Online City Bank Form – Fill Out and Use This PDF

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"Please note that the 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 (For Individuals Only)	Application No. :

Please fill in ENGLISH and in BLOCK LETTERS with black ink

A. Identity Details (please see guidelines overleaf)

1.N ame o f A pplicant (As a ppearing i n s upporting i dentification d ocument).

Name

PHOTOGRAPH

Father’s/Spouse Name

Please affix

2.

G ender

Male

F emale

B. M arital s tatus

Single

M arried

C. Date of Birth

d

d

/ m

m / y

y

y

y

the recent passport

3.

N ationality

Indian

Other

(Please s pecify)

size photograph and

4.

Status Please tick () Resident Individual

Non Resident

Foreign National (Passport Copy Mandatory for NRIs & Foreign Nationals)

sign across it

5.PAN Please enclose a duly attested copy of your PAN Card Unique Identification Number (UID)/Aadhaar, if any:

6.Proof of Identity submitted for PAN exempt cases Please Tick ()

UID (Aadhaar)

Passport

Voter ID

Driving Licence

Others

(Please see guideline ‘D’ overleaf

B. Address Details (please see guidelines overleaf) 1. Address for Correspondence

City / Town / Village

Pin 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.

Passport

Ration Card

Registered Lease/Sale Agreement of Residence

Driving License

Voter Identity Card *Latest Bank A/c Statement/Passbook

*Latest Telephone Bill (only Land Line)

*Latest Electricity Bill

*Latest Gas Bill

Others (Please specify)

*Not more than 3 Months old. Validity/Expiry date of proof of address submitted

d

/

m

/

y

y

y

d

m

y

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

City / Town / Village

Pin 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.

Passport

Ration Card

Registered Lease/Sale Agreement of Residence

Driving License

Voter Identity Card

*Latest Bank A/c Statement/Passbook

*Latest Telephone Bill (only Land Line)

*Latest Electricity Bill *Latest Gas Bill

Others (Please specify)

*Not more than 3 Months old. Validity/Expiry date of proof of address submitted

/

m

m

/

d

d

y

y

y

y

C. Other Details (please see guidelines overleaf)

1. Gross Annual Income Details ( Please tick (): Below 1 Lac

1-5 Lac

5-10 Lac

10-25 Lac

> 25 Lacs

OR

Net-worth in `.

(*Net worth should not be older than 1 year)

as on (date)

/

m

/

d

d

m

y

y

y

y

2.Occupation (Please tick () any one and give brief details):

	Private Sector Service			Public Sector	Government Service		Business	Professional	Agriculturist	Retired
	Housewife	Student		Forex Dealer	Others (Please specify)
3.	Please tick, if applicable:			Politically Exposed Person		Related to a Politically Exposed Person
	For definition of PEP, please refer guideline overleaf
4.	Any other information:

DECLARATION

SIGNATURE OF APPLICANT

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. In case any of the above information is found to be

false or untrue or misleading or misrepresenting, I am/we are aware that I/we may be held liable for it.

Place:

Date:

/ m

m / y

FOR OFFICE USE ONLY

IPV Done

on

d

d

y

y

y

AMC/Intermediary name OR code

Seal/Stamp of the intermediary should contain

Seal/Stamp of the intermediary should contain

Staff Name

Staff Name

(Originals Verified) Self Certified Document copies received

Designation

Designation

(Attested) True copies of documents received

Name of the Organization

Name of the Organization

Signature

Signature

Main Intermediary

Date

Date

A.IMPORTANT POINTS:

1.Self attested copy of PAN card is mandatory for all clients.

2.Copies of all the documents submitted by the applicant should be self-attested and accompanied by originals for verification. In case the original of any document is not produced for verification, then the copies should be properly attested by entities authorized for attesting the documents, as per the below mentioned list.

3.If any proof of identity or address is in a foreign language, then translation into English is required.

4.Name & address of the applicant mentioned on the KYC form, should match with the documentary proof submitted.

5.If correspondence & permanent address are different, then proofs for both have to be submitted.

6.Sole proprietor must make the application in his individual name & capacity.

7.For non-residents and foreign nationals,(allowed to trade subject to RBI and FEMA guidelines), copy of passport/PIOCard/OCICard and overseas address proof is mandatory.

8.For foreign entities, CIN is optional; and in the absence of DIN no. for the directors, their passport copy should be given.

9.In case of Merchant Navy NRI’s, Mariner’s declaration or certified copy of CDC (Continuous Discharge Certificate) is to be submitted.

10.For opening an account with Depository participant or Mutual Fund, for a minor, photocopy of the School Leaving Certificate/Mark sheet issued by Higher Secondary Board/Passport of Minor/Birth Certificate must be provided.

11.Politically Exposed Persons (PEP) are defined as individuals who are or have been entrusted with prominent public functions in a foreign country, e.g., Heads of States or of Governments, senior politicians, senior Government/judicial/military officers, senior executives of state owned corporations, important political party officials, etc.

B.Proof of Identity( POI): List of documents admissible as Proof of Identity:

Agreement of Residence/Driving License/Flat Maintenance bill/Insurance Copy.

2.Utility bills like Telephone Bill (only land line), Electricity bill or Gas bill

-Not more than 3 months old.

3.Bank Account Statement/Passbook - Not more than 3 months old.

4.Self-declaration by High Court and Supreme Court judges, giving the new address in respect of their own accounts.

5.Proof of address issued by any of the following: Bank Managers of

Scheduled Commercial Banks/Scheduled Co-Operative

Bank/Multinationa Foreign Banks/Gazetted Officer/Notary

public/Elected representatives to the Legislative Assembly/Parliament/Documents issued by any Govt. or Statutory Authority.

6.Identity card/document with address, issued by any of the following:

Central/State Government and its Departments, Statutory/Regulatory Authorities, Public Sector Undertakings, Scheduled Commercial Banks, Public Financial Institutions, Colleges affiliated to Universities and Professional Bodies such as ICAI, ICWAI, ICSI, Bar Council etc.,to their Members.

7.For FII/sub account, Power of Attorney given by FII/sub-account to the Custodians (which are duly notarized and/or apostiled or consularised) that gives the registered address should be taken.

8.The proof of address in the name of the spouse may be accepted.

D.Exemptions/clarifications to PAN

(*Sufficient documentary evidence in support of such claims to be collected.)

1.In case of transactions undertaken on behalf of Central Government and/or State Government and by officials appointed by Courts e.g. Official liquidator, Court receiver etc.

2.Investors residing in the state of Sikkim.

3.UN entities/multilateral agencies exempt from paying taxes/filing tax returns in India.

4.SIP of Mutual Funds upto Rs 50,000/- p.a.

1.PAN card with photograph. This is a mandatory requirement for all applicants except those who are specifically exempt from obtaining PAN (listed in Section D).

2.Unique Identification Number (UID) (Aadhaar) / Passport / Voter ID card / Driving license.

3.Identity card/ document with applicant’s Photo, issued by any of the following: Central/State Government and its Departments, Statutory/Regulatory Authorities, Public Sector Undertakings, Scheduled Commercial Banks, Public Financial Institutions, Colleges affiliated to Universities, Professional Bodies such as ICAI, ICWAI, ICSI, Bar Council etc., to their Members; and Credit cards/Debit cards issued by Banks.

C.Proof of Address (POA): List of documents admissible as Proof

of Address: (*Documents having an expiry date should be valid on the date of submission.)

1.Passport/Voters Identity Card/Ration Card/Registered Lease or Sale

5.In case of institutional clients, namely, FIIs, Mfs, VCFs, FVCIs, Scheduled Commercial Banks, Multilateral and Bilateral Development Financial Institutions, State Industrial Development Corporations, Insurance Companies registered with IRDA and Public Financial Institution as defined under section 4A of the Companies Act, 1956, Custodians shall verify the PAN card details with the original PAN card and provide duly certified copies of such verified PAN details to the intermediary.

E.List of people authorized to attest the documents:

1.Notary Public, Gazetted Officer, Manager of a Scheduled Commercial/Co-operative Bank or Multinational Foreign Banks (Name, Designation & Seal should be affixed on the copy).

2.In case of NRIs, authorized officials of overseas branches of Scheduled Commercial Banks registered in India, Notary Public, Court Magistrate, Judge, Indian Embassy/Consulate General in the country where the client resides are permitted to attest the documents.