KNOW YOUR CLIENT (KYC) APPLICATION FORM
* Mark fields are Compulsory
A. Identity, Address and Other Details
Name
(Exactly as mentioned on PAN)*
Father's / Spouse Name *
Gender *  
Marital Status *  
Date of Birth
(As on the PAN / ID proof) *
(dd/mm/yyyy)
Nationality *
Status *
PAN * Know your PAN
Unique Identification Number
(UID) / Aadhaar, If any (optional)
Proof of identity
Email Id *
Mobile No *
Residence phone (Optional)
Office phone (Optional)
Correspondence Address *
(Max characters 81)
City/Town/Village *
State *
Country *
Pincode *
Proof of Address provided Correspondence *
Permanent Address
(If different from correspondence address) *
(Max characters 90)
City/Town/Village *
State *
Country *
Pincode *
Income Range p.a. *
 
Occupation*
 
 
Please select if applicable
 
Place *
Date * (dd/mm/yyyy)
C. Bank and other details
Bank Name *
Branch Name *
Bank Address *
Account Number *
Account Type *
IFSC Code *
MICR No *
Trading Preferences :
NCDEX (dd/mm/yyyy)
MCX (dd/mm/yyyy)
D. DP Details (In case other DP is linked)
Depository Participant Name
Beneficiary Name
DP Name
DP ID
BO ID
E. Nomination Details
Nominee Name
Nominee DOB (dd/mm/yyyy)
Nominee's Address
(Max characters 40)
Nominee's Pan No
Relationship with the Applicant
Guardian Details (In case of a Minor Nominee)
Full Name of the Guardian of Nominee Address
(Max characters 40)
F. Introducer details
Name of the Introducer
Introducer Address
(Max characters 92)
Please provide Introducer’s Modex Code
Status of the Introducer
Witness
Name
Address
(Max characters 40)
Name
Address
(Max characters 40)
Dealing Through other Members
Member's/Authorised Person Name
Exchange
Exchange Registration No.
Concerned Member's Name with whom AP is registerd
Registered office Address
(Max characters 40)
Telephone No:
Fax No:
Email Id:
Client Code
Details of Disputes/dues pending from/to such member / AP :
Name
(Exactly as on your Certificate of Incorporation / Registration / PAN of HUF) *
Date of Incorporation
(as on PAN) *
(dd/mm/yyyy)
Place of Incorporation *
Date of Commencement of Business * (dd/mm/yyyy)
Status (Select one) *
 
PAN * Know your PAN
Email Id *
Mobile Number *
Residence phone (Optional)
Office Phone (optional)
Fax
Correspondence Address *
(Max characters 81)
City/Town/Village *
State *
Country *
Pincode *
Proof of Address provided Correspondence *
Registration Number *
Registered Address
(If different from correspondence address) *
(Max characters 77)
City/Town/Village *
State *
Country *
Pincode *
Income Range p.a. *
 
Please select if applicable
 
Other Details (If space is insufficient, enclosed these details seperatly(illustrative format enclosed))
Name, PAN, Residential Address and Photographs of Promoters/Partners/Karta/Trustees and whole time directors
DIN OF Whole time Directors :
AADHAR number of Promoters/Partners/Karta :
Details of Promoters/Partners/Karta/Trustees and whole time directors forming a part of Know Your Client (KYC) Application Form for Non-Individuals
Select Number of partners :
1. Name DPIN
PAN DIN (For Directors) / UID (for Others)
Aadhar (UID) Number Designation
Residential /Registered Address
(Max characters 83)
City/Town/Village
State Country
Pincode Relationship with Applicant
(i.e. promoters, whole time directors etc.)
Please select if applicable
Bank Account Details
Bank Name * Bank Address * Bank Account Number *
IFSC Code * MICR No * Account Type *
Depository Account details, if available
Depository Participant Name Beneficiary Name DP Name
DP ID Beneficiary ID
Trading Preferences : NCDEX (dd/mm/yyyy)
  MCX (dd/mm/yyyy)
Dealing Through other Members
Member's/Authorised Person Name Exchange Exchange Registration No.
Concerned Member's Name with whom AP is registered Registered office Address
(Max characters 40)
Telephone No:
Fax Email Client Code
Details of Disputes/dues pending from/to such member / AP
Introducer details
Name of the Introducer Introducer Address
(Max characters 40)
Status of the Introducer