Re-KYC form for Please affix recent photo

Resident Individuals
PERSONAL (A) Sign Across

Customer ID Account Number

Customer Name Date of Birth D D M M Y Y Y Y
Prefix (Mr ,Miss ,Mrs) Full Name (Please leave space between two words)

S U R N A M E
PAN Number Form 60. (In Case of No-Pan)

OCCUPATION & INCOME (B)

Occupation Salaried Self-employed Retired Self-employed Student Housewife Politician Others (Please Specify)
professional
If salaried
employed with.
Private Proprietorship Public sector Multinational Partnership Public Limited Government Others (Please Specify)
Limited

Please Tick PEP / Relative or Close Associate of PEP Yes No

Self Employed Years Months Date of Incorporation If Company Owner
since

Nature of Agriculture Stock Real Estate Manufacturing Service Trader Others (Please Specify)
Business Broker Provider
Type of Partnership Private Public Sole Others (Please Specify)
Company/ Firm Limited Co. Limited Co. Proprietorship

Self Employed Doctor IT Consultant Lawyer CA/CS Architect Others (Please Specify)
Professional
Source of Salary Agriculture Business Investment Others (Please Specify)
Funds Income Income

Gross Annual <50,000 50,000-1 Lac 1-3 Lac 3-5 Lac 5-7.5 Lac 7.5-10 Lac 10-15 Lac >15.25 Lac
Income (`r)
>25.50 Lac >50 Lac -1CR >1CR

Residence Rental/ Ancestral/ Company

Type Owned Leased Family Provided

There is change in my mailing There is change in permanent There is no change in mailing & permanent address
address & contact details address

MAILING ADDRESS & CONTACT (C) (Please leave space between two words)

Flat no/
Bldg Name
Road Name
Landmark
City PIN Code
State Country
Extension
Tel. (R) S T D - N U M B E R Tel. (0) S T D - N U M B E R Number

Email ID*
Mobile Number +91 N U M B E R

PERMANENT ADDRESS (D)

93317/12.08.2024_M253

Flat no/
Bldg Name
Road Name
Landmark
City PIN Code
State Country

Branch Code
LG Code

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EXTENDED KYC (E)
Section A Section B

Maiden Name (if any)

Foreign tax residency details if any (Please consult your professional tax
advisor for further guidance on your tax residency, if required)
Please Tick, if you are a tax resident of any country outside India. If you do
not tick, it is your affirmation that you are a tax resident of India and not of
any other foreign country.
Father’s Name (mandatory)

Spouse’s Name Country/(ies) of

Tax residency
Tax identification
Marital Status Married Unmarried Others Number (TIN)
Identification Type
DD / MM / YYYY
Passport Date of Expiry ____________________ Identification Type
DD / MM / YYYY (TIN or other, please specify)
Driving License Date of Expiry _________________
Aadhaar card / letter
Election / Voter’s ID card
NREGA Card NPR Letter

Identification Number - for the Please tick if your address for Same as permanent address
identification type mentioned tax purpose is other than your
above Mailing address
Please mention your Resident Individual Please tick if your Residential and Business
Residential Status if it Non Resident Indian address for tax Business
is any one of these purpose is other than Registered Office
Foreign National
your Mailing address
Person of Indian Origin

Proof of Address Passport Voter Identity Card

Driving License NREGA Job Card
UID (Aadhaar) NPR Letter Please Upate if Tax Please Mention
resident outside if your Country
India/Nationality is of Birth is other
Please tick if Address Type Residential and Business other than India than India
is other than Residential Business
Registered Office
Nationality (if national of more than
one country, please mention all the City of Birth
countries separated by a comma)

AADHAAR CONSENT DECLARATION (F)

Aadhaar Non DBT Consent
1. I voluntarily opt for Aadhaar OVD KYC or e-KYC or offline verification, and submit to the BANK my Aadhaar number, Virtual ID, e-Aadhaar, XML,
Masked Aadhaar, Aadhaar details, demographic information, identity information, Aadhaar registered mobile, face authentication details and/or
biometric information (collectively information)
2. I am informed by the Bank, that:
(i). submission of Aadhaar is not mandatory and there are alternative options for KYC and establishing identity including by way of physical KYC with
officially valid documents other than Aadhaar. All options were given to me.
(ii) For e-KYC / authentication verification, Bank will share Aadhaar number and/or biometric with CIDR/UIDAI and CIDR/UIDAI will share with Bank,
authentication data, Aadhaar data demographic details, registered mobile number, identity information which shall be used for the informed purposes
mentioned in 3 below.
3. I authorise and give my consent to the Bank (and its service providers), for following informed purposes:
(i). KYC and periodic KYC process as per the PML Act 2002 and rules thereunder and RBI guidelines, or for establishing my identity, carrying out my
identification, offline verification or e-KYC or Yes/No authentication, demographic or other authentication/verification/notification as may be permitted as
per applicable law for all accounts, facilities, services and relationships of/through the Bank, existing and future.
(ii). collecting, sharing, storing, preserving information, maintaining records and using the information and authentication/verificaiton/identificaiton
records: (a), for the informed purpose above, (b) as well as for regulatory and legal reporting and filing and/or (c) where required under applicable law.
(iii) enabling my account for Aadhaar enabled Payment Services (AEPS).
4. I Understand that the Aadhaar number and coro biometrics will not be stored/shared except as per law and for CIDR submission. I have downloaded
the e-Aadhaar myself using the OTP received on my Aadhaar registered mobile number. I will not hold the Bank or its officials responsible in the event
this document is not found to be in order or in case of any incorrect information provided by me.
5. The above consent and purpose of collecting information has been explained to me in my local language.

DECLARATION
I declare that the information provided with respect to my account is up to date and correct. Applicant Signature
I have also attached my recent photograph.

FOR BANK USE

Sourcing Branch Name _____________________________________________ Documents Received: Self Certified True Copies Notary

Employee Name:___________________________________ Employee Code _____________________ Employee Designation: ____________________________________

Sourcing Employee Branch Name:___________________________ Branch Code _____________________

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Signature verified and form approved by BDA/BM employee code _________________________ Signature & Date ______________________________

CUSTOMER ACKNOWLEDGEMENT COPY

Reference Number ______________________________ Acknowledgement Date ________________ Signature of Bank Official _________________________