CENTRAL KYC REGISTRY | Know Your Customer (KYC) Application Form | Individual
Important Instructions:
A) Fields marked with ‘*’ are mandatory fields. E) List of State / U.T code as per Indian Motor Vehicle Act, 1988 is available at the end.
B) Please fill the form in English and in BLOCK letters. F) List of two character ISO 3166 country codes is available at the end.
C) Please fill the date in DD-MM-YYYY format. G) KYC number of applicant is mandatory for update application.
D) Please read section wise detailed guidelines / instructions H) For particular section update, please tick ( ) in the box available before the
at the end. section number and strike off the sections not required to be updated.
For office use only Application Type* New Update
(To be filled by financial institution)
KYC Number
Account Type* Normal Simplified (for low risk customers) Small
A. In case of Existing Customer, please specify your loan account number below :
Loan Account Number :
1. PERSONAL DETAILS (Please refer instruction A at the end)
Prefix First Name Middle Name Last Name
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
PHOTO
Gender* M- Male F-Female T-Transgender
Marital Status* Married Unmarried Others
Citizenship* IN-Indian Others (ISO 3166 Country Code)
Residential Status* Resident Individual Non Resident India
Foreign National Person of Indian Origin
Occupation Type* S-Service ( Private Sector Public Sector Government Sector)
O-Others ( Professional Self Employed Retired Housewife Student
B-Business
X-Not Categorised
Others (Please tick wherever is applicable) Antique Dealers Dealers in Arms Bullion Dealers Signature / Thumb
Impression
Conducting Money Service Bureau such as money exchangers Exports/Imports Activity.
Real Estate & Constuction Business Politically Exposed Person
Networth (Assets – Liabilities) Less than Rs. 5 Crore Rs. 5 Crore or More
2. TICK IF APPLICABLE RESIDENCE FOR TAX PURPOSES IN JURISDICTION(S) OUTSIDE INDIA (Please refer instruction B at the end)
ADDITIONAL DETAILS REQUIRED* (Manadatory only if section 2 is ticked)
ISO 3166 Country Code of Jurisdiction of Residence*
Tax Identification Number or equivalent (If issued by jurisdiction)*
Place / City of Birth* ISO 3166 Country Code of Birth*
3. PROOF OF IDENTITY (PoI)* (Please refer instruction C at the end)
(Certified copy of any one of the following Proof of Identity[PoI] needs to be submitted)
A- Passport Number Passport Expiry Date D D M M Y Y Y Y
B- Voter ID Card
C- PAN Card
D- Driving Licence Driving Licence Expiry Date D D M M Y Y Y Y
E- UID (Aadhaar)
F- NREGA Job Card
Z- Others (any document notified by the central government) Identification Number
S- Simplified Measures Account - Document Type code Identification Number
4. PROOF OF ADDRESS (PoA)*
4.1 CURRENT / PERMANENT / OVERSEAS ADDRESS DETAILS (Please see instruction D at the end)
(Certified copy of any one of the following Proof of Address [PoA] needs to be submitted)
Address Type* Residential / Business Residential Business Registered Office Unspecified
Proof of Address* Passport Driving Licence UID (Aadhaar)
Voter Identity Card NREGA Job Card Others
Address Simplified Measures Account - Document Type code
Line 1*
Line 2
Line 3 City / Town / Village*
District* State / UT Code* Country Code* Pin / Post Code*
Signature / thumb
impression
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4.2 CORRESPONDENCE / LOCAL ADDRESS DETAILS * (Please see instruction E at the end)
Same as Current / Permanent / Overseas Address details (In case of multiple correspondence / local addresses, please fill ‘Annexure A1’)
Line 1*
Line 2
Line 3 City / Town / Village*
District* Pin / Post Code* State / U. T. Code* ISO 3166 Country Code*
4.3 ADDRESS IN THE JURISDICTION DETAILS WHERE APPLICANT IS RESIDENT OUTSIDE INDIA FOR TAX PURPOSES* (Applicable if section 2 is ticked)
Same as Current / Permanent / Overseas Address details Same as Correspondence / Local Address details
Line 1*
Line 2
Line 3 City / Town / Village*
State* ZIP / Post Code* ISO 3166 Country Code*
5. CONTACT DETAILS (All communications will be sent on provided Mobile no. / Email-ID) (Please refer instruction F at the end)
Tel. (Off) Tel. (Res) Mobile
FAX Email ID
6. DETAILS OF RELATED PERSON (In case of additional related persons, please fill ‘Annexure B1’ ) (please refer instruction G at the end)
Addition of Related Person Deletion of Related Person KYC Number of Related Person (if available*)
Related Person Type* Guardian of Minor Assignee Authorized Representative
Prefix First Name Middle Name Last Name
Name*
(if KYC number and name are provided, below details of section 6 are optional)
PROOF OF IDENTITY [PoI] OF RELATED PERSON* (Please see instruction (H) at the end)
A- Passport Number Passport Expiry Date D D M M Y Y Y Y
B- Voter ID Card
C- PAN Card
D- Driving Licence Driving Licence Expiry Date D D M M Y Y Y Y
E- UID (Aadhaar)
F- NREGA Job Card
Z- Others (any document notified by the central government) Identification Number
S- Simplified Measures Account - Document Type code Identification Number
7. REMARKS (If any)
8. APPLICANT DECLARATION
I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I 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 aware
that I may be held liable for it.
I hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/email address.
Date : D D M M Y Y Y Y Place : Signature / Thumb Impression of Applicant
9. ATTESTATION / FOR OFFICE USE ONLY
Documents Received Certified Copies
KYC VERIFICATION CARRIED OUT BY INSTITUTION DETAILS
Date
Name
Emp. Name
Emp. Code Code
Emp. Designation
Emp. Branch
[Institution Stamp]
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CENTRAL KYC REGISTRY | Instructions / Check list / Guidelines for filling Individual KYC Application Form
General Instructions:
1 Fields marked with ‘*’ are mandatory fields.
2 Tick wherever applicable.
3 Self-Certification of documents is mandatory.
4 Please fill the form in English and in BLOCK Letters.
5 Please fill all dates in DD-MM-YYYY format.
6 Wherever state code and country code is to be furnished, the same should be the two-digit code as per Indian Motor Vehicle, 1988 and ISO
3166 country code respectively list of which is available at the end.
7 KYC number of applicant is mandatory for updation of KYC details.
8 For particular section update, please tick (? ) in the box available before the section number and strike off the sections not required to be
updated.
9 In case of ‘Small Account type’ only personal details at section number 1 and 2, photograph, signature and self-certification required.
A Clarification / Guidelines on filling ‘Personal Details’ section
1 Name: Please state the name with Prefix (Mr/Mrs/Ms/Dr/etc.). The name should match the name as mentioned in the Proof of Identity
submitted failing which the application is liable to be rejected.
2 Either father’s name or spouse’s name is to be mandatorily furnished. In case PAN is not available father’s name is mandatory.
B Clarification / Guidelines on filling details if applicant residence for tax purposes in jurisdiction(s) outside India
1 Tax identification Number (TIN): TIN need not be reported if it has not been issued by the jurisdiction. However, if the said jurisdiction has
issued a high integrity number with an equivalent level of identification (a “Functional equivalent”), the same may be reported. Examples of
that type of number for individual include, a social security/insurance number, citizen/personal identification/services code/number, and
resident registration number)
C Clarification / Guidelines on filling ‘Proof of Identity [PoI]’ section
1 If driving license number or passport is provided as proof of identity then expiry date is to be mandatorily furnished.
2 Mention identification / reference number if ‘Z- Others (any document notified by the central government)’ is ticked.
3 In case of Simplified Measures Accounts for verifying the identity of the applicant, any one of the following documents can also be submitted
and undernoted relevant code may be mentioned in point 3 (S).
Document Code Description
01 Identity card with applicant’s photograph issued by Central/ State Government Departments, Statutory/ Regulatory
Authorities, Public Sector Undertakings, Scheduled Commercial Banks, and Public Financial Institutions.
02 Letter issued by a gazetted officer, with a duly attested photograph of the person.
D Clarification / Guidelines on filling ‘Proof of Address [PoA] - Current / Permanent / Overseas Address details’ section
1 PoA to be submitted only if the submitted PoI does not have an address or address as per PoI is invalid or not in force.
2 State / U.T Code and Pin / Post Code will not be mandatory for Overseas addresses.
3 In case of Simplified Measures Accounts for verifying the address of the applicant, any one of the following documents can also be submitted
and undernoted relevant code may be mentioned in point 4.1.
Document Code Description
01 Utility bill which is not more than two months old of any service provider (electricity, telephone, post-paid mobile
phone, piped gas, water bill).
02 Property or Municipal Tax receipt.
03 Bank account or Post Office savings bank account statement.
04 Pension or family pension payment orders (PPOs) issued to retired employees by Government Departments or Public
Sector Undertakings, if they contain the address.
05 Letter of allotment of accommodation from employer issued by State or Central Government departments, statutory or
regulatory bodies, public sector undertakings, scheduled commercial banks, financial institutions and listed
companies. Similarly, leave and license agreements with such employers allotting official accommodation.
06 Documents issued by Government departments of foreign jurisdictions and letter issued by Foreign Embassy or
Mission in India.
E Clarification / Guidelines on filling ‘Proof of Address [PoA] - Correspondence / Local Address details’ section
1 To be filled only in case the PoA is not the local address or address where the customer is currently residing. No separate PoA is required to
be submitted.
2 In case of multiple correspondence / local addresses, Please fill ‘Annexure A1’
F Clarification / Guidelines on filling ‘Contact details’ section
1 Please mention two- digit country code and 10 digit mobile number (e.g. for Indian mobile number mention 91-9999999999).
2 Do not add ‘0’ in the beginning of Mobile number.
G Clarification / Guidelines on filling ‘Related Person details’ section
1 Provide KYC number of related person if available.
H Clarification / Guidelines on filling ‘Related Person details – Proof of Identity [PoI] of Related Person’ section
1 Mention identification / reference number if ‘Z- Others (any document notified by the central government)’ is ticked.
I. #Politically
exposed persons are individuals who are or have been entrusted with prominent public functions in a foreign country, e.g. Head of
States or of Governments, senior politicians, senior government / judicial / military officers, senior executives of state-owned corporations,
important political party officials, etc.
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Annexure A1
CENTRAL KYC REGISTRY | Know Your Customer (KYC) Application Form | Individual | Related Person
Important Instructions:
A) Fields marked with ‘*’ are mandatory fields. E) List of State / U.T code as per Indian Motor Vehicle Act, 1988 is available at the end.
B) Please fill the form in English and in BLOCK letters. F) List of two character ISO 3166 country codes is available at the end.
C) Please fill the date in DD-MM-YYYY format. G) KYC number of applicant is mandatory for update application.
D) Please read section wise detailed guidelines / instructions H) For particular section update, please tick ( ) in the box available before the section
at the end. number and strike o f the sections not required to be updated.
For office use only Application Type* New Update
(To be filled by financial institution) KYC Number (Mandatory for KYC update request)
1. CORRESPONDENCE / LOCAL ADDRESS DETAILS (Please see instruction E at the end)
Same as Current / Permanent / Overseas Address details (In case of multiple correspondence / local addresses, please fill ‘Annexure A1’)
Line 1*
Line 2
Line 3 City / Town / Village*
District* Pin / Post Code* State / U. T. Code* ISO 3166 Country Code*
2. CONTACT DETAILS (All communications will be sent on provided Mobile no./ Email-ID) (Please refer instruction F at the end)
Tel. (Off) Tel. (Res) Mobile
FAX Email ID
3. APPLICATION DECLARATION
I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I 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 aware that I may be held liable for it.
Signature / Thumb Impression
Date : D D MM YYYY Place : Signature / Thumb Impression of Applicant
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Annexure B1
CENTRAL KYC REGISTRY | Know Your Customer (KYC) Application Form | Individual | Related Person
Important Instructions:
A) Fields marked with ‘*’ are mandatory fields. E) List of State / U.T code as per Indian Motor Vehicle Act, 1988 is available at the end.
B) Please fill the form in English and in BLOCK letters. F) List of two character ISO 3166 country codes is available at the end.
C) Please fill the date in DD-MM-YYYY format. G) KYC number of applicant is mandatory for update application.
D) Please read section wise detailed guidelines / instructions H) For particular section update, please tick ( ) in the box available before the section
at the end. number and strike o f the sections not required to be updated.
For office use only Application Type* New Update
(To be filled by financial institution) KYC Number (Mandatory for KYC update request)
1. DETAILS OF RELATED PERSON (Please see instruction G at the end)
Addition of Related Person Deletion of Related Person KYC Number of Related Person (if available*)
Related Person Type* Guardian of Minor Assignee Authorized Representative
Prefix First Name Middle Name Last Name
Name*
(if KYC number and name are provided, below details of section 6 are optional)
PROOF OF IDENTITY [PoI] OF RELATED PERSON* (Please see instruction (H) at the end)
A- Passport Number Passport Expiry Date D D M M Y Y Y Y
B- Voter ID Card
C- PAN Card
D- Driving Licence Driving Licence Expiry Date D D M M Y Y Y Y
E- UID (Aadhaar)
F- NREGA Job Card
Z- Others (any document notified by the central government) Identification Number
S- Simplified Measures Account - Document Type code Identification Number
2. APPLICATION DECLARATION
I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I 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 aware that I may be held liable for it.
Signature / Thumb Impression
Date : D D MM YYYY Place : Signature / Thumb Impression of Applicant
3. ATTESTATION / FOR OFFICE USE ONLY
Documents Received Certified Copies
KYC VERIFICATION CARRIED OUT BY INSTITUTION DETAILS
Date
Name
Emp. Name
Emp. Code Code
Emp. Designation
Emp. Branch
[Institution Stamp]
