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KYC Application Form and overleaf instructions should be printed on the same page (back to back). If printed separately then both the pages should be attached and signed by the applicant."

Know Your Client (KYC)
Application Form	Application
	No. :
	No. :

(For Individuals Only)

Please fill this form in ENGLISH and in BLOCK LETTERS (All Information as applicable in Sections A, B and C below is mandatory)

This information is sought under the Prevention of Money Laundering Act, 2002, the rules notified thereunder and SEBI’s guidelines on Anti Money Laundering.

For existing Mutual Fund investors, the address(es) furnished herein will be replaced in the records of

the Mutual Fund / Authorised Agent. (Refer Notes

/ Guidelines overleaf)

A. Identity Details (Please see guidelines A1 to A5 overleaf)

1. Name of Applicant (As appearing in supporting identification document) Title

Mr.

Ms.

Others

Please specify

Gender Male

Female

Name

Father's Name

Please affix

2. Date of Birth

most recent

Indian

Others

colour photograph

3. Nationality

Please

specify

30mm x 40 mm

4. Status Please tick ()

Resident Individual

Non-Resident

Sign across the photograph

5. Permanent Account Number (PAN) (MANDATORY)

Please tick ()

Copy of PAN Card attached

B. Address Details (Please see guidelines B1 to B4 overleaf)

1. Address for Correspondence

City / Town / Village

Postal Code

State

Country

2. Contact Details

Tel. (Off.)

(ISD)

(STD)

Tel. (Res.)

(ISD)

(STD)

Mobile

(ISD)

(STD)

Fax

(ISD)

(STD)

E-Mail Id.

3. Proof of address to be provided by Applicant.

Please submit ANY ONE of the following valid documents &

tick () against the document attached.

Latest

Telephone Bill

Latest Electricity

Bill

Passport

Driving License

Latest Bank

Passbook

Latest

Bank Account

Statement

Latest Demat Account statement

Voter Identity Card

Ration Card

Registered Lease / Sale Agreement of residence

Any other proof of address document (as listed overleaf)

4. Permanent Address of Resident Applicant if different from B1 above OR Overseas Address (Mandatory) for Non-Resident Applicant

City / Town / Village

Postal Code

State

Country

5. Proof of address to be provided by Applicant. Please submit ANY ONE of the following valid documents & tick () against the document attached.

Latest Telephone

Bill

Latest Electricity

Bill

Passport

Driving

License

Latest Bank

Passbook

Latest Bank Account Statement

Latest Demat Account statement

Voter Identity Card

Ration Card

Registered Lease / Sale Agreement of residence

For NRIs - Any other document attested by local authority.

C. Other Details

(Please see guidelines C1 and C2 overleaf)

1. Gross Annual Income Details Please tick ()

Upto Rs. 5,00,000

Rs. 5,00,001 to Rs. 25,00,000

Rs. 25,00,001 to Rs. 1,00,00,000

Rs. 1,00,00,001 to Rs. 5,00,00,000

Rs. 5,00,00,001 and above.

2. a. Occupation Details Please tick () any one

Private Sector Service

Public Sector / Government Service

Business

Professional

Agriculturist

Retired

Housewife

Student

Forex Dealer

Others (Please specify) _______________________________________

b. If the following is additionally applicable to you Please tick () one or more as applicable

Civil Servant

Bureaucrat

Current or Former MP, MLA or MLC

Politician

Current or Former Head of State

"Please note that the

DECLARATION

I hereby confirm that I have read and understood the Instructions mentioned overleaf and apply to CDSL Ventures Limited ('CVL') or other agent of the mutual fund registered under the SEBI (M utual Funds) Regulations, 1996 for compliance of Know Your Client (KYC) procedure for transacting in units issued by M utual Funds and I agree to abide by the terms, conditions, rules, regulations and other statutory requirements applicable to the respective M utual Funds. I hereby declare that the particulars given herein are true, correct and complete to the best of my knowledge and belief, the documents submitted along with this application are genuine and I am not making this application for the purpose of contravention of any Act, Rules, Regulations or any statute or legislation or any Notifications, Directions issued by any governmental or statutory authority from time to time. I hereby undertake to promptly inform CVL / the mutual fund agent of any changes to the information provided hereinabove and agree and accept that CVL, the respective M utual Funds, their authorised agents and representatives ('the Authorised Parties') are not liable or responsible for any losses, costs, damages arising out of any actions undertaken or activities performed by them on the basis of the information provided by me as also due to my not intimating / delay in intimating such changes. I hereby authorize CVL / the mutual fund agent to disclose, share, remit in any form, mode or manner, all / any of the information provided by me to the respective M utual Funds in which I may transact / have transacted and / or to their authorised agents and representatives including all changes, updates to such information as and when provided by me. I hereby agree to provide any additional information / documentation that may be required by the Authorised Parties, in connection with this application. I hereby confirm that this is a unique KYC application and I have not applied for KYC in the past.

SIGNATURE OF APPLICANT

Place :

Date :

For			Ref.
For	Stamp of POS	Name and Employee Number of Receiver
Office	Stamp of POS

Use	(Name & Location)		KYC
	(Name & Location)	(Originals Verified) Self Certified Document copies received
	& Receiver's Signature
	& Receiver's Signature
Only		(Attested) True copies of documents received
Only		(Attested) True copies of documents received

INDIVIDUAL KYC FORM

IMPORTANT NOTES - PLEASE READ BEFORE FILLING UP THE FORM

1.This Application Form is meant to enable a person to comply w ith the client identification programme laid down by the Prevention of M oney Laundering Act, 2002 (PM LA) hereinafter referred to as Know Your Client (KYC) requirements. It is for use by INDIVIDUALS only. A separate form is provided for non-individual entities such as Hindu Undivided Family (HUF), Corporates, Trusts, Societies, etc.

2.This form is not an Investment Application Form, and is only meant for providing information and documents required for KYC compliance. Applicant must be KYC compliant while investing with any SEBI registered M utual Fund which has subscribed to the services of CDSL Ventures Limited (CVL) for compliance of the KYC procedure. A list of M utual Funds is available on the website of AM FI at w w w.amfiindia.com.

3.Subscription to M utual Fund Units may be made only after obtaining the KYC Acknowledgement at their respective designated Points of Acceptance / Investor Service Centres.

4.Each Unitholders / Investors must attach their KYC Acknowledgement along with the Investment Application Form(s) / Transaction Slip(s) while investing for the first time in every folio. Applications Forms / Transaction Slips not accompanied by KYC Acknowledgement are liable to be rejected by the M utual Funds.

5.Joint Holders: Joint holders need to be individually KYC compliant before they can invest with any M utual Fund. e.g. in case of three joint holders, all holders need to be KYC compliant and copies of each holder’s KYC Acknowledgement must be attached to the investment application form with any M utual Fund.

6. M inors: In case of investments in respect of a M inor, the Guardian should be KYC compliant and attach their KYC Acknowledgement while investing in the name of the minor. The M inor, upon attaining majority, should immediately apply for KYC compliance in his/her own capacity and intimate the concerned M utual Fund(s), in order to be able to transact further in his/her own capacity.

7.Pow er of Attorney (PoA) Holder: Investors desirous of investing through a PoA must note that the KYC compliance requirements are mandatory for both the PoA issuer (i.e. Investor) and the

Attorney (i.e. the holder of PoA), both of whom should be KYC compliant in their independent capacity and attach their respective KYC Acknowledgements while investing.

8. If an individual becomes a M utual Fund Investor due to an operation of law, e.g., transmission of units upon death of an investor, the claimant / person(s) entering the Register of Unitholders of the M utual Fund(s) will be required to be KYC compliant before such transfer can take place.

9.The KYC process requires investors to provide their Proof of identity (PAN card copy only) and Proof of Address (any valid documents listed in section B of the KYC Application Form) to comply with KYC requirements. M utual Funds reserve the right to seek any additional information / documentation in terms of the PM LA at any point of time.

10. M utual Funds/ CVL will not be liable for any errors or omissions on the part of the applicant / Unit holders in the KYC Application Form. Documents received in support of KYC requirements will be verified at the designated “ Points of Service” (PoS), on a best effort basis. However acceptance and processing of the KYC Application Form is subject to independent verification by CVL. In the event of any KYC Application Form being rejected for lack of information / deficiency / insufficiency of mandatory documentation, etc. CVL will inform the applicant of such rejection.

11.The M utual Fund, its Asset M anagement Company (AM C), Trustee Company and their Directors, employees and agents shall not be liable in any manner for any claims arising whatsoever on

account of freezing the folios / rejection of any application / non-allotment of units or mandatory redemption of units / refund due to non-compliance with the provisions of the PM LA, SEBI guidelines or where the AM C / M utual Fund believes that transaction(s) by an applicant / investors is / are suspicious in nature within the purview of the PM LA and SEBI guidelines and requires reporting the same to Financial Intelligence Unit - India (FIU-IND).

12.Once the investor is KYC compliant, he will be required to intimate his/her KYC details to all the M utual Funds with whom he/she has investments. The KYC Compliance will be deemed to have been completed for the investor in all folios held by him/her (identified by his/her PAN) in the records of the M utual Fund..

GUIDELINES FOR FILLING UP THE KYC APPLICATION FORM

General

1.The Application Form should be completed in ENGLISH and in BLOCK LETTERS.

2.Please tick in the appropriate box wherever applicable.

3.Please fill the form in legible handwriting so as to avoid errors in your application processing. Please do not overwrite. Corrections should be made by canceling and re-writing, and such corrections should be counter-signed by the applicant.

4.Applications incomplete in any respect and/or not accompanied by required documents are liable to be rejected.

5.Applications complete in all respects and carrying necessary documentary attachments should be submitted at the designated PoS. A complete list of PoS is available on the website of AM FI at w w w.amfiindia.com, w w w.cdslindia.com and M utual Fund w ebsites.

6.You are required to submit a Proof-of-Identity document (PAN card is the only document which can be submitted) and a Proof-of-Address document for each address filled by you in this form. Documents submitted to support Identity and Address should be

i.Proof of Identity

•Original PAN Card + Self-attested photocopies (Originals will be returned over-the-counter after verification)

ii.Proof of Address

•Original Documents + Self-attested photocopies (Originals will be returned over-the-counter after verification) OR

•True Copies attested by a Notary Public / Gazetted Officer / M anager of a Scheduled Commercial Bank or M ultinational Foreign Banks (Name, Designation and Seal should be affixed on the copy).

Unattested photocopies of an original document are not acceptable

•If the above documents including attestation / certifications are in regional language or foreign language then the same has to must be translated into English for submission.

A. Identity Details

1. Name : Please state your name as Title (M r / M rs / M s / Dr / Commander / etc.), First, M iddle and Last Name in the space provided. This should match w ith the name as mentioned in the PAN card failing w hich the application is liable to be rejected. If the PAN card has a name by w hich the applicant has been know n differently in the past, than the one provided in this application form, then requisite proof should be provided e.g. marriage certificate, or gazetted copy of name change.

2.Date of Birth: Please ensure that this matches with the Date of Birth as indicated in the PAN card.

3.Nationality: Foreign Nationals are not allowed to apply, unless they are Non-Resident Indians (NRIs) or Persons of Indian Origin (PIO).

4.Status : Please tick your current residential status.

5.PAN : PAN is mandatory to be KYC compliant. Please read instruction given in 6(i) above carefully.

6.Please affix most recent colour photograph and sign across the photograph.

B.Address Details

1.Address for Communication : Please provide here the address where you wish to receive all communications sent by the M utual Funds with whom you invest. The address you give here w ill supercede existing information in the records of the M utual Fund / Registrars and

Transfer Agent to the M utual Fund. This address should match w ith the address in the ‘Proof-of-Address’ submitted as supporting document; otherw ise the KYC Application Form is liable to be rejected.

2.Contact Details: Please provide your Telephone / Email contact details. The contact details given by you here w ill not supercede existing information in the records of the M utual Fund / Registrars and Transfer Agent to the M utual Fund. You will have to independently communicate the same to them in case of any change(s).

3.Proof of Address Documents : Please note that each of the two addresses mentioned by you will need to be supported by a ‘Proof-of-Address’ bearing your or your spouse’s / parent’s (documents to establish relationship also to be submitted) name as supporting documents. Please tick the box as applicable, for the document provided by you. You may attach any one of the following documents (Any document having an expiry date should be valid on the date of submission):

• Latest* Telephone Bill • Latest* Electricity Bill • Passport • Driving License • Latest* Bank Passbook • Latest* Bank Account Statement • Voter Identity Card • Ration Card • Latest* Demat Account Statement • Registered Lease / Sale Agreement of residence • Proof of Address issued by Bank M anagers of Scheduled Commercial Banks / M ultinational Foreign Banks / Gazetted Officer/ Notary Public / Elected Representatives to the Legislative Assembly / Parliament / Document issued by any Government or Statutory Authority

* These documents should not be more than three months old as on the date of submission of this form.

4.Permanent Address / Overseas Address: If you are a Resident Indian, and your Permanent address is different from the one mentioned in the Address for Correspondence, please state it here. If you are a Non-Resident Indian or a Person of Indian Origin, it is mandatory for you to state your Overseas Address here.

C. Other details

1.Gross Annual Income details: Please tick the applicable box indicating your Gross Annual Income (including both taxable and tax-free incomes).

2.Occupation details: Please indicate your current occupation by ticking the one most applicable to you. You are required to fill up the next section, if it additionally applies to you.

After you have completed filling up the KYC Application Form, please submit the same along w ith the entire set of supporting documents to any designated PoS. Please also submit a photocopy of the Form for acknow ledgement purpose, w hich you can retain for your records. Other important notes, after the KYC Acknow ledgement is issued to you:

1.Please preserve the document from CVL which confirms your KYC compliance. You will need to attach photocopies of this document when you invest for the first time in every folio, in any M utual Fund.

2.If you observe any error in the details captured by CVL, you are requested to approach your nearest designated PoS.

3.If you are already holding investments in any M utual Funds, please provide a copy of your KYC

acknow ledgement, giving details of your folio / account numbers to such Funds or their Registrars. Please note that your signature on the KYC Application Form should match with that on the records of the M utual Funds.

4.In respect of new investors, signature on the Application Form for investing / transacting in M utual Fund should match with that on this KYC Application Form.

5.After allotment of KYC compliance, if there are any changes in an Applicant’s details such as Name, Address, Status, Income bracket, Occupation or Signature, the change should be registered with CVL through a designated PoS expeditiously, by using the KYC Details Change form. It

should be noted that only after such registration w ill the change be reflected in the M utual Fund’s records. Particularly w ith respect to change of address, investors should register such change giving 10 days time for the subsequent communications from M utual Funds to reach them at their new address. Original / Attested copies of documents supporting the change will be required to be submitted together with the KYC Details Change Form. For any other investment related information or changes thereto, the applicant should approach the M utual Funds or their Registrars.

CHECKLIST

(Before submitting this form, please go through the following checklist)

1.Please ensure that the form is completed in all respects and signed by you.

2.Please affix your recent photograph and sign across the photograph.

3.Please attach a your PAN card as proof of Identity Document. This should be a photocopy plus original for verification.

4. Please attach a Proof of Address Document (one for each distinct address). These should be either original + photocopies or attested / notarised photocopies.

5.If you are an NRI, you must mention your overseas address in B(4).

6.Please submit a photocopy of the duly completed KYC Application Form.

For assistance or enquiries please approach the Point of Service w here you had submitted your KYC Application Form.

alok graphics

INDIVIDUAL KYC FORM

Question	Answer
Form Name	Icici Bank Re Kyc Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	icici bank kyc update online, kyc form, icici bank kyc online, icici kyc online

Icici Bank Re Kyc Form – Fill Out and Use This PDF

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