eSignDocument
eSignDocument
Intermediary
Application Form (For Individuals Only) CDSL VENTURES LIMITED
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….Exploring New Horizons
Normal EKYC OTP EKYC Biometric Online KYC Offline EKYC ✔ Digilocker
(Passport mandatory for NRIs and Foreign Nationals. PIO selection is only for CKYC and not for KRA KYC.
Select NRI or Foreign National based on Nationality of the individual)
Proof of Identity (POI) submitted for PAN exempted cases (Please tick)
A — Aadhaar Card XXXX XXXX __ __ __ __
(Expiry Date)
B — Passport Number
C — Voter ID Card
(Expiry Date)
D —Driving License
E —NREGA Job Card
F — NPR
Z —Others (any document notified by Central Government)
Identification Number
2. Address Details* (please refer guidelines overleaf)
A. Correspondence/ Local Address*
Line 1* SUKANTA KUMAR SAHOO, 21, SIDHESWARPUR, HIGH SCHOOL
Line3 INDIA
Applicant e-SIGN
1
B. Permanent residence address of applicant, if different from above A / Overseas Address* (Mandatory for NRI Applicant)
Line 1* SUKANTA KUMAR SAHOO, 21, SIDHESWARPUR, HIGH SCHOOL
Line3
INDIA
City/
SIDHESWARPUR CUTTACK 754100
Town/Village* District* Pin Code*
ORISSA INDIA
State* Country*
Address Type* Residential/Business ✔ Residential Business Registered Office Unspecified
Proof of Address* (attested copy of any 1 POA for correspondence and permanent address each to be submitted)
✔ A — Aadhaar Card 0244
XXXX XXXX __ __ __ __
B — Passport Number (Expiry Date)
C — Voter ID Card
(Expiry Date)
D —Driving License
E —NREGA Job Card
F — NPR Letter
Z—Others (any document notified by Central Government)
Identification Number
4. Applicant Declaration
I/We hereby declare that the KYC details furnished by me are true and correct to Applicant e-SIGN Applicant Wet Signature
the best of my/our knowledge and belief and I/we under-take to inform you of any
changes therein, immediately. In case any of the above information is found to be
false or untrue or misleading or misrepresenting, I am/We are aware that I/We
may be held liable for it.
I/We hereby consent to receiving information from CVL KRA through SMS/Email on
the above registered number/Email address.
I am/We are also aware that for Aadhaar OVD based KYC, my KYC request shall be
validated against Aadhaar details. I/We hereby consent to sharing my/our masked
Aadhaar card with readable QR code or my Aadhaar XML/Digilocker XML file, along
with passcode and as applicable, with KRA and other Intermediaries with whom I
have a business relationship for KYC purposes only.
27/11/2024
DATE: _________________________ (DD-MM-YYYY)
GURGAON
PLACE: _______________________________________
2
Proof of Identity / PAN (mandatory)
5
Proof of Address (mandatory)
6
Applicant Wet Signature Page (mandatory)