Customer Information Application

Corporate/KYC

New Customer Update of Existing Customer Base No.

Branch Name/Branch Code Date D D M M Y Y Y Y

Basic Information

Full Name q
(legal name as per official documents)
Trading Name
Type of Business
Trade Insurance Industry Agriculture
Travel Office Real Estate Investment Money Exchange
Other
Customer Type
Sole Proprietorship Trust Partnership Firm Liquidator
Hindu Undivided Family Limited Liability Partnership Private Limited Company Artificial Juridical Person
Public Limited Company Co-operative Society Not Categorized
Association of Persons/Body of Individuals Other

Accountholder Type
US Reportable Other Reportable
Owner Documented FI with specified US Owners
Passive Non-Financial Entity with one or more controlling persons that Reportable Persons
Passive Non-Financial Entity with substantial US owner(s) Other Reportable Person
Non-Participating FFI
Passive Non-Financial Entity that is CRS Reportable
Specified US Person Not Applicable
Direct Reporting NFFE Not Applicable

Customer Details
RBI approval Ref
PAN No. Identification Type:
Expiry Date D D M M Y Y Y Y TIN Company Identification No. US GIIN
Country of Residence Global Entity Identification No. Other
Country of Incorporation Place of Incorporation
Date of Incorporation Date of Business Commencement

Contact Details and Registration Address

Email
Area P.O. Box
Zip Code Street
City Tel. (Office)
Tel. (Home Country) Fax No.

Current/Permanent/Overseas Address Details

Address Type Residential/Business Residential Business Registered Office Unspecified
Proof of Address Certificate of Incorporation/Formation Registration Certificate

State/U. T Code Pin/Post Code ISO 3166 Country Code

IN/2/1/1 V2.0
Correspondence/Local Address Details

Address Type Residential/Business Residential Business Registered Office Unspecified

Proof of Address Certificate of Incorporation/Formation Registration Certificate

State/U. T Code Pin/Post Code ISO 3166 Country Code

Address in the Jurisdiction where entity is resident outside India for Tax Purposes

Address Type Residential/Business Residential Business Registered Office Unspecified

Proof of Address Certificate of Incorporation/Formation Registration Certificate

State/U. T Code Pin/Post Code ISO 3166 Country Code

Financial Information
Entity Purposes/Type of the Activities as per the CR/AOA

Main Purpose of Account: Credit Facilities Investments

Transfers Outside KSA Import/Export
Payroll Other

Countries Involved

Source of Income Main Activities Shares profits

Real-Estate Revenues Others

Country of the Source of Income

Estimated Net Worth of Assets
Expected Banking Transactions Monthly Debit & Credit
Estimated Annual Revenue
Expected Size of Business

Other Details

Industry Sector Code Global Intermediary Identification No. (GIIN)***

Residence For Tax Purpose in Jurisdiction Outside India Listed

Entity Name

Base No.

IN/2/1/1 V2.0
Related Parties Details

Name Tax Resident ID No. & Share ٪ Related Person Type: Nationality Address Country of KYC No.
and Expiry Date Director/Promoter/Karta/ and Residence
PAN No. Trustee/Partner/ Contact No.
Authorized Signatory/
Court Appointed Official/
Beneficiary

*For each Legal Person owning more than 10% of the capital, a separate related parties form, must be filled.
** Individual ultimately owns or controls the entity.
*** For Foreign Financial Institutions only.

Declaration
Please open an account for the company as detailed above. I/We confirm that the information given is true and correct.

Customer Signature

Authorized Signatory Name

Authorized Signature Date D D M M Y Y Y Y

IN/2/1/1 V2.0