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Customer Identity Form 01

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sivam
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581 views3 pages

Customer Identity Form 01

Uploaded by

sivam
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
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sami Branch Name wera ‘CUSTOMER IDENTITY FORM Su Bar INDIVIDUAL, a esto shad inte ‘customer: FormNo.23 etn “ckYC No ‘Customer Type: Name: _| Mi Ean FEET “pplication Type: |New | Update Account Type: Normal Simplified Small INSTRUCTIONS: Fill up in CAPITAL Letters and use Black ik fr filing this form. Please () Appropriate box Public | Staff] Senior citizen: | Yes | Minor. | Yes | NRI:_| Yes FNRI, Mandatory to attach FATCA Ms, Ms, _| Others Name of father / Husband Guardian: | Me | Ms, Mrs. _| Others Mothers Maiden Name: Maral status Marie __| Unmarried Date of arth Gender: Male _| Female __|rans_| Nationality PAN No. ‘oR _ | Form60 — Aadhaar Permanent Address (If NRI, Mention Overseas Address) Landmark Steet PINizP ity state Landline Country Communication Address _|Same as above (If NRI, Mention Local indian Address) Landmark Stet iN 2 ay state Landline county omer “Contact Details: (Mandatory) eal Din APTALLETIES eg, ARCD@MALLCOM Mobile | fal ™ =“ ‘Additonal Details: Residential Status Resident _|Nor-Resident | Foreign National _| Person of nn Origin ataenship INndian Others (03166 County Code |_|) Physically challanged | N ‘capaton Type Sserice( | PivateSecar | Publ Secor | Goverment Seca)_|Pofesional | Sl-Employed fered __|Housewife Student’ —_| Employment Agicaturst | Business Not Categorized Atal Occupation Relion Hinds | Musim ctvisn (Sih an” buds Community osc MBC sc st _ | othes Educational Qualification Non Maticulate | SSLOHSC —_|Graduate _|Post Graduate | Professional | Others Income Tax Stats Individual Senior Citizen Very Snir Cizen Iassese YON Relationship with bank (TMB) |_| Employee staff No. Director _| Outsource _| Sembee" _| Seveceateners Accommodation wn independent House Own Ft | Onrental_ Company Provided thes Vice Type Two Whedler —|cCar While ownership owned Company Provided Source of Funds Solay | Pension _| Rental | Business| Investment _|Agcutre | Renton Aad Expected Annual Income & Gross Annual Income Range <1 Lakh _|1-5 lakhs | 5-10 Lakhs _|10-25 Lakhs [25-50 Lakhs _| 50-100 Lakhs _| >100 Lakhs Purpose of Account Opening Petsonal Savings Investment __| Business Activities Others ‘Accounts with other Bank(s)/ Bank Branch / Address Account Type ‘Account No, Selenide Date of becoming Non-Resident Country Eee “+ Uhereby dearethatthe deta fumished above are nue ad core the bes fry knawledge ad bead | undertake inform yout ay changes therein, mmesiatel.Incase tnyothe above fomoton's fonda bela or untueamsleadingormisrepreseatinglamaware that Im beheld blo Hy pesonalKYC etal maybe shared ith Cental CReisry "hetey consent receing infomation tom ental ¥CRegit throughSMjEmalonthesbave registered eunbarenalladress hereby gvemy voluary conse seeding my AadhaarNunbertoallny kankaccourseastundermy cstomerD Inavers cbjcion inauterticting mye with Aachaar based Autencation system and heey em voluntay consents equedundertheAadhaar A201 Gand Regultions ‘romed therurde far sea my Aadhor tuber omy bank count to prov de'ny Jey oman (adhas number nec lomaton 8 demogpa norma) ot ‘adhaarbase authencaton forthe pupose farang othe banking services, ++ thereby athorse tase my ke Aadhaoeabled bank account for esing Govern payment across schemes that lam lg &a ary ter pyre sing Aodhan based inflation and NCI may MAP yang cuttin the ashaar Mapp NFCL + Ihavebeen expand about the nature ofinforation hat my be share ypon authentication. have been iver to understand that my nfematon submited tthe bark herewith ‘Staller be sed for any purpose other han menoned ove ras perrequement la IsFATCA, cS applicable Yes _| Wo Ys, ease fll up FATCA Delain Form) sho Regier ame na Nat al Reiter | Yes | No Sigs Documents Sectio TE. Peet inaddessProofasapatabe AEE RSME TD [AaarSS] Conf that, Rave ead and understood the above declan ad thatthe details Document Name roof] Post | provided nthefern are core Pasar Natt Fasspor Expy Date SA Namber ‘sa ald Upto cae pa ate a “rai ert Ca Accor Holer Sprawe pan Mautner ewjuaasscernse se Diving Lense Driving ens xy Date 0 fait) me REG od « ‘thers fay document otiied bythe Cental Goverment DECLARATION BY THE BRANCH Heelan Cad Oat By (BANK USE) 1sG So glee aa camo Soe Eon cee the ged Doct Ne ‘Senos ey on tes Pe wt olor ne Spiolrepnmelbesent Document Name Smplied Document No. “Thetold in ry arth apple's potgaph sues by Gov ep ma jon jer |g Leterisued by a Gaeted ocr Simplifed Document (Deemed Address Proof) ‘iy Wa Teephone Poi ne Ped as we ae within 2 months ald) o« OO OO OOS &* Ca) Property or Muni Tax Receipt DECLARATION BY CFC Salt Decaration &Pstive Canfation Certificate NA Psion o family pesin payment orders PPO) {ater of alniment of ccemmadston from ensloyer ‘Sued by Sate or Cental Government partner Donets issued by Got, Dep of Foran iisccion pate need foreign bss / Miso in nia oe TE) OI) DOG # Cer ee Ue Aaa ee) The signature on the ID proof / Address / Cheque provided i diferent fom my signature on the Account Opening Form Please consider the signature onthe Account Opening Ferm as myupdated ignatre in your Bankrecoes (lg signature New signature ‘sper documents! Eisting CustomerID As per account at anairy ‘opening form |agreeto indemnity and keep indeed the Bank atalltinesromand aganstall cass, charges, damages, peraies including atorey fees) sufered anlarincuredbyforany done oromitedtobe dane an acount ofthe above dedaration. Form for declaration to be fled by an individual or a person (not being a company or firm) who does not have a permanent account number and who enters into any transaction specified in rule 1148, 1) applied for PAN adit is not et generated ener dat of appliation and acinowledgement umber, 19 1 PAW not applied fil exited trl income (nung income of Spouse, minor cil ee 35 per Section 64 of Income-ax At, 1961) fr the rani year in which the above ‘ranscion is eld 2. Agua income >, other than Agcutural income VERIFICATION f ohereb decare tat what isstatedabovelstuetothe best of my knowledge andbelet further decoretnat donothave a Permanent Account Number and my/our estinated total nome inducing nome of spouse, mince. spr section 6 of ncome-ax Ac, 1961) computed inaccordance with the provisions of Incometax Ac, 1961 forthe nancial yearn which the above wansacton eld wil be estan maximum amour not chargeable tot Vertedtoday,the - dayof 20- Date. Fle Sapa answer eying ese a lama tx resident af nia and not resident of any other county OR _| ama tax resident of he countries mentioned in the able below: Pease indicate the countyes in which the entity I a tesident fo tax purposes and the associated Tax 1D Number belo: cyte Coumy a dies ype lrTarhopese__| peel |ausness _|Regitedotice come | Belden Taran pe as Frou " umes | Nerciecpleasespcs |_| ConmuniatonAdouss _|eranent Ades Please ote te aes owe fm sate. couney ‘eat net te lial ee en col UH a Menor amt stab na poi cleans fire naa nce nant eens th Fam ough ae ata 8 an a ey ‘Somat womon potentiometer FATCA-HS Terms ond Cantons ‘he on et fie Tes as ied an 7h August 205 Rls 10 14H arto comet ules, 196, hh Rls eqs nan arial statins such a the Sanka sek ‘atonal prea tx and beneSal anne infamaton ard carn ctfstans snd acamertaton Farle aout halen release, frmatan wil eet ep oak sutton agence thing ape he prose easing pppoe nneHng om he acon or ry poses nrebin thee, Saal hv be ay rage Any inoratn rovseay you pleavesmteYousdvius pomp. wien 30 yuhave ny questions aba outside plea conse yor aia yo a 3 Stn ser ten cad hl es inde United Stats inthe rege out inlaraton Fialogwihou'U oerhaion anbe$ tsar osuply aor untanal equler county wihyuatetanesdet sus suerte. Hae Ws ycoolblearh tye besued pssepevdean enlraionandatachhstothetrm. ‘ype of Guardian [rather __|Mather _|cour Appointed _| Testamentary Gurion Guard Cust Fall Name of Gurdon hereby dec tht the dt of bith fhe ior ho my. ‘rdlangurdion appointed by cout ode dated — =< '5 )_t_J_J)_)_ land am nse tual and tl

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