SIDBI, __________________________________ (Name of Branch)

Know Your Customer (KYC) – APPLICATION FORM (for NON-INDIVIDUALS only) - Initial KYC Compliance / Change / Updation

(A) Identity Details

1 Customer ID :
2 Name of the Entity :
(as in the supporting document)
3 Beneficial Owner details :
4 Industry Group /sub-group
5 Type of organization : Proprietorship Partnership Pvt. Ltd. Company Public Ltd. Company NBFC
[pl. tick in the appropriate box;
and write NA, if any column is
Govt. Body HUF Society Trust Others (pl.specify) __
not applicable in this form; and
use extra sheets for providing
more / additional information]
6 Is it a registered entity : Yes No ( 5). PAN No.__

7 If Partnership, is it LLP : Yes No

8 Details of Regist. :
(The Act under which registered)
9 Date of Incorporation / : (9) Regist. No. __
Registration
10 Nature of Business : Manufacturing Trading Service Others (pl. specify) __

11 Industry / Sector / Product :

12 State, if : A Subsidiary Co. An Associate

13 If yes, name of Holding / :

Group Co.
14 Listing status of the Co. : Listed Co. Unlisted Co. (15) If listed __
(name of stock exchange)
15 Contact Details : STD Code Tel. No(s). Fax No(s).

E-mail address(s)
16 Details of Contact Person
Name Mr/Ms __ Designation __

STD code __ Ph. No(s) __ Mob. No(s) __

e-mail address __
17 Name(s) of :
Proprietor/Partners / 1. __ 2. __
Directors etc.
(If more nos. add extra sheet) 3. __ 4. __

5. __ 6. __
18 Previous Year’s Turnover :
(FY __ ) : ` __ Lakh
19 Details of ID proof :
documents submitted
(B) Address Details :
20 Address for corrsp/
Regi. Off./Overseas addrs
21 Factory / Unit address(s) :
22 Address proof submitted :
DECLARATOIN SIGNATURE OF THE APPLICANT
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 the 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 any changes to the information provided herein above. I hereby
authorise SIDBI, its authorised agents and representatives to disclose, share, remit in any form, mode or manner all /any of the
information provided by me. I hereby agree to provide any additional information/documents that may be required in connection with Date :
this application. Place :
FOR OFFICE USE
KYC Risk Catg. of Customer : HIGH MEDIUM LOW Maker Checker
 Whether all information has been filled up by the applicant YES / NO YES / NO
 Verified with originals and self certified copies of all required KYC Documents received. YES / NO YES / NO
 The name(s) of the applicant have been checked in the latest updated prescribed list(s) of terrorist individual /
organizations and no matches found. YES / NO YES / NO
 PAN verification has been done, , wherever copy of PAN card obtained.

[COPIES OF DOCUMENTS OBTAINED TO BE PLACED/STAPLED/TIED WITH THIS KYC APPLICATION]

(Signature) (Signature)
GUIDELINES FOR CUSTOMERS
IMPORTANT NOTES – PLEASE READ BEFORE FILLING UP THE FORM
1. This KYC Application Form is meant for use by NON- 4. SIDBI will not be liable for any errors or omissions on the part of
INDIVIDUALS only to comply with the Customer Identification the applicant in the KYC Application Form.
Programme laid down under the Prevention of Money Laundering 5. SIDBI and its Directors, employees and agents shall not be liable in
Act, 2002 (PMLA) hereinafter referred to as Know Your Customer any manner for any claims arising whatsoever on account of
(KYC) requirements. A separate form is provided for rejection of any application due to non-compliance with the
INDIVIDUALS provisions of the PMLA or where SIDBI believes that transaction(s)
2. This form is not an Application for any facility (Loan/Deposit etc.), by an applicant / investors is / are suspicious in nature within the
and is only meant for providing information and documents purview of the PMLA and RBI guidelines and requires reporting the
required for KYC compliance. KYC compliance is a must for same to Financial Intelligence Unit – India (FIU-IND).
availing any facility. 6. Power of Attorney (PoA) Holder: Customers desirous of acting
3. The KYC process requires customers to provide identity and through a PoA must note that the KYC compliance requirements
address information supported by documentary evidence to are mandatory for both the PoA issuer (i.e., customer) and the
comply with the KYC requirements, apart from other information Attorney (i.e., the holder of PoA), both of whom should be KYC
and copies of relevant documents as per the prescribed compliant in their independent capacity.
guidelines. SIDBI reserves the right to seek any additional 7. As per the guidelines, KYC compliance is also required in respect
information/ documentation in terms of the PMLA at any point of of third party mortgagors / guarantors / pledgers etc.
time.
GUIDELINES FOR FILLING UP THE KYC APPLICATION FORM
General 3. Please mention the date of incorporation or registration of your
1. The Application Form should be completed in ENGLISH and in organization. If your company is listed on any stock exchange,
BLOCK LETTERS. please mention the details.
2. Please tick in the appropriate box wherever applicable . 4. Mention PAN in the space provided and attach a self-attested
3. Please write NA, if any column is not applicable. photocopy of the same. Please also submit your original Pan Card
4. Please tick in the appropriate box to indicate viz. initial KYC which will be returned across the counter after verification.
compliance / subsequent Change or periodic Updation at the B. Address Details
top of this KYC Application Form. 1. Address for Communication: Please provide here the address where
5. Please fill the form in legible handwriting so as to avoid errors in you wish to receive all communications sent by the Bank. The
your application processing. Please do not overwrite. Corrections Addresses mentioned should match with the address in the ‘Proof-of-
should be made by canceling and re-writing, and such corrections Address’ submitted as supporting document. Otherwise, the KYC
should be counter-signed by the applicant. application is liable to be rejected.
6. Applications incomplete in any respect and / or not accompanied 2. Contact Details : Please provide the Contact Person’s Name /
by required documents are liable to be rejected. Telephone No(s). / E-mail contact details for the Bank to
7. You are required to submit a copy of Proof-of-Identity communicate with you.
document and a Proof-of-Address document (apart from 3. Address for correspondence / Registered Office / Overseas address :
copies of all other required) documents as per the extant Entities having a separate correspondence address apart from that of
the registered office address etc., they should mention same
guidelines. separately. Entities having any Overseas Address must quote the
8. Any document having an expiry date should be valid on the date same supported by required documents duly certified.
of submission.
4. TO PROVIDE MORE/ADDITIONAL INFORMATION, IF
9. Copies of all the documents submitted by the applicant should be
self-attested and accompanied by originals for verification. In case ANY :For providing more information at any column or for any
the originals of any document is not produced for verification, then additional information, additional sheets may be used and
the coies should be properly attested by - stapled with this KYC application.
 a Notary Public / Gazetted Officer / Manager of a Scheduled After you have completed filling up the KYC Application Form,
Commercial Bank or Multinational Foreign Banks (Name, please submit the same along with the entire set of supporting
Designation and Seal should be affixed on the copy). documents. Please also submit a photocopy of the Form for
 In case of a foreign entity - authorized officials of overseas acknowledgement purpose, which you can retain for your records.
branches of scheduled commercial Banks registered in India,
Notary Public, Court Magistrate, Judge, Indian Embassy / Other important notes, after the KYC Acknowledgement is issued to you :
Consulate General in the country where the person reside.
7. Unattested photocopies of an original document are not 1. Signature on this KYC Application Form should match with that on
acceptable. the Application for any facility like Loan/Fixed Deposit Application
8. If the documents including attestation / certifications are in regional Form etc.
language or foreign language then the same has to be translated 2. If there are any changes in an Applicant’s details after submission of
into English for submission. this form such as Name, Address, Status, etc., the change should
A. Identity Details be registered expeditiously. Similarly, periodic updation of KYC
1. Customer ID : Customer ID is to be filled after creating the unique details should be provided to the Bank as per the guidelines. Please
customer ID for the Customer by the Bank. tick in the appropriate box at the top of the Application to indicate
2. Name : This should be match exactly with the name as mentioned the purpose.
in the PAN card and other supporting documents; otherwise, the 3. Original / Attested copies of documents supporting the change will
application is liable to be rejected. If the PAN card and other be required to be submitted together with the KYC Details Change
supporting documents has a name by which the applicant has Form. Latest attested copies of supporting documents to be
been known differently in the past, than the one provided in this provided along with KYC Updaiton Form.
application form, then requisite proof should be provided e.g.
Name Change Certificate.