SBICAP SECURITIES LIMITED

For office use only Account Type Normal Simplified (for low risk customers) Small Application Type New Update
(To be filled by financial institution) KYC Number (Mandatory for KYC update request)

1. PERSONAL DETAILS
Prefix First Name Middle Name Last Name
Name (Same as ID proof)
Father / Spouse Name
Mother Name

Date of Birth DOB Document Submitted

Place of Birth: _________________ Country of Birth __________________
Gender: M- Male F- Female T-Transgender Marital Status: Married Unmarried Others
Nationality: IN- Indian Others Tax Residency: _______________
Residential Status: Resident Individual Non Resident Indian Foreign National Person of Indian Origin
PAN: Foreign TIN: __________________ Issuing Country: _________________

Unique Identification Number(UID) / Aadhaar, If any

Proof of Identity submitted for PAN exempt cases (Ö ) UID (Aadhaar) Passport Voter ID Driving License
Occupation Type: S-Service ( Private Sector Public Sector Government Sector)
O-Others ( Professional Self Employed Retired Housewife Student)
B-Business X- Not Categorised Signature / Thumb
Impression
Financial Status (Income Range per Annum): Up to Rs.1 Lac Rs.1 Lac to Rs.5 Lac Rs.5 Lac to Rs.10 Lac Rs.10 Lac to Rs.25
Lac Rs.25 Lac to Above (Specify) ______________________________________________
2. PROOF OF ADDRESS (PoA)
2.1 CORRESPONDENCE / LOCAL ADDRESS DETAILS
Correspondence Residence
Proof of Address: UID (Aadhaar) Passport Driving License Voter Identity Card NREGA Job Card
Utility Bill* (Tel. / Electric city / Gas bill) Allotment Letter please specify
Others _____________________
Address
Line 1
Line 2
City / Town / Village: District:
State: Pin / Post Code: Country Name:
2.2 CURRENT / PERMANENT / OVERSEAS ADDRESS DETAILS Same as Correspondence / Local Address details

Proof of Address: UID (Aadhaar) Passport Driving License Voter Identity Card NREGA Job Card
Address
Line 1
Line 2
City / Town / Village: District:
State: Pin / Post Code: Country Name:
*Not more than 2 months old. Validity / Expiry date of proof of address submitted

3. CONTACT DETAILS

Tel. (Off) Tel. (Res) Mobile

FAX Email ID

4. APPLICANT DECLARATION
I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake 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 / KRA through SMS/Email on the above registered number/email address. [Signature / Thumb Impression]
I am/We are also aware that for Aadhaar OVD based KYC, my KYC request shall be validated against Aadhaar details. I/We hereby consent to sharing my/our masked Aadhaar card with
readable QR code or my Aadhaar XML/Digilocker XML file, along with passcode and other data as applicable, with KRA and other Intermediaries with whom I have a business relationship for KYC
purposes only. Signature / Thumb Impression of Applicant
Date : Place :

DOCUMENT VERIFIED WITH ORIGINALS AND IN-PERSON VERIFICATION DONE BY

Name of the Employee For SBICAP Securities Ltd.
Designation

IPV Done on Date

Signature of Verifier

eIA No.: Approved Person ID:

 DECLARATION AND UNDERTAKING (FATCA)
For the purposes of taxation, I am a resident in the following countries and my Tax Identification Number (TIN)/functional equivalent in each country
is set out below or I have indicated that a TIN/functional equivalent is unavailable (kindly fill details of all countries of tax residence if more than one):
First Holder:
Country/countries Tax Identification TIN Issuing Country Documents provided
of tax residency Number (TIN) (copy of certificate of residence or copy of TIN)

Second Holder:
Country/countries Tax Identification TIN Issuing Country Documents provided
of tax residency Number (TIN) (copy of certificate of residence or copy of TIN)

Third Holder:
Country/countries Tax Identification TIN Issuing Country Documents provided
of tax residency Number (TIN) (copy of certificate of residence or copy of TIN)

Documents Required: Kindly provide the documentary evidence of residence or TIN for all the countries listed in the aove table.
I/We certify that:
a) the information provided in the Form is in accordance with section 285BA of the Income Tax Act, 1961 read with Rules 114F to 114H of the
Income tax Rules, 1962.
b) the information provided by me/us in the Form, its supporting Annexures as well as in the documentary evidence provided by me/us are, to
the best of our knowledge and belief, true, correct and complete and that I/we have not withheld any material information that may affect the
assessment/categorization of the account as a Reportable account or otherwise.
c) I/We permit/authorise SBICAP Securities Limited (‘the Company’) to collect, store, communicate and process information relating to the Account
and all transactions therein, by the Company and any of its affiliates wherever situated including sharing, transfer and disclosure between them
and to the authorities in and/or outside India of any confidential information for compliance with any law or regulation whether domestic or
foreign.
d) I / We 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 in the Form, its supporting Annexures as well as in the documentary evidence provided by us or if any certification
becomes incorrect and to provide fresh self certification alongwith documentary evidence.
e) I / We also agree that our failure to disclose any material fact known to us, now or in future, may invalidate our application and the Company
would be within its right to put restrictions in the operations of my/our account or close it or report to any regulator and/or any authority
designated by the Government of India (GOI) /RBI for the purpose or take any other action as may be deemed appropriate by the Company if
the deficiency is not remedied by us within the stipulated period.
f) I / We hereby accept and acknowledge that the Company shall have the right and authority to carry out investigations from the information
available in public domain for confirming the information provided by me / us to the Company.
g) It shall be my / our responsibilities to educate myself / ourself and to comply at all times with all relevant laws relating to reporting under section
285BA of the Act read with the Rules thereunder.
h) I/We also agree to furnish such information and/or documents as the Company may require from time to time on account of any change in law
either in India or abroad in the subject matter herein.
i) I/We shall indemnify the Company for any loss that may arise to the Bank on account of providing incorrect or incomplete information.

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Date: ______________________ ______________________________ FH04

Place: _____________________ Name: ____________________________