CENTRAL KYC REGISTRY | Know Your

Customer (KYC) Appllcation Form | Legal Entity/Other

Important Instructions: than Individuals
A) Fields marked with ""
are Imandatory ields
B) Tick wherever applicable F) List of Slate
/0Tcode as por Indion Motor Vehicle
C) Please fill the date in G) List of two clharacter Act 1988 is available at
D) Please fill the fornn in
DD-MM-YYYY formot. IS0 3166 country codes is
aVailable at the end
the end
English and in BLOCK lellers H) Pletse read soction
wise detailod quidelines I
E) KYC number of applcant is mandaBory I) For partlculnr instructions
sectlon update, please ick (v )in the at the end
for update application,. box AVallable before the CEASÀ!
For office use only secion umber And strike off the sections not required lo bo
(To be filed by financial
Application Type* New Update updated
insttution) KYC Number
Account Type (Mandatory for KYC Update toquest)
Nomal ||Simblifiod (Plonan tolor inntruotion
01, ENTITY DETAILS(Please Ant the end)
refer instructlon C at the end)
OName
Entity Constitution Type
Date of
Chirag Road Linas (Plense reler instructlon B al the
Incorporation /Fomation' end)
Dale of Commencement of
Place of Inoonporation / Fomation Business'
Country of Incotporation /Formation
PAN BASa sOE Fornn 60 furnished
TIN or Equivalent lssuing
Country
TIN/ GST Registration Number
2PROOF OF IDENTITY (Pol)' (Please refer
instruction D at the end)
nOficially valid document(s) in
respect of person authorised to transact
DCertificate of lncorporation /Fommation
(Certified copies of the documents, as applicable,
need to be submitted)
n Memorandunm and Articles of DRegistration Certificate
AssoCiation /Partnership Deed / Trust Deed
DActivity Proof - 1(For Sole Proprietorship Oniy) Resolution of Board / Managing Committee
Power of attorney granted to its manager,
Activity Proof -2 (For Sole Proprietorship Oniy) officers or employees to transact on its behalf
3. ADDRESS* (Certified copies of the documents, as
3.1 Registered Office Address / Place of applicable, need to be submitted) (Please see
Business" instruction E at the end)
Proof of Address
DCertificate of Incorporation / Formation
Line 1* Registration Certificate D Other Document
Line 2 Ot No3 Masw Tajpur Reac, Molarbaud Extw
Line 3 Badarpu Neus Delli
District City /Town / Village
PIN /Post Code' LO02 State /U.T Code' ISO 3166 Country Code'
3.2 Local Address in India (If
different from Above)'
Line 1
Line 2
Line 3
District City / Town / Village
PIN IPost Code State /U.T Code' ISO 3166 Country Code'
4. CONTACT DETAILS (Allcommunications will be
sent on provided Mobile no Email-1D) (Please refer instruction F
at the end)
Tel. (Off)
FAX
Mobile
Email iD
Mobile
Email ID

5. NUMBER OF RELATED PERSONS (Please refer instruction G at the end)

 REMARIKS (0t any)

7. APPLICANT DECLARATION (leano rofor

Iuatuelon Hot tho ond)
yuf tl alov
I n y be thet iao or
. I heiey osenl hnemi
intoaton v ensl Clouuuy 1huuulh iMul on the above
egutered undettul teoss For CHIRAG ROAD LINES
Date
Plaço:
8.
ATTESTATION IFOR OFFICE USE ONLY
Documents Received Certified Coples Proprietor
KYC VERIFICATION CARRIED OUT
BY
ldentity Venfication INSTITUTION DETAILS
D
Done Date
Narne
Emp Nanne
Code
Emp Code
Emp. Designation
Emp Branch