M - 336(V-1.

1–09-2020)
Branch Instant Account Opening Form
For Individuals (Primary Applicant)
e-kyc / Non E-kyc

Product: A/c Num: ........................................................................................................................................... ...............................................

ORN: ______/_______ CKYC ID

First Name Middle Name Last Name Customer ID Date of Birth

Father’s Name Mother’s Name

Spouse Name Guardian Name

Joint Holder 2 Joint Holder 3 Joint Holder 4

Gender Married Nationality Religion PAN:

M / F / T Y / N
Aadhaar:
E Mail Mobile Profession Politically Exposed Qualification
Person (REP)
   YES      NO
Identity Proof Details Address Proof Details Nature of Business Annual Income / Turnover

Expiry Date: Expiry Date:

Address
(Permanent)

City:               State:               Pincode:

Address
Communication
(Mention mailing address if
different from
permanent address) City:               State:               Pincode:
Residence for Tax Purposes in Jurisdiction(s) Outside India - Y / N
Operating Initial Payment Amount
Instructions

Photo Photo Photo Photo

Signature (A/c holder 1) Signature (A/c holder 2) Signature (A/c holder 3) Signature (A/c holder 4)

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KYC details of Primary Applicant. (Joint account holder(s) have to submit separate KYC form)
Assets Owned Car House Two Gold Silver Land Four Wheeler
(Tick) Wheeler
Other Assets

Loans Availed Credit Personal Jewel Loan Professional Two Four Mortgage
(tick) Card Wheeler Wheeler
Housing
Other Loans

Investments Deposits Insurance Shares Mutual

(tick) Funds House :- Rented / Owned / Employers
Other
Investments
SMS Alert Debit Alert:   Yes / No Credit Alert: Yes / No Both: Yes / No

Amount above: ` Amount above: ` Amount above: `

E-Mail Alert Debit Alert:   Yes / No Credit Alert: Yes / No Both: Yes / No

Amount above: ` Amount above: ` Amount above: `

Rules and Regulations:

Account Opening: I/ We have checked and confirmed the details entered on the device. The terms and conditions, services,
product features, charges etc. have been explained to me/us. I/We understand that detailed Snd updated information on
all services, terms and conditions, rules and regulations etc. are available inside the welcome kit and also on the corporate
website www.kvb.co.in. I/We accept and agree to be bound by the said terms and conditions, and I/We understand that
changes to terms and conditions will be available in the corporate website www.kvb.co.in only.

Services and Charges: I/We understand that the Bank at its absolute discretion shall discontinue any of the services completely /
partially by issuing due notification to me/us. I/We agree that the Bank shall debit my/our account for service charges as
applicable from time to time with applicable service tax. I/We understand that any change to service charges/fees etc. will be
communicated to me/us 30 days in advance through SMS/e-mail. If no funds are available in the account to pay fees/charges,
I/We authorize Karur Vysya Bank Ltd. to set off any available credit, including amounts flowing into the account from collection
proceeds or any deposits.

Account close/freeze: I/We hereby authorize Karur Vysya Bank to close my/our account in-case (a) there are high occurrences
of dishonored payments in the account. (b) If it is suspected that my/our account is being misused as a money mule or as a
channel for unauthorized money pooling or as a conduit for any illegal activity. I/We hereby authorize Karur Vysya Bank to
freeze my/our account incase there is no operation in my/our account for a continuous period of 2 years.

Channel facilities: All channel facilities provided by Karur Vysya Bank including Debit cards, Internet Banking, Mobile Banking
etc. are subject to specific guidelines that are available in www.kvb.co.in. I/We am/are aware that Karur Vysya Bank does not
seek any information relating to sensitive credentials like ATM card number, CVV number, Internet Banking login ID/Password,
T-pin, Mobile Banking login/password, M-pin etc. through SMS/e-mail/phone/otherwise. I/We further agree and confirm that
Karur Vysya Bank shall not be liable for any losses arising from my/our sharing/disclosing of sensitive credentials to anyone.
I/We further agree to take all precautions to protect my/our account details so as to avoid any unauthorized use.

I/We hereby note to update the change to my/our personal details to the Bank. I/We agree to indemnify the Bank for any fraud,
losses & damages due to my/our providing wrong information or not providing information in time to Karur Vysya Bank.

Welcome kit acknowledgement: I/We hereby acknowledge that l/we have received the welcome kit with account number
_________________. I/We understand that the account shall be operated only after it has been activated and an SMS/E-mail
confirmation is sent to me/us by the Bank. I/We are aware that the delivery of welcome kit cannot be construed to mean that

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Karur Vysya Bank has agreed to open the account. The Bank at its sole discretion can reject my/our application without
assigning any reason whatsoever or call for additional documents. In case of rejection of my/our application, l/we undertake to
return the welcome kit to the Bank.
I/We declare that the information provided in the application form is true and correct to the best of our knowledge and belief.
Please do not sign the form if it is Blank. Please ensure all relevant sections and columns are completely filled to your satisfaction
and then sign the form.
Re-KYC (Applicable for existing customers):
□ I/We hereby declare that l/we are residing in the same address and there is no change in the mobile/contact no./Identity
address as detailed earlier. This can be treated as KYC re-verification.
□ I/We hereby declare that there is change in my residential address/Mobile no. (enclosed the proof for the same)

Signature A/c holder 1     Signature A/c holder 2     Signature A/c holder 3     Signature A/c holder 4
e-KYC resident consent (For paperless KYC verification): I hereby grant my explicit consent to the Bank to retrieve my
demographic details viz.. Name, Age, Gender, Address, Photograph etc. available with UIDAI (Unique Identification Authority of
India) and authorize the Bank to store the demographic details for their records. I understand that the details can be retrieved by
the Bank only when I furnish my Aadhaar number to the Bank and authenticate with my finger prints/iris on a biometric device,
and that my biometric finger prints / iris pattern details will be used by the Bank only for authentication of my details with UIDAI
and will not be stored by the Bank in electronic form or otherwise. I also understand that my details cannot be compromised
during electronic transfer of data as the Bank uses a secure medium of communication.

Signature of the primary account holder

I confirm that I personally know the applicant detailed herein for more than 6 months and confirm his / her identity and address.
Introducer ID: Introducer Name: Introducer A/c:

Canvassed By (code): Name: Signature of the Introducer

I hereby certify that this account opening form is complete in all respects and relevant documents have been obtained as per
the KYC guidelines of RBI. Due diligence has been performed to verify the genuineness of the customer.

Risk Category (Primary Customer): Low / Medium / High Date: Signature, seal & code of Bank Official
IF MINOR ACCOUNT
Name of the Parent / Guardian ___________________________________________________
Relationship □ Father □ Mother □By Court order (enclose a copy)
I shall represent the minor in all transactions of any description in the above account till the said minor attains majority. I shall fully indemnify the bank against any
claim of the above minor for any withdrawal/transaction made by me in his/her account.
DECLARATION OF THE GUARDIAN
*My minor son/daughter, Master/Miss ........................................................................................................ has opened on SB Account with your bank with
A/c No. ............................................................ in his/her own name. I declare the date of birth of the minor is .........../........../..........
*l have opened a joint SB A/c with your bank in the name of myself and my minor son/daughter, Master/Miss ................................................................... with A/c No.
....................................................... I declare the Date of birth of the minor is ........./......../..............
*l am his/her natural and lawful guardian. *l am the guardian appointed by the court vide order dated ........../........../.......... (Copy enclosed).
For the sake of operational convenience, I have requested the bank to issue an ATM Debit Card to my minor son/daughter to be used by him/her. I will explain
to the minor, the rules of operation of the account as well as safeguards to be followed while using ATM Debit Cards. I will suitably guide my son/daughter for the
safekeeping of the ATM Debit card and maintaining the secrecy of PIN number allotted to him/her. I will also explain the consequences of loss/misuse/abuse of
the ATM card. I undertake to supervise the use of the ATM debit card by the minor and the account would be operated under my guidance and I will monitor the
transactions done through ATM. I will not hold the bank responsible and liable for any transactions done by the minor and I undertake not to make any claim against
the Bank for consequences arising out of unauthorized use/misuse/abuse of the card. All the transactions done using the ATM Debit Card will bind me, as if done
by me only.

*Strike out whichever is not applicable. SIGNATURE OF THE GUARDIAN

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 FORM NO. 60
(See third proviso to rule 114B)
Declaration to be filled by a person who does not have either a PAN or General Index Register Number and who makes
payment in cash in respect of transaction specified in clauses (a) to (h) of Income Tax Rule 114B.
Full name of the Declarant Account Number

Address of the Declarant

Particulars of transaction: Amount of transaction If applied for PAN and it is not yet generated

Opening of Savings / Current A/c Date of application _________________ Acknowledge number _________________
If PAN not applied, fill estimated total income (including income of spouse, minor child etc. as per Section 64 of Income-tax Act 1961) for the
financial year in which the above transaction is held
a. Agricultural Income (`) ________________ b. Other than agricultural Income (`) ___________________

Details of document being produced in support of address

Declaration by Customer
I do hereby declare that what is stated above is true and correct to the best of my knowledge and belief. Verified today, the ________________
day of __________ 20___
Date :
Place : Signature of the Declarant

Nomination Form (DA-1) - Nomination under Section 45ZA of the Banking Regulation Act,1949 and Rule2(1) of the Banking Companies
(Nomination) Rules,1985
Bank has explained to me the benefits of availing nomination for deposits. I/We do not wish to avail nomination facility.
I/We nominate the following person to whom in the event of my/our death, the eligible amount outstanding in the account
____________________ shall be returned by The Karur Vysya Bank Ltd. _______________________________ branch in which the deposit is
held.
Account Type: Account No. Nominee Name Date of Birth Relationship

Address Gender - Μ / F / Τ

Mobile No. ______________________

Strike out if nominee is not a minor

As the nominee is a minor on this date, l/we appoint Shri/Smt/Kum ________________________________ Aged ______ currently residing at

To receive the amount of deposit on behalf of the nominee in the event of my/our minor’s death during the minority of the nominee.

Name of witness 1: Address of witness 1:

Name of witness 2: Address of witness 2:

Place:
Date : Signature of the account holders

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Tear Off Portion - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Acknowledgement to customer for Nomination Registration by Bank

The Karur Vysya Bank Limited Nominee Name and Address

Account Number: Nominee Relationship

Registration No. & Date

Signature of Manager / Officer

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 Application for E-services
For Individuals / Corporate Photo
Please paste colour stamp
size photo here. Please
Please fill all the details in CAPITAL LETTERS and in BLACK INK only. do not use pins, staples
or tape

Branch Name: _____________________________ Branch Code: _________ Date _____________

ACCOUNT
CUSTOMER ID
NO.
I/We wish to apply for the following Ε-Services with your bank. I/We furnish the details of my/our account for which the facility
shall be enabled.
FACILITY / SERVICES REQUIRED
ATM Card Debit Card Add on Card Alert (Mob / E-mail) Internet Banking Mobile Banking (M-pay)

Mr./Ms/ ACCOUNT NAME: (IN THE ORDER OF FIRST, MIDDLE & LAST NAME) leave space between words.
Messers

Fill up the rows applicable to the facility requested

1. ATM/DEBIT CARD
(Name to appear on the card)
   PHOTO CARD YES NO ADD ON CARD : YES NO
2. ADD ON CARD DETAILS CUSTOMER ID JOINT HOLDER NON CUSTOMER (Joint applicant Form to be attached)
   ADD ON CARD (Name to appear on the card)
3. ALERT: SMS / E-mail ID     Customer ID               Mobile Number / E-mail ID

ALERT: SMS / E-mail ID     Customer ID               Mobile Number / E-mail ID

ALERT: SMS / E-mail ID     Customer ID               Mobile Number / E-mail ID

SMS: TRANSACTION TYPE Debit Credit Balance E-MAIL: TRANSACTION TYPE Debit Credit Balance
AUTHORISED USER NAME – 1
(For Alert)
AUTHORISED USER NAME – 2
(For Alert)
AUTHORISED USER NAME – 3
(For Alert)
4. MOBILE BANKING – M-PAY (mobile number) 9 1
HANDSET MAKE – MODEL (Eg.: NOKIA-3110C)
AUTHORISED USER NAME
(For Mobile banking – M-pay)
5. NET BANKING: Retail – Fin-Personal Fin-Personal and Third Party Non-Fin RSA TOKEN (Optional and charges are applicable)
Corporate – Fin Non-Fin (Maker is one who enters the transactions. Checker is the one who authorize the transaction.) RSA TOKEN mandatory.
AUTHORISED USER NAME E-MAIL ID (F/NF) Maker / Checker Limit (`)

I/We confirm that the mandate from the competent authority has been obtained for the corporate user(s) for operating our accounts and transaction
through internet banking services of KVB. The copy of the resolution is enclosed.

SIGNATURE OF THE ACCOUNT HOLDER/S

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DECLARATION
Debit Card: l/We have read and understood the terms and conditions governing the usage of the Debit Card. I/We accept to be bound by the said terms and
conditions and to any changes made therein from time to time by the Bank, at its sole discretion without any notice to me/us. I/We confirm that l/we am/are the
sole account holder or have the required mandate to operate all the accounts linked to the Debit Card(s) singly. I/We understand that upon issue of a Debit Card
to me/us, the existing ATM card linked to my account will be deactivated. I/We understand and undertake that the usage of the Debit Card shall be strictly in
accordance with the Exchange Control Regulation and in event of any failure to do so, l/we will be liable for action under the Foreign Exchange Management
Act, 1999 and the amendments thereof stipulated by the Reserve Bank of India, or rules notified under the Act or any other Act governing such transactions. l/We
accept full responsibility for my Debit Card and agree not to make any claims against Karur Vysya Bank, in respect thereto. I/We agree that the cash deposited
by me/us in the ATM will be credited by the Bank to the account after due verification and if it is found in order within 24 hours from the next working day. I/We
agree further that all complaints pertaining to all ATM transactions will be resolved by the Bank within about 2 months.
Mobile Banking (Alert): I/We wish to apply for the SMS banking and subscribe for the Mobile alerts facility offered by KVB. I am herewith furnishing the details of
my/our account for which this facility shall be enabled. I/We have read and agree to abide by the terms and conditions governing KVB @ Mobile made available
to me/us by THE KARUR VYSYA BANK LTD. l/We am/are responsible for the registration of Mobile Banking at the Hand phone Number/s mentioned above. In
the event of availing any additional/specialized facility through Mobile Banking, l/we shall be fully responsible for the account being debited on instruction from the
above mobile Number/s. I/We have no objection to the fees, duties or any other charges which is associated with the service. In case of any mistake on my part or
that of the mobile service provider in respect of these services, l/we agree that the Bank will not be responsible and agree not to make any claim against the
Bank.
Mobile Banking (Dlite): I hereby confirm that the following. I / We have read and agree to abide by the terms and conditions governing Mobile Banking
services (KVB Dlite) made available to me/us by THE KARUR VYSYA BANK LTD. (a copy of which I am in possession/displayed in the banks website
www.kvb.co.in) I am the sole account holder or I have the required mandate for joint account to singly operate the account through mobile banking. I am solely
responsible for all the transactions happening through my mobile number. I will keep the application password / MPIN / any other form of security/
authentication PIN provided by the bank and maintain the confidentiality and secrecy. In case of change in mobile number, I will uninstall/remove the mobile
banking application installed in my mobile, for maintaining the confidentiality and secrecy. In case of lost / theft of my mobile / SIM, I will immediately inform the
bank to cease/suspend the mobile application facility. I am aware of the charges applicable for this service and hereby authorize Karur Vysya Bank to debit my
account(s) towards any service charges for availing mobile banking facility, as and when it is applicable. Charges as per my tarrif plan may be levied by my
mobile service provider. I declare that the above details mentioned in the application are true and correct to the best of my knowledge.
INTERNET BANKING: I/We have read and agree to abide by the terms and conditions governing KVB@NET internet facility of THE KARUR VYSYA BANK
LTD. provided to me/us including those excluding/limiting the Bank’s liability and agree to any other changes to be made by the Bank from time to time and
acknowledge that the Bank may in its absolute discretion discontinue any of the services completely or partially without notice to me/us. I/We request you to
provide access as requested above. I/We agree that the Bank may debit my/our account for the service charges as applicable from time to time.
RSA Security Token: I/We agree to receive RSA token which generates pass code for me/each individual authorized signatory(s) as given above for the
purpose of transacting my/our accounts through internet banking. I/We agree and authorize the bank to debit my/our primary account with the bank at the rate
applicable from time to time for the issuance of duplicate RSA token if any, for the specific facility (which is non-refundable) to be issued to me/individually to
each of the authorized signatory(s). Issuance of RSA token for retail users is optional and charges are as applicable from time to time. Issuance of RSA token
is mandatory for corporate and is free of cost. RSA token is valid for 5 years from the date of issuance. I/We confirm that the mandate from the competent
authority has been obtained for the corporate user(s) for operating our accounts and transaction through the Internet banking services of KVB. The detail of the
resolution and a copy is enclosed. In order to ensure safety of “Online” banking, l/we shall ensure to observe the following precautions: a) I/We will visit the
Internet Banking site directly. I/We will avoid accessing the site through a link from another site or an e-mail and verify the domain name displayed to avoid
spoof websites. b) I/We will ignore any e-mail asking me/us the password or PIN and inform the Bank of the same immediately to investigate the same. c) I/We
understand that neither the Police nor the Bank will ever contact me/us to ask to reveal my/our online banking or payment card PINs, or my/our password
information. d) I/We will not use cyber cafes/shared PCs to access our internet banking site. e) I/We will update our PC with latest antivirus and spy ware
software regularly. l/We will install security programmes to protect against hackers, virus attacks or malicious ‘Trojan Horse’ programmes. I/We understand that
a suitable firewall installed will protect my/our PC and its contents from outsiders on the Internet. f) I/We will disable the ‘File and Print Sharing’ feature on my/
our operating system. g) l/We will log off from the bank’s website in my/our PC when not in use. h) l/We agree not to store my/our ID/PIN in the Internet
Explorer browser. i) I/We agree to check my/our account and transaction history regularly. j) l/We will use the Bank’s websites to get help and guidance on how
to stay online. l/We agree that the Bank is NOT liable for any loss arising from my/our sharing or otherwise passing of my/our User Ids, passwords,
cards, card numbers or PINs with anyone, NOR from their consequent unauthorized use. l/We have read and agree to abide by the above additional
terms and conditions governing KVB@NET, Internet Banking facillty of THE KARUR VYSYA BANK LTD. provided to me/us which shall constitute an
agreement between me/us and the Bank. l/We have read and understood the rules governing the above channel services and agree to abide by the same.

SIGNATURE OF THE AUTHORISED USER SIGNATURE OF ACCOUNT HOLDERS

Note: 1. For existing customers the details given in the above application I certify that all the above information has been verified, updated
should be same as in the customer master. This should be strictly appropriately and are correct. The above requested services can be
verified by the Manager/Officer before forwarding. enabled for the applicant.
2. For new accounts, leave account number column as blank.
3. Add on cards should be issued only to the spouse of the account
holder (If not a joint account holder).

MANAGER / OFFICER       DATE:

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 FATCA/CRS Declaration Form (For Individuals)
(Foreign Account Tax Compliance Act / Common Reporting Standard)

Customer ID: Customer Name:

Mobile No.:
E-Mail:
Prefix with country code

City of Birth: Occupation:

PAN: Aadhaar No.: Date of Birth:
Fathers’ Name: Spouse Name:
PART A
Country of Residence
Residence for Tax Purposes (Country)

Address (if outside India)

Country of Birth
US Person* (YES / No)

PART Β
If in any of the fields under “PART A”, the ‘Country’ mentioned is other than ‘INDIA’ or if U.S. person=Yes, then
either fill the details in Part-B (i) below OR sign the self-declaration in Part-B(ii)
Part Β (i)
S.No. Country of Tax Tax Payer Identification Issuing Country of Specify whether column (3) is
Residency # Number (TIN) / TIN / Functional TIN / Functional Equivalent
Functional Equivalent Equivalent
(1) (2) (3) (4) (5)

# to incude all countries other than India, where investor is Citizen / Resident / Green Card Holder / Tax Residert in those
respective countries especially of USA
Part Β (ii) (If Part Β is applicable but Part B(i) has not been filled in, kindly provide information below)
I confirm that I am neither a U.S. Person nor a resident for Tax purpose in any country other than India, though one or more
parameters suggest my relation with the country outside India. Therefore, I am providing the following document as proof of
my citizenship and residency in India.
Passport Voter ID Aadhaar ΡΑΝ Driving License Govt. ID
NREGA Job Card Document# _________________ Signature

*-Definition for the term ‘U.S. Person’ is available on the rear of this form

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Declaration by customer:
1. I hereby certify that I have declared my status as per the rules applicable under Section 285BA of the Income Tax Act,
1961 as notified by Central Board of Direct Taxes(CBDT) vide notification No.S.0.2155(E) dated 7th August 2015 and
RBI Circular No. RBI/2015-16/165.DBR.AML.BC.No.36/14.01.001/2015-16 dated 28th August 2015 in this regard.
2. I understand that the Bank is relying on this information for the purpose of determining the status of the applicant named
above in compliance with FATCA/CRS. I shall seek advice from a professional tax advisor for clarification on my tax
residency and its implication under FATCA/CRS.
3. I understand and acknowledge that as per the provisions of Income Tax Act, Rules made thereunder and guidelines
issued by the RBI in the matter, depending upon the residential status and/or other criteria stipulated therein, the Bank
may have to report the details in respect of my account(s) as per the prescribed format to the Central Board of Direct Taxes
(CBDT) or other Government Agencies to comply with the obligations as per the Inter-Governmental Agreements(IGA)
and Common Reporting Standards (CRS) and or any other similar arrangements.
4. I certify that the information provided by me above as applicable to me and signed by me as well as in the documentary
evidence provided by me is, to the best of my knowledge and belief, true, correct and complete and that I have not
withheld any material information that may affect the assessment/categorization of my account as a U.S. Reportable
Account or other Reportable Account or otherwise. In case any of the above information is found to be false or untrue or
misleading or misinterpreting, I am aware that I may be held liable for it.
5. I undertake the responsibility to declare and disclose within 30 days from the date of change, any changes that may take
place in the information provided above, as well as in the documentary evidence provided by me or if any certification
becomes incorrect and to provide fresh and valid self-declaration along with documentary evidence.
6. I agree to make good any loss that may be caused to KarurVysya Bank on account of providing incorrect or incomplete
information by me.

Place: Date: Customer Signature

Note:
The term ‘United States person’ will be based on one or more of the following indicia:
1. An individual, being a citizen or resident of the United States of America.
2. Unambiguous indication of a US place of birth.
3. Current US mailing/residence address (including a US post office box)/Current U.S. telephone Number.
4. Standing instructions to transfer funds to an account maintained in USA.
5. Current effective power of attorney or signing authority granted to a person with a US address (or) An ‘in-care-of’ or
‘Hold mail’ address that is the sole address the Indian Financial Institution has on the file for the account holder.

Signature & Stamp of Branch Official

-------------------------------------------------------------------- Tear off portion ------------------------------------------------------------------

Acknowledgement
Karur Vysya Bank hereby confirms that the Bank has received FATCA/CRS declaration from Mr/Ms/Mrs
__________________________ on _______________

Signature & Stamp of Branch Official