowledgment, 2. Copy of Form 16 in case of salary income, 3. Salary Slip,
4. Bank account statement for last 6 months 5. Copy of demat account Holding statement.

☞(Full signature required)

Occupation Details (please tick any Private Sector Public Sector Government Service Business Professional
one and give brief details)
Agriculturist Retired Housewife Student Others

Name of Employer / Establishment Designation

Office Address

State / Union Territory Country Pin code

Phone (with STD/ ISD codes) Mobile Fax

E-Mail ID Length of service with present employer (____Years____Months

Investment/Trading Experience Y Y Years in Capital Y Y Years in Commodities Y Y No Prior experience

Market

Value chain participant

Exporter

Commercial Participant (If yes, please specify) Importer

Hedger

Others ____________________

Client Profile (For commodity) OR

Financial Participant

Trader

Non commercial Participant (If yes, please specify) Arbitrager

Others ____________________

Changes may be effected in my all accounts under the above PAN

☞(Full signature required)
Date D D M M Y Y Y Y Place

Received Date Updated by Emp. Code and Sign

For HO Use
Rejected By Date of Updation /Rejection