Re-KYC Declaration – Individuals (Resident & Non Resident)

(Including Authorised Signatories/Proprietor/Partners/Beneficial Owner)

Customer ID D D M M Y Y Y Y

Account Number(s)

Name Photo

PAN Number
In case of change of Name/Pan update - kindly provide supporting documents under it (kindly sign across the photo)
Note: Customer to select either section A or B as applicable. Section C is to be mandatorily filled.

Section A There is no change in my contact details/ current address.

Section B I wish to change my contact details/current address in the bank records. Attached herewith are the KYC documents for
the purpose of updation.
1. Current/ #Overseas Address (Address proof is mandatory)
Non resident customers to tick in case of an overseas address (#Only for Non-Resident Customers)
Address

City State

Country Pin Code

I request RBL Bank to update the current address with above-mentioned address.
Proof of Address - Officially Valid Document (OVD):
Aadhaar UID Voter ID card Driving Licence Passport
NREGA Job Card Simplified Measures Account Small Account Others
Aadhaar No
(Mandatory if Proof of Address provided
is Aadhaar. Only mention last 4 digits)

*Identification number
(Please do not write the Aadhaar No here)

*Issuing Authority
*Place of Issue

Document Issue Date D D M M Y Y Y Y *Document Expiry Date D D M M Y Y Y Y

(Applicable for Driving License & Passport only)

Preferred Mailing Same as Current Address If Preferred Mailing Address is different, please fill Form A.
Address
Permanent Address Same as Current Address If Permanent Address is different, please fill Form A

2. Contact details:
Country Code STD Code Phone No. Extension
Mobile No. (For receiving SMS Alerts)

Email ID
(For e-statement
& e-alerts)

ACKNOWLEDGEMENT
We acknowledge the receipt of KYC documents for your Customer ID ____________________________
Important Terms for processing of request:
a) Changes requested will be effected in Bank’s records basis validation with requisite authorities
b) Request will not be processed, if PAN details in bank records do not match with details available with NSDL or is inoperative (PAN not linked with Aadhar)
c) All accounts linked to Customer ID of the 1st Account holder will be registered for E-statements on the email id mentioned and physical statements will not be sent.
d) All deliverables will be sent to the communication address as per the latest records available with RBL Bank
e) I/We, authorise RBL Bank to update my PAN as mentioned above in your records.
f] I hereby state that I have no objection in authenticating myself with Aadhaar based authentication system and consent to providing my Aadhaar number, Biometric and/
or One Time Pin (OTP) data(and/or any similar authentication mechanism ) for Aadhaar based authentication for the purposes of Re-KYC for updating my details with RBL Bank.

___________________________________ Date: D D M M Y Y Y Y SR No.: _____________________________

(Name & Signature with Bank Seal)
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Section C (Mandatory for all customers)
1. Customer Profiler :
*Educational Qualification Undergraduate Graduate Post Graduate Professional Illiterate
*Employment Type Salaried Self-employed Politician Professional Housewife Retired Student Diplomat Unemployed Farmer
*Type of Company/Firm Propretership Partnership LLP Private Ltd. Listed Public Ltd Unlisted Public Ltd Public Sector Government
(For Salaried/Self-employed)

*Industry Type Manufacturing Construction NBFC Non Profit Micro Enterprises Others
(For Salaried/Self-employed/Diplomat) Organization Please refer annexure

Employer Name (For Salaried)

*Occupation Doctor CA/CS Lawyer Architect Engineer Consultant Agriculturist Others
Please refer annexure
*If Agriculturist Landless Laborer Below 2.5 Acres of Land 2.5 - 5 Acres of Land Above 5 Acres of Land
*Source of Income Salary Business Income Investment Income Agriculture Dependent Fees/Commission/Brokerage
Gross Annual Income <= 60 K 60K-1.2 Lakh 1.2 - 2 Lakh 2-3 Lakh 3-5 Lakh 5-10 Lakh 10-50 Lakh >50 Lakh-1Crore >1 Crore

2. FATCA/CRS Declaration
I am a tax resident of India and not resident of any other country
I am a tax resident of country other than India. (Please provide the below mentioned details)
Tax Identification Number or equivalent TIN Description
Country of Tax Jurisdiction TIN Issue country

City of Birth Country of Birth

Customer Declaration: I/We confirm to have read and understood the Terms & Conditions pertaining to the changes mentioned below:
a) Changes requested will be effected in Bank’s records basis validation
b) Request will not be processed, if PAN details in bank records do not match with details available with NSDL or is inoperative (PAN not linked with Aadhar)
c) All accounts linked to Customer ID of the 1st Account holder will be registered for E-statements on the email id mentioned and physical statements will not be sent.
d) All deliverables will be sent to the communication address as per the latest records available with RBL Bank
e) In case there are joint holders OR POA/Mandate holders, in the account; ReKYC for such CIF holders to be submitted
f) I/We, authorise RBL Bank to update my PAN as mentioned above in your records.
g) I/We understand and declare that all the particulars filled in the form are true, correct, complete & up-to-date in all respects and information is withheld.
h) I hereby state that I have no objection in authenticating myself with Aadhaar based authentication system and consent to providing my Aadhaar number, Biometric and/
or One Time Pin (OTP) data(and/or any similar authentication mechanism ) for Aadhaar based authentication for the purposes of Re-KYC for updating my details with
RBL Bank.
i) I the undersigned account holder/Power of attorney holder/Authorised Signatory of the below-mentioned account(s) hereby declare that the information given above, is
true and correct.

Signature Name:
For Branch Use:
Mode of receipt of the declaration : Mail / Face to Face D D M M Y Y Y Y
Name of the RM :
For current address change OVD collected Signature Verified By:
Yes No
(Name & Signature)
Customer Category High Medium Low
Approved By:
FATCA/CRS Declaration: (wherever applicable) Yes No (Name & Signature)
Emp ID: Emp ID:
ReKyc/Feb/21022022/Version1

SR No. : Maker Id Maker Sign:

Aadhaar Ref Key Checker Id Checker Sign:

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ReKyc/Feb/21022022/Version1

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+91 22 61156300 [email protected] www.rblbank.com
[email protected]

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