Name of the Group-Entity Group-Entity’s logo
KNOW YOUR CUSTOMER (KYC) FORM
STRICTLY CONFIDENTIAL
S.No. Particulars Details
1 Full Name of the Customer _______________________________________________
2 Legal Status Individual Company Partnership
Others ___________________________________
3 Permanent Address _______________________________________________
_______________________________________________
_______________________________________________
4 Business/Trading Address _______________________________________________
_______________________________________________
_______________________________________________
5 ID No./CR No./Registration No. _________________________________
Purpose and Nature of Transaction to be
6
undertaken _______________________________________________
7 In case of Individual
(i) Nationality _________________________________
(ii) Occupation or Profession _______________________________________________
(iii) Name of Establishment or Employer _______________________________________________
(iv) Location of activity _______________________________________________
(v) Is the Individual a Politically Important
YES NO
Person (PEP)?
8 In case of Others
(i) City & Country of Incorporation _______________________________________________
9 Date of Birth / Incorporation _________________________________
10 What is the principal business/activity of the
Customer? _______________________________________________
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Name of the Group-Entity Group-Entity’s logo
11 Is the Customer acting on behalf of
YES NO
another Person ?
If Yes,
(i) Name of Beneficial Owner _______________________________________________
(ii) ID No./CR No./Registration No. _________________________________
(iii) Domicile Country _________________________________
(iv) If Beneficial Owner is an Individual, then
a) Nationality _________________________________
b) Is the Individual a Politically Important
YES NO
Person (PEP)?
Independent
12 Regulatory Status
Regulator Non-Independent Regulator
Unregulated
13 Name of Regulator (if any) _______________________________________________
14 Name of Stock Exchange(if Listed) _______________________________________________
_______________________________________________
If a Holding company, name of any other
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subsidiaries/branches/associated companies
_______________________________________________
16 If not, Group Company (if any) _______________________________________________
_______________________________________________
If business activities are conducted in more
17 than one country, please indicate names of all _______________________________________________
countries
_______________________________________________
18 Bank Details _______________________________________________
19 Contact Details of Customer
(i) Contact Person _______________________________________________
(ii) Tel & Fax _______________________________________________
(iii) E-mail/website _______________________________________________
(iv) Contact details of Compliance Officer (if any) _______________________________________________
_______________________________________________
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Name of the Group-Entity Group-Entity’s logo
20 Copies* of Customer Identification Documents
Please submit the documents and tick( a) against the documents attached
(i) Individual:- ID Card/Passport/Driving License(DL) Proof of Domicile Country**
(ii) Company:- Company Registration (CR) List & Passport copies of Authorised Signatories
List of Major Shareholders List & Proof of Domicile Country** of Directors
Major Shareholders:-Shareholders who, directly or indirectly, owns or controls more than5% of the shares or voting rights
(iii) Partnership:- Certificate of Registration Partnership Deed
List & Passport copies of Authorised Signatories List & Proof of Domicile Country** of Partners
(iv) Trust:- Certificate of Registration Trust Deed List & Passport copies of Settlor,Trustees,Protector
List & Passport copies of Authorised Signatories List of Major Beneficiaries
Major Beneficiaries:-Beneficiary who is to receive atleast 25% of the funds of the Trust
(v) Any other Legal Person:- Registration Document List & Passport copies of Authorised Signatories
List of the Individuals/Entities who ultimately owns, or exercises effective control over such person
Declaration
I/We hereby confirm that the above information provided to you is true and correct to the best of our knowledge. I/We
acknowledge that if the information provided is found to be false or misleading then the business relationship may be
annulled anytime at your discretion. I/We hereby agree to provide any additional information/documentation that may be
required.
Date:- __________________ _________________________
Signature of Authorised Signatory
*Certified copies of documents clearly signed, stamped and dated by any of the following:-
(1) A representative of an embassy, consulate or high commission of the country; or (2) A lawyer or attorney; or
(3) A notary public or commissioner of oaths; or (4) A chartered or certified accountant.
The date of signatory should not be older than 3 months.
Copies of certified copies is not acceptable.
**Any document to show the residential address like utility bill, tenancy agreement,etc.
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