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    New CVL-KRA-Individual-Form

    Uploaded by

    Trilokynath
    New KYC form is introduced by CVL KRA. This form is having editable fields and can be filled as normal form and pdf can be generated easily.

    Copyright:

    © All Rights Reserved

    New CVL-KRA-Individual-Form

    Uploaded by

    Trilokynath
    248 views2 pages
    New KYC form is introduced by CVL KRA. This form is having editable fields and can be filled as normal form and pdf can be generated easily.

    Copyright

    © © All Rights Reserved

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    New KYC form is introduced by CVL KRA. This form is having editable fields and can be filled as normal form and pdf can be generated easily.

    Copyright:

    © All Rights Reserved
    248 views2 pages

    New CVL-KRA-Individual-Form

    Uploaded by

    Trilokynath
    New KYC form is introduced by CVL KRA. This form is having editable fields and can be filled as normal form and pdf can be generated easily.

    Copyright:

    © All Rights Reserved
    of 2

    Know Your Client (KYC)

    Intermediary
    Application Form (For Individuals Only) CDSL VENTURES LIMITED
    Logo
    ….Exploring New Horizons

    Please fill the form in ENGLISH and in BLOCK letters

    Fields marked * are mandatory Application Number:


    +
    Fields marked are pertaining to CKYC and mandatory only if processing CKYC
    also Application Type*:  New KYC  Modification KYC
    KYC Mode*: Please Tick (✓)

    Normal EKYC OTP EKYC Biometric Online KYC Offline EKYC Digilocker

    1. Identity Details (please refer guidelines overleaf)


    PAN* Please enclose a duly attested copy of your PAN Card
    ____________________________

    Name* (same as ID proof)


    Maiden Name+ (if any)
    Fathers/Spouse’s Name*
    Date of Birth*
    Gender* Male Female Transgender
    Marital Status* Single Married Recent passport size
    Nationality* Indian Other Applicant Photo

    Residential Status* Resident Individual Non Resident Indian


    Please Tick (✓)
    Foreign National Person of Indian Origin
    Cross Signature across photograph

    (Passport mandatory for NRIs, PIOs and Foreign Nationals)

    Proof of Identity (POI) submitted for PAN exempted cases (Please tick)
    A — Aadhaar Card XXXX XXXX __ __ __ __
    B — Passport Number (Expiry Date)

    C — Voter ID Card
    (Expiry Date)
    D —Driving License
    E —NREGA Job Card
    F — NPR
    Z —Others (any document notified by Central Government)

    Identification Number

    2. Address Details* (please refer guidelines overleaf)


    A. Correspondence/ Local Address*
    Line 1*
    Line 2
    Line3
    City/Town/Village* District* Pin Code*
    State* Country*
    Address Type* Residential/Business Residential Business Registered Office Unspecified

    Applicant e-SIGN

    1
    B. Permanent residence address of applicant, if different from above A / Overseas Address* (Mandatory for NRI Applicant)
    Line 1*
    Line 2
    Line3
    City/
    Town/Village* District* Pin Code*
    State* Country*
    Address Type* Residential/Business Residential Business Registered Office Unspecified
    Proof of Address* (attested copy of any 1 POA for correspondence and permanent address each to be submitted)
    A — Aadhaar Card XXXX XXXX __ __ __ __
    B — Passport Number (Expiry Date)

    C — Voter ID Card
    (Expiry Date)
    D —Driving License
    E —NREGA Job Card
    F — NPR Letter
    Z—Others (any document notified by Central Government)

    Identification Number

    3. Contact Details
    Email ID
    ________________________________________________________________________________________
    Mobile No. _____ ____________________________
    Tel (Off) _____ ____________________________ Tel (Res) _____ ____________________________

    4. Applicant Declaration
    I hereby declare that the details furnished above are true and Applicant e-SIGN Applicant Wet Signature
    correct to the best of my/our 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/We are aware that I/We may
    be held liable for it.
    I/We hereby consent to receiving information from CVL KRA
    through SMS/Email on the above registered number/Email ad-
    dress.
    DATE: _________________________ (DD-MM-YYYY)
    PLACE: _______________________________________

    5. For Office Use Only


    In-Person Verification (IPV) carried out by* Intermediary Details*

    IPV Date Self certified document copies received (OVD)

    Emp. Name True Copies of documents received (Attested)


    AMC / Intermediary Name :
    Emp. Code

    Emp. Designation

    Employee Signature and Stamp Institution Name and Stamp

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