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Kyc Annexure A May 2022 - Fillable

This document is a Self Declaration Form for KYC Updation for individuals at the Bagula Branch of the State Bank of India. It requires customers to confirm that there are no changes in their KYC information and to provide necessary personal details. The form also includes a declaration of responsibility for any changes in the provided information and is intended for both customer use and bank verification purposes.

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2001palashghosh
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333 views1 page

Kyc Annexure A May 2022 - Fillable

This document is a Self Declaration Form for KYC Updation for individuals at the Bagula Branch of the State Bank of India. It requires customers to confirm that there are no changes in their KYC information and to provide necessary personal details. The form also includes a declaration of responsibility for any changes in the provided information and is intended for both customer use and bank verification purposes.

Uploaded by

2001palashghosh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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KYC ANNEXURE ‘A’

BAGULA (01302) BRANCH


STATE BANK OF INDIA___________________

SELF DECLARATION FORM FOR KYC UPDATION


(INDIVIDUALS: NO CHANGE IN KYC INFORMATION)
Account Number*
CKYCR No *
OVDs submitted to Bank ✔ YES NO Date of Expiry of OVD
are valid/not expired (as (If applicable)
on date) *
Name*
PAN Number (If available)
Current Address* Line 1: ________________________________________________________________
Line 2: ________________________________________________________________
City/Town/Village: _______________ District: ____________________________
State: _____________________ PIN: _____________________________________
Country: _______________
Occupation*
Annual Income*
Sources of Income
(Please tick all that are Salary Business Income Agriculture Investment Income Pension Others
applicable) *
Mobile Number
Email ID

CUSTOMER’S DECLARATION
I hereby declare that there is no change in existing status of my KYC Information which was provided at the time of opening the
account / last KYC updation. I undertake the responsibility to declare, disclose and provide immediately and in no case beyond 30
days from the date of change, any changes that may take place in the information provided herein/or otherwise, as well as in the
documentary evidence provided by me or if any certification becomes incorrect or undergoes a change. In case the above information
is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.

Date:………………………. Signature/Thumb Impression of Customer


Place:……………………… Name ……………………………………………………..

For Office Use only


1. Certified that KYC Documents of the Customer available with the Bank are as per current Customer Due Diligence (CDD)
Standards.
2. CKYCR Number of the customer is available in Bank records.
3. PAN details (if available) have been verified from database issuing authority.
4. Information submitted by the customer verified & KYC updation date entered in CBS.

Maker……………………….. Checker……………………………
PF No.......................... (S.S. No______________)
(This form is to be sent to LCPC for digitisation and storage)

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