Customer Code

Activation Date

Customer Status

Customer name

Fathers Name

Mothers Name

Spouse Name

Guardian Name

Date Of Birth

PAN

KYC/CKYC No

Nationality

Aadhar No

Other ID (if required)

Full Address

Mobile Number

Email Address

Place & Country of Birth

US / Canada Citizenship
APPLICABLENOT APPLICABLE

Tax Liability other than India
YesNo

PEP Details:
YESRELATEDNOT APPLICABLE

Occupation

Income Group

Qualification:

Address Type:

Primary Bank Details

Primary Bank Name :

Primary Bank Branch:

Primary Bank Account Type:

Primary Bank Account Number :

Primary Bank IFSC:

Primary Bank MICR Code:

Nominee Name:

Nominee Date Of Birth:

Nominee Contact:

Nominee ID:

Nominee Relation:

Appointee Name:

Appointee Relation with Minor:

Segment:

MFShareFDLife Ins.Health Ins.NPSOther

Annexure for Additional Bank Details

Bank-1 Name :

Bank-1 Branch:

Bank-1 Account Type:

Bank-1 Account Number :

Bank-1 IFSC:

Bank-1 MICR Code:

Bank 2 Details

Bank-2 Name :

Bank-2 Branch:

Bank-2 Account Type:

Bank-2 Account Number :

Bank-2 IFSC:

Bank-2 MICR Code:

Bank 3 Details

Bank-3 Name :

Bank-3 Branch:

Bank-3 Account Type:

Bank-3 Account Number :

Bank-3 IFSC:

Bank-3 MICR Code:

Annexure for Additional Nominee

Nominee-2 Name:

Nominee-2 Date Of Birth:

Nominee-2 Contact:

Nominee-2 ID:

Nominee-2 Relation:

Appointee-2 Name:

Appointee-2 Relation with Minor:

Nominee-3 Name:

Nominee-3 Date Of Birth:

Nominee-3 Contact:

Nominee-3 ID:

Nominee-3 Relation:

Appointee-3 Name:

Appointee-3 Relation with Minor:

Any Other Special Notes

Scan Copy Form:

Image:

Signature: