Line 1*

Line 2

Line 3 City / Town / Village*

District* Zip / Post Code*

State/UT* Country*

Address Type* Residential / Business Residential Business Registered Office Unspecified

(Certified copy of any one of the following Proof of Address [PoA] needs to be submitted)

Proof of Address*

1. Identity Details (Please refer instruction A at the end)

Name* (same as ID proof)

Maiden Name (If any*)

Father / Spouse Name*

Mother Name*

Date of Birth* D D M M Y Y Y Y

Gender* M- Male F- Female T-Transgender

Marital Status* Married Unmarried Others

Citizenship* IN- Indian Others – Country Country Code

Residential Status* Resident Individual Non Resident Indian

(Please fill the form in English and in BLOCK Letters)

Fields marked with „*‟ are mandatory fields

Photo

3.1 Current / Permanent / Overseas Address Details (Please see instruction D at the end)

Signature/

Thumb Impression

3. Proof of Address (PoA)*

(Certified copy of any one of the following Proof of Identity [PoI] needs to be submitted)

Middle Name

Last Name

Same as Current / Permanent / Overseas Address details (In case of multi ple correspondence / local addresses, please fill „Annexure A1‟, Submit relevant documentary proof)

PAN Please enclose a duly attested copy of your PAN Card

New

Application

Type*

Update KYC Number*

Country Code

as per ISO 3166

State/UT Code

as per Indian Motor Vehicle Act, 1988

State/UT* Country*

Country Code

as per ISO 3166

State/UT Code

as per Indian Motor Vehicle Act, 1988

Address

Passport Number Passport Expiry Date

Voter ID Card

Driving Licence Driving Licence Expiry Date

Aadhaar Card

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