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)
Email Id *
Mobile No *
Residence phone (Optional)
Office phone (Optional)
Correspondence Address *
(Max characters 65)
City/Town/Village *
State *
Country *
Pincode *
Proof Of Address *
 
Permanent Address
(If different from correspondence address) *
(Max characters 115)
City/Town/Village *
State *
Country *
Pincode *
Proof of Address provided *
 
Income Range p.a. *
 
Occupation*
 
 
Please select if applicable
Place *
Date * (dd/mm/yyyy)
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)
Correspondence Address *
(Max characters 90)
City/Town/Village *
State *
Country *
Pincode *
Proof of Address provided Correspondence *
 
Registration Number *
Registered Address
(If different from correspondence address) *
(Max characters 90)
City/Town/Village *
State *
Country *
Pincode *
Proof of Address provided Registered *
 
C. Bank and other details
Bank Name *
Branch Name *
Bank Address *
Account Number *
Account Type *
IFSC Code *
MICR No *
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 92)
Phone Number (optional)
City
State
Country
Pin Code
Fax
Nominee's Father's Name
Nominee's Pan No
Relationship with the Applicant
UID
Email Id
Relationship with BO(if any)
Date of Birth(Mandatory if nominee is minor) (dd/mm/yyyy)
Guardian Details (In case of a Minor Nominee).
Full Name of the Guardian of Nominee
Address
(Max characters 92)
City
State
Country
Pincode
Telephone No:
Fax No:
Pan:
UID:
Email Id:
Relationship of Guardian with Nominee:
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 70)
Name
Address
(Max characters 70)