Re-KYC Form for Non-Individuals & TASC

Please fill all the details in CAPITAL LETTERS and Black Ink only. Fields with (STAR) are MANDATORY
PERSONAL

*Customer ID: *A/C Number:

*Entity Name: (Please leave space between two words)

*Address:

*Pin Code:
*Mobile: *E-mail ID:
*Tel. (R): -- *(Off): --

*DOI: D D M M Y Y Y Y *PAN: or Form 60: If PAN not available, fill Form 60.
There is no change in my/our mailing address.
Address proof to be provided.
Address & Contact
I/We wish to change my/our mailing address as below (Please leave space between two words)
Address proof to be provided for change of address.
Communication Address:
Premise/
Shop / Office No.: Bldg Name:
Street / Road No.: Street/Road Name:
Suburb / Locality/
Landmark: Area:
Town: City: *Pin Code:
State: Country:

I/We wish to update the following details.

Tel. (R): -- (Off): --

*Mobile: *E-mail ID:

*DOI: D D M M Y Y Y Y *PAN: or Form 60: If PAN not available, fill Form 60.

Disclaimer: I/We hereby authorise the bank to send me/us alerts and e-mails to the afore-mentioned mobile number and e-mail id provided
by me/us.

Business Entity Details

1. Nature of Business: Services Trading Manufacturing Agriculture Related Retailing Stock Broker Real Estate
Self Employed Others____________

2. Source of Funds: Business Income Rental Income Agriculture Income Equity Infusion Grants Donation
Others_____________

3. Annual Sales Turnover (Rs.): <40 lakh 40 lakh to < 5Cr >5Cr to <25Cr 25Cr to <100Cr > =100 Cr Not Applicable

4. Whether involved in Import Export IEC Number:

Please specify
5. Industry Type : _______________________________. (Tick from the below options else specify if not available)

*Please specify the type of Industry (Please Tick):

Automobile Restaurants IT/Software/BPO Agriculture Commodities Petrol Pump Forex Dealer/Bullion Media/Entertainment

Leasing & Hire Purchase Contractors Construction Housing Finance Oil Fisheries/Poultry Steel/Hardware

Fertilizers/Chemical-Seeds-pesticides Consultancy Cements/Paints Dairy/Food processing Electronics-Computer Hardware

Education Engineering Goods Shroff Issue & Portfolio Management NBFC Pharmaceuticals Textile/Garments Hospital/Nursing

Home/Clinics Retail Jewelry Hotels/Resorts Printing/Publishing FMCG Furniture/Timber Consumer Durables

Travel/Touring Agency Term Lending Institution Broking Money Lender Marble/Granite Auto Finance Advt. Agencies

Transportation/Logistics
 Ownership and Control Structure Information Sheet
1. Details of Authorised Signatory, Beneficial owner, 2. Details of Authorised Signatory, Beneficial owner,
Proprietor, Trustee, Grantors, Settlors, Karta Proprietor, Trustee, Grantors, Settlors, Karta

*Designation: Authorised Signatory Beneficial owner Authorised Signatory Beneficial owner

(Please Tick) Proprietor Trustee Grantors Proprietor Trustee Grantors
Settlors and beneficiaries of Trust Karta Settlors and beneficiaries of Trust Karta

Prefix (Mr./Miss/Mrs.)
*Name:
DOB: (DD/MM/YYYY) (DD/MM/YYYY)
Nationality:
*PAN (mandatory)
Customer ID:
*Address:
Flat No./Bldg Name:
Road/Street Name.:
Land Mark:
City: *Pin Code: *Pin Code:
State: Country: Country:
Telephone No.: (R): (Off): (R): (Off):
*Mobile No.:
Email ID:
Identity proof:
Address proof:

Declaration:
• I hereby authorise the Bank to update my Bank account/s and any other facilities product/s held by me with the Bank, basis the details provided
by me in this form.
• I declare that the information provided above with respect to my account is up to date and correct.
Please tick this declaration only if you voluntarily opt/consent to Aadhaar based authentication/verification:
• I/We hereby agree and confirm that I/we have been provided various options by the Bank for KYC compliance in relation to KYC updation and
• I/We hereby agree and opt for Aadhaar based authentication/ verification (in physical or electronic form) for the purpose of KYC updation.

I submit a self- attested photocopy of the following as:

Entity proof: 1)

Entity proof: 2) Place: Date:

Signature and Photographs

Authorised Signatory 1 Authorised Signatory 2

(30 mm x 40 mm) (30 mm x 40 mm)

For additional authorised signatory / beneficial owner please fill separate Re-KYC form.

For Branch Use Only

(Please specify)
I confirm having met Mr/Mrs_________________________________________________________________ in person, at his /her residence /office/
(Please specify)
Others ____________________________________. I also confirm that the form has been signed and filled by the applicant in my presence.
Date: D D M M Y Y Y Y Employee Number:

Signature of the Bank official

Acknowledgement To Customer

Re-KYC for A/C Number:______________________________________

Acknowledgment Date: D D M M Y Y Y Y Reference No.: ____________________________ Signature of the Bank official