All fields marked with * are mandatory

Vendor Name*: F I R S T N A M E M I D D L E N A M E L A S T N A M E

Vendor Type* : Connector DSA NDSA

Constitution* : Individual Proprietorship Partnership Pvt Ltd co. Public Ltd Co. Others

Profession*: Chartered Accountant Tax consultant Financial Advisor Insurance Advisor Auxilary Financial Services

Marketing Agency Real Estate Developer Shopkeepers / Retail stores Others

Office Address*:
Plot No / House No / Building Name*

Street* Area/Locality*

Town/Village* Landmark*

City* State*

Pin Code* Landline No. (STD Code)

Email ID* Mobile No* + 9 1

PAN No*: GSTIN*:

Number of Years in Current Business* :

Contact Person Name: Mobile No + 9 1

Current relationship with other Banks/NBFC*

Is your office rented or Owned : Rented Owned

Office space (in Sq. ft.) No of Workstations

No of Backend staff No of Telemarketing staff

Partnership deed Pan Card in name of Entity/Individual Shop & Establishment Act

Others (Pls Specify)

Office Address GST registration certificate Latest Electricity bill copy Latest Telephone bill Copy
Proof :
Rental Agreement (along with recent utility bill) Others (Pls Specify)

Account Name*:

Type of account*: Savings Current

Bank Name*: Account No*:

Bank Branch*: IFSC Code*:

Cancelled Cheque leaf / Bank Statement / Bank Passbook Attached* Yes No

*Please fill separate sheet for each Partner/Director/Trustee

Name*: F I R S T N A M E M I D D L E N A M E L A S T N A M E
Photograph of
Date of Birth*: D D M M Y Y Y Y Proprietor/ Partner/
Director/
Father's Name*/Spouse Name*: Trustee/Member
"Self Attested”
PAN*:

Email Id:

Mobile No*: + 9 1

Plot No / House No / Building Name*

Street* Area/Locality*

Town/Village* Landmark*

City* State*

Pin Code*

Please tick the checkbox if permanent address is same as current address

Plot No / House No / Building Name*

Street* Area/Locality*

Town/Village* Landmark*

City* State*

Pin Code*

List of Documents (Proprietor/Partner/Director etc.)(Please tick any one)

Address Proof : Aadhaar card Passport Voter ID Card

Driving License Rental Agreement (along with recent utility bill) Others (Pls Specify)

ID Proof : PAN Card Passport Voter ID Card

Driving License Others (Pls Specify)

Place :
Seal & Signature of Vendor Date : D D M M Y Y Y Y
 S.No Checklist Individual/Proprietor Partnership Pvt Ltd
1. Channel Enrollment Form
2. Vendor Profile
3. RCU Report (for DSA)
4. Service Provider Agreement
ID Proof ID Proof
ID Proof
Address proof of all partners Address proof of all directors
5. KYC
GSTIN Proof
Address proof GSTIN Proof
MOA/AOA
6. Cancelled Cheque leaf / Bank statement /
Bank Passbook

Chola Branch Name*: Chola Branch ID*:

DST Name*: BSM Name*:

DST Emp ID*: BSM Emp ID*:

Approved by,

Emp ID

Emp Name

Designation

Signature