CENTRAL KYC REGISTRY | Know Your Customer (KYC) Application Form | Individual

Important Instructions:
A) Fields marked with ‘*’ are mandatory fields. E) List of State / U.T code as per Indian Motor Vehicle Act, 1988 is available at the end.

B) Please fill the form in English and in BLOCK letters. F) List of two character ISO 3166 country codes is available at the end.
C) Please fill the date in DD-MM-YYYY format. G) KYC number of applicant is mandatory for update application.
D) Please read section wise detailed guidelines / H) For particular section update, please tick (3)inthebox available before the
instructions at the end. section number and strike off the sections not required to be updated.

For office use only Application Type* New Update

(To be filled by financial institution)

KYC Number

Account Type* Normal Simplified (for low risk customers) Small

A. In case of Existing Customer, please specify your loan account number below :

Loan Account Number :

1. PERSONAL DETAILS (Please refer instruction A at the end)

Prefix First Name Middle Name Last Name
Name* (Same as ID proof)

Maiden Name (If any*)

Father / Spouse Name*

(Please tick wherever is applicable)
Mother Name*

Date of Birth* D D M M Y Y PHOTO

Gender* M- Male F-Female T-Transgender

Marital Status* Married Unmarried Others

Citizenship* IN-Indian Others (ISO 3166 Country Code)
Residential Status* Resident Individual Non Resident Indian
Foreign National Person of Indian Origin
Signature / Thumb
Occupation Type* S-Service ( Private Sector Public Sector Government Sector) Impression

O-Others ( Professional Self Employed Retired Housewife Student)

B-Business
X-Not Categorised
Activities Engaged In (Please tick wherever is applicable)
Antique Dealers Dealers in Arms Bullion Dealers
Conducting Money Service Bureau such as money exchangers Exports/Imports Activity.
Real Estate & Constuction Business Politically Exposed Person
Networth (Assets – Liabilities) Less than Rs. 5 Crore Rs. 5 Crore or More

2. TICK IF APPLICABLE RESIDENCE FOR TAX PURPOSES IN JURISDICTION(S) OUTSIDE INDIA (Please refer instruction B at the end)

ADDITIONAL DETAILS REQUIRED* (Manadatory only if section 2 is

ticked) ISO 3166 Country Code of Jurisdiction of Residence*
Tax Identification Number or equivalent (If issued by
jurisdiction)* Place / City of Birth* ISO 3166 Country Code of Birth*

3. PROOF OF IDENTITY (PoI)* (Please refer instruction C at the end)

(Certified copy of any one of the following Proof of Identity[PoI] needs to be

submitted) A- Passport Number Passport Expiry Date D D M M Y Y

B- Voter ID Card

C- PAN Card

D- Driving Licence Driving Licence Expiry Date D D M M Y Y

E- UID (Aadhaar)

F- NREGA Job Card

Z- Others (any document notified by the central government) Identification Number

S- Simplified Measures Account - Document Type code Identification Number

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 4. PROOF OF ADDRESS (PoA)*
4.1 CURRENT / PERMANENT / OVERSEAS ADDRESS DETAILS (Please see instruction D at the end)
(Certified copy of any one of the following Proof of Address [PoA] needs to be submitted)

Address Type* Residential / Business Residential Business Registered Office Unspecified

Proof of Address* Passport Driving Licence UID (Aadhaar)

Voter Identity Card NREGA Job Card Others

Simplified Measures Account - Document Type code

Address
Line 1*
Line 2
Line 3 City / Town / Village*
District* Pin / Post Code* State / UT Code* ISO 3166 Country Code*

4.2 CORRESPONDENCE / LOCAL ADDRESS DETAILS * (Please see instruction E at the end)

Same as Current / Permanent / Overseas Address details (In case of multiple correspondence / local addresses, please fill ‘Annexure A1’)
Line 1*
Line 2
Line 3 City / Town / Village*
District* Pin / Post Code* State / UT Code* ISO 3166 Country Code*

4.3 ADDRESS IN THE JURISDICTION DETAILS WHERE APPLICANT IS RESIDENT OUTSIDE INDIA FOR TAX PURPOSES* (Applicable if section 2 is ticked)
Same as Current / Permanent / Overseas Address details Same as Correspondence / Local Address details
Line 1*
Line 2
Line 3 City / Town / Village*
District* ZIP / Post Code* ISO 3166 Country Code*

5. CONTACT DETAILS (All communications will be sent on provided Mobile no. / Email-ID) (Please refer instruction F at the end)

Tel. (Off) Tel. (Res) (M)

FAX Email ID

6. DETAILS OF RELATED PERSON (In case of additional related persons, please fill ‘Annexure B1’ ) (please refer instruction G at the end)

Addition of Related Person Deletion of Related Person KYC Number of Related Person (if available*)

Related Person Type* Guardian of Minor Assignee Authorized Representative

Prefix First Name Middle Name Last Name
Name*
(if KYC number and name are provided, below details of section 6 are optional)
PROOF OF IDENTITY [PoI] OF RELATED PERSON* (Please see instruction (H) at the end)

A- Passport Number Passport Expiry Date D D M M Y Y

B- Voter ID Card

C- PAN Card

D- Driving Licence Driving Licence Expiry Date D D M M Y Y

E- UID (Aadhaar)

F- NREGA Job Card

Z- Others (any document notified by the central government) Identification Number

S- Simplified Measures Account - Document Type code Identification Number

7. REMARKS (If any)

8. APPLICANT DECLARATION
I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I under take 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 consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/email address.

Date : D D M M Y Y Place : Signature / Thumb Impression of Applicant

Original seen & verified by Signature

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 Annexure A1

CENTRAL KYC REGISTRY | Know Your Customer (KYC) Application Form | Individual | Correspondence | Local Address | Related Person

Important Instructions:
A) Fields marked with ‘*’ are mandatory fields. E) List of State / U.T code as per Indian Motor Vehicle Act, 1988 is available at the end.
B) Please fill the form in English and in BLOCK letters. F) List of two character ISO 3166 country codes is available at the end.
C) Please fill the date in DD-MM-YYYY format. G) KYC number of applicant is mandatory for update application.
D) Please read section wise detailed guidelines / H) For particular section update, please tick (3)inthebox available before the section
instructions at the end. number and strike o f the sections not required to be updated.

For office use only Application Type* New Update

(To be filled by financial institution)
KYC Number (Mandatory for KYC update request)

1. CORRESPONDENCE / LOCAL ADDRESS DETAILS (Please see instruction E at the end)

Same as Current / Permanent / Overseas Address details (In case of multiple correspondence / local addresses, please fill ‘Annexure A1’)

Line 1*
Line 2
City / Town /
Line 3 Village*
District* Pin / Post Code* State / UT Code* ISO 3166 Country Code*

2. CONTACT DETAILS (All communications will be sent on provided Mobile no./ Email-ID) (Please refer instruction F at the end)

Tel. (Off) Tel. (Res)

FAX

3. APPLICATION DECLARATION
I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I under tak e 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.
Signature / Thumb Impression

Date : D D M M Y Y Y Y Place : Signature / Thumb Impression of Applicant

3
 Annexure B1

CENTRAL KYC REGISTRY | Know Your Customer (KYC) Application Form | Individual | Related Person

Important Instructions:
A) Fields marked with ‘*’ are mandatory fields. E) List of State / U.T code as per Indian Motor Vehicle Act, 1988 is available at the end.
B) Please fill the form in English and in BLOCK letters. F) List of two character ISO 3166 country codes is available at the end.
C) Please fill the date in DD-MM-YYYY format. G) KYC number of applicant is mandatory for update application.
D) Please read section wise detailed guidelines / H) For particular section update, please tick (3)inthebox available before the section
instructions at the end. number and strike o f the sections not required to be updated.

For office use only Application Type* New Update

(To be filled by financial institution) KYC Number (Mandatory for KYC update request)

1. DETAILS OF RELATED PERSON (Please see instruction G at the end)

Addition of Related Person Deletion of Related Person KYC Number of Related Person (if available*)

Related Person Type* Guardian of Minor Assignee Authorized Representative

Prefix First Name Middle Name Last Name
Name*
(if KYC number and name are provided, below details of section 1 are optional)

PROOF OF IDENTITY [PoI] OF RELATED PERSON* (Please see instruction (H) at the end)

A- Passport Number Passport Expiry Date D D M M Y Y

B- Voter ID Card

C- PAN Card

D- Driving Licence Driving Licence Expiry Date D D M M Y Y

E- UID (Aadhaar)

F- NREGA Job Card

Z- Others (any document notified by the central government) Identification Number

S- Simplified Measures Account - Document Type code Identification Number

2. APPLICANTS DECLARATION
I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I under take 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.
[Employee / Thumb & Signature]

Date : D D M M Y Y Place : Signature / Thumb Impression of Applicant

3. ATTESTATION / FOR OFFICE USE ONLY

Documents Received Certified Copies
KYC VERIFICATION CARRIED OUT BY INSTITUTION DETAILS

Date
Name
Emp. Name
Code
Emp. Code
Emp. Designation

Emp. Branch
[Institution Stamp]

[Employee Signature]