PERSONAL
CustomerID
CustomerName
Father/Mother
Date of Birth*
PAN Number Occupation
Source of
Income
Gross
Annual
Income
Customer Type Code : (Refer Table B overleaf)
Widow/
Marital
Married
Status
City of Birth
Employment
Status Salaried Housewife
Unemployed
Company (If Applicable)
[Firm Name
PERMANENT ADDRESS (Please leave space between two words)
Flat No/
Bldg Name Road Name
Landmark
City
State
Tel. (R)
Email ID'
MAILING/CURRENT ADDRESS (If different from permanent Address)
Flat No/
Bldg Name
M O H DE
Road Name
Landmark
PIN code )
Country g)2
D
City
State
Note: - For Minor below 10 years, separate self-declaration form for both "Minor' as well as 'Guardian' is mandatorily required.
In case of Joint Account, all account holder has to submit the declaration separately. PAN/Form60 is required for KYC purpose.
DECLARATION
I dec re that the information provided above with respect to my account is up to date and correct.
I declare that I am tax resident of India and not resident of any other country. OR
I declare that I am tax resident of
I hereby consent to update above information in Bank's Record. I further declare that the details furnished above are
true and correct to the best of my knowledge and belief and I undertake to inform Bank of any changes therein,
immediately. In case any of the information is found to be false or untrue or misleading or misrepresenting, I am aware that
I may be held liable for it.
I hereby consent to receiving information from CKYC Registry through SMS/Email on the above registered number/email address
Affix Recent Photo
I have also attached my recent photograph alongside
Place
Date
