ANNEXURE-II

(Individual/Retail)
Karnataka Bank Ltd. Date: KYC/Customer Profile form
Your Family Bank, Across India
CKYC Number:
Branch Name and Address:
Customer ID:

Account Number:

APPLICANT’S DETAILS

Name: Mr. Ms. Mrs.

Date Of Birth: Gender: Male Female Transgender Religion: Marital Status: Married Unmarried Others

Father's Name:

Mother's Name:

Spouse Name:

CORRESPONDENCE ADDRESS: IS THERE CHANGE IN ADDRESS: YES [ ](attach proof) , NO [ ]

RESIDENTIAL OFFICE BUSINESS RESIDENT/BUSINESS UNSPECIFIED

District: State: PIN: Country:

Telephone No: Existing Mobile No: Existing E-mail id:

*New Mobile No: *New E-mail id:

PERMANENT ADDRESS: Same as Correspondence Address : Yes No (If NO, furnish below &attach proof)

Address line1:
Address line2:
Address line3:
City:
District: State: PIN: Country:

Telephone No: Existing Mobile No: Existing E-mail id:

*New Mobile No: *New E-mail id:

Income (Gross) Monthly Annually Source of Income: Designation/Profession:

Educational Qualification: Illiterate Under Graduate Graduate Post Graduate Professional Other (specify)............... Occupation:.....................

If employed: Organization's Name:

Address:

PAN : or Please fill Form 60/61 if you donot have PAN

KYC DOCUMENTS (Official Valid Document)

Any one document for a photo-identity and proof of address(Mention ID no. & attach proof):

Aadhar No: Driving License:

Passport: Job card issued by NREGA:

Voter's ID: National Population Register Letter:

I hereby declare that the details furnished above are true and correct to the best of my/our
knowledge and belief and I undertake to inform you of any changes therein, immediately

Paste a latest Passport In case any of the above information is found to be false or untrue or misleading or
size photograph in the misrepresenting, I am aware that I may be held liable for it.
box

Signature/Thumb impression(s) of depositor

FOR OFFICE USE ONLY

The KYC Documents received on ….... / ….... / …................. Updated in CRM on: ….... / ….... / ….................

Received by: Verified by:(Officer/ABM/BM)

Emp.Name: Emp.Name:

Designation: Designation:

Staff No: Staff No:

Signature: Signature:

Customer Acknowledgement

Received from Shri/Smt/Kum/Ms.__________________________________application for KYC details updation on ____/____/______.

Bank Official Seal and Signature: