CO kotak Kotak Mahindra Bank
OPTY ID I Service Request No:L
Request for Linking/Seeding Aadhaar Number and Receiving DBT Benefits into Bank Account
Name Uma Vedprakash Yadav
Frst Nane Middle Name Nam
Customer Relationship Number: 475774456 Aadhaar Number:491237810279
DOB 04/05/1984 Gender Male Female Transgender
Name of the Aadhaar Holder Uma Vedprakash Yadav
as in Aadhaar Card
1 Isubmit my Aadhaarnumber 491237810279 l& give my voluntary consent to
" Use my Aadhaar Details to authenticate me from UIDAI
Link the Aadhaar Number toall my existing/newfuture accounts &customer profile (Customer Relationship Number -CRN)
with your Bank.
(Signature of Customer)
2. Option for receiving DBT Benefits (Tick only one from below)
Iwish to seed my account No. with NPCI mapper to enable me to receive Direct
Benefit Transfer (DBT) including LPG Subsidy from Government of India in my above account. Iunderstand that if
more than one Benefit transfer is due to me, I willreceive all benefit transfers in this account.(Applicable to customer
who have not so far seeded account with NPCI)
Irequest you to change my NPCI mapping *(DBT Benefit Account)to my account with your Bank. I already
have an account with |State Bank 0f India having IN Number** |310880
and seeded with NPCI mapper for receiving DBT from Government of India.
I do not want to change my NPCI mapping* (DBT Benefit Account) from the existing Bank. I already have
an account with another Bank having IIN Numbert*
and seeded with NPCI mapper for receiving DBT from Government of India.
Di do not wish to seed my accounts from your Bank with NPCI mapper (I will not be getting DBT).
Declaration:
Ihave been explained about the nature of information that may be shared upon authentication. I have been given to understand that my information
submitted to the bank herewith shall not be used for any purpose other than mentioned above, or as per requirements of law.
Ihereby declare that all the above information voluntarily furnished by me is true, correct and complete.
In case if my DOB/Gender as per bank records does not match with that of as per my Aadhaar, I hereby authorise bank to rectify my DOB/Gender in my bank
record as per the Aadhaar.
l am aware thatcommunication on my Linking/Seeding of Aadhaar number will be received on the mobile number registered in Bank records.
(Signature of Customer)
NPCI Mapping - Mapping is a process of associating a Bank with Aadhaar Number which is facilitated by NPCI for Direct Benefit Transfer to the respective Bank who have linked the
Aadhaar Numberto a specific Bank account for receiving Direct Benefits to which customer has qiven the consent.
lIN Number(Issuer ldentification Number) will be provided by Bank receiving the consent application.
For Branch Use Only FOR CPC uSE ONLY
Branch Name / Code: Received Date: KMB
Applicant's Signature verified: N Request Captured by:.
Employee Name: Request Authorized by:
Sign: Execution Date:
Employee Code:
Date forwarded to RPC:
Acknowledgement
Date. Time
Request for Linking of Aadhaar for Mr/ Mrs
Seeded to Account Number. for receipt of DBT credits
Service Request Number Bank official sign and Branch seal
Kotak Mahindra Bank Ltd.|CIN: L65110MH1985PLC038137.
Registered Office: 27 BKC,C27, G Block, Bandra Kurla Complex, Bandra (E), Mumbai - 400 051. www.kotak.com
