Download Form - Karur Vysya Bank

Annexure – JPART I - KNOW YOUR CLIENT Annexure (KYC) APPLICATION – J FORM (For Individuals)PART I - KNOW YOUR CLIENT (KYC) APPLICATION FORM (For Individuals)THE KARUR VYSYA BANK LTDDP ID : - IN303382DEMATCELLName SECOND and address FLOOR of intermediary No. 29, RANGAN (pre-printed) STREETT. NAGARPlease fill this form in ENGLISH and in BLOCK LETTERSCHENNAI - 600017A. IDENTITY DETAILSPlease fill this form in ENGLISH and in BLOCK LETTERSPhotograph1 A. IDENTITY Name of the Applicant DETAILS21 Father’s Name of / the Husband’s Applicant NamePlease affix your recentpassport Photograph size photograph2 Father’s / Husband’s Name MaleSingle3 a) Gender Female b) Marital status Married c) Date of Birth D D M M Y Y C1YYMaleSingle3 a) Gender IndianResident IndividualFemale b) Marital status Married c) Date of Birth D D M M Y Y Y YOtherNon Resident4 a) Nationalityb) Status(Please Indian specify,________________________)Foreign Resident National IndividualOtherNon Resident4 a) Nationalityb) Unique Identification b) Number Status5 a) PAN (Please specify,________________________)Foreign National(UID) / Aadhaar, if any65 Specify a) PAN the proof of identity submittedB. 6 SpecifyADDRESSthe proofDETAILSof identity submittedB. ADDRESS DETAILS1 Correspondence Address1 Correspondence Addressb) Unique PAN Identification card Number(UID) Any / Aadhaar, other (Please if any specify; ________________________________________)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________City/town/villageStateCity/town/village2 Specify the proof of address submittedStatefor correspondence address2Tel. (Off.)Specify the proof of address submitted for correspondence address3 Contact DetailsFax No.Tel. (Off.)3 Contact DetailsEmail IDFax No.44Permanent Address (If differentfrom above. Mandatory forPermanentNon-ResidentAddressApplicant(If differenttospecifyfrom above.overseasMandatoryaddress)forNon-Resident Applicant tospecify overseas address)PIN CodeCountryPIN CodeTel. (Res.)Mobile No.Tel. (Res.)____________________________________________________Email ID________________________________________________________________________________________________________________________________________________________________________________________________________________City/town/villageStateCity/town/village5 Specify the proof of address submitted for permanent addressStateC. 5 OTHER Specify the DETAILS proof of address submitted for permanent address1 Gross Annual Income Details (please specify):C. OTHER DETAILS1Income Range per annumGross Annual Income Details (please specify):Below ` 1 lacIncome Range per annum` 1- 5 lac` Below 5- 10 ` lac 1 lac` 10- 1- 525 lac lacMore ` 5- 10 than lac ` 25 lac` 10- 25 lacMore than ` 25 lacORNetworthPIN CodeCountryPIN CodeSignature AcrossPlease affix your photograph recentpassport size photographPAN cardAny other (Please specify; ________________________________________)ORCountryMobile No.CountrySignature Acrossphoto graphAmount (`) _________________________NetworthAs Amount on (date) (`) _________________________D D M M Y Y Y Y(Networth As on (date) D D M M Y Y Y Yshould not be older than 1 year)(Networth should not be older than 1 year)

Occupation (please tick any one and give brief details): ________________________________________________________2Private SectorPublic SectorGovernment ServiceBusinessProfessionalAgriculturistRetiredHousewifeStudentOthers (Please specify; ______________________________________________)3 Please tick, if applicable: Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP)4 Any other informationD. DECLARATIONI hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake toinform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading ormisrepresenting, I am aware that I may be held liable for it.C2Signature of the Applicant _______________________________________ Date D D M M Y Y Y Y= = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =FOR OFFICE USE ONLY(Originals verified) True copies of documents received(Self-Attested) Self Certified Document copies receivedSignature of the AuthorisedSignatory___________________________________________________Date D D M M Y Y Y YSeal/Stamp of theintermediary

THE KARUR VYSYA BANK LTDDEMATCELL, SECOND FLOORNo 29, RANGAN STREETT. NAGARCHENNAI - 600017Annexure – JPART II – ACCOUNT OPENING FORM(FOR INDIVIDUALS)Client –ID(To be filled by Participant)DP ID : - IN303382I/We request you to open a depository account in my/our name as per thefollowing details: (Please fill all the details in CAPITAL LETTERS only)A) Details of Account holder(s):NameDate D D M M Y Y Y YPANSole/ FirstHolderSecondHolderThirdHolderB) For HUF, Association of Persons (AOP), Partnership Firm, Unregistered Trust, etc., although the account is opened in the nameof the natural persons, the name & PAN of the HUF, Association of Persons (AOP), Partnership Firm, Unregistered Trust, etc.,should be mentioned below:a) Name b) PANC) Type of accountOrdinary ResidentQualified Foreign InvestorMarginD) In case of NRIs/ Foreign NationalsNRI-RepatriableForeign NationalOthers (Please specify) _________________NRI-Non RepatriablePromoterRBI Approval Reference NumberRBI Approval date D D M M Y Y Y YE) Bank details1 Bank account type Savings Account Current Account Others (Please specify)_________________2 BankAccountNumber3 Bank Name4 BranchAddress______________________________________________________________________________________________________________________________________________________City/town/villageStatePIN CodeCountry5 MICR Code6 IFSCF) Standing Instructions1 I/We authorise you to receive credits automatically into my/our account. YesNo

2 Account to be operated through Power of Attorney (PoA) Yes3 SMS Alert facility: [Mandatory if you are giving Power of Attorney (PoA). Ensure that the mobile number is provided inthe KYC Application Form]Sr. No. Holder Yes No1 Sole/First Holder2 Second Holder3 Third HolderG) Guardian Details (where sole holder is a minor):[For account of a minor, two KYC Application Forms must be filled i.e. one for the guardian and another for the minor (to besigned by guardian)]Guardian NamePANRelationship of guardianwith minorH) Nomination OptionNoI/We wish to make a nomination.I/We do not wish to make a nomination.[As per details given below][Strike off the nomination details below]Nomination DetailsI/We wish to make a nomination and do hereby nominate the following person in whom all rights and / or amount payable inrespect of securities held in the Depository by me / us in the said beneficiary owner account shall vest in the event of my / ourdeath.1 Name of theNominee(Mr./Ms.)2 Relationship with theApplicant (if any)Photograph of nomineeSignature of nominee acrossphotograph3 Address of Nominee__________________________________________________________________________________________________________________________________________4 Contact Details ofnominee5 Signature of nomineeCity/town/villageStateTel. (Off.)Fax No.Email IDXPIN CodeCountryTel. (Res.)Mobile No.To be filled-up (Sr. Nos. 6-11) only if nominee is a minor:6 Date of Birth (in case of minor nominee)D D M M Y Y Y Y

7 Name of Guardian(Mr./Ms.) (in case ofminor nominee)Photograph of guardian (forminor nominee)8 Address of Guardian ________________________________________________________________________________________________________Signature of guardian acrossphotograph9 Contact Details ofGuardian10 Relationship ofGuardian withnomineeCity/town/villageStateTel. (Off.)Fax No.Email IDPIN CodeCountryTel. (Res.)Mobile No.11Signature ofGuardianXSignature of two Witnesses for nominationName of witness Address Signature of witness with date_______________________________a.______________________________________________________________Xb._____________________________________________________________________________________________XDeclarationThe rules and regulations of the Depository and Depository Participants pertaining to an account which are in force now have beenread by me/us and I/we have understood the same and I/we agree to abide by and to be bound by the rules as are in force from time totime for such accounts. I/we hereby declare that the details furnished above are true and correct to the best of my/our knowledge andbelief and I/we undertake to inform you of any changes therein, immediately. In case any of the above information is found to be falseor untrue or misleading or misrepresenting, I am/ we are aware that I/we may be held liable for it. In case non-resident account, I/wealso declare that I/we have complied and will continue to comply with FEMA regulations.Name(s) of holder(s)Signature(s) of holderSole/ First Holder/Guardian (in casesole holder is minor)(Mr./Ms.)Second Holder(Mr./Ms.)XXC3Third Holder(Mr./Ms.)X

Notes :1. All communication shall be sent at the address of the Sole/First holder only.2. Thumb impressions and signatures other than English or Hindi or any of the other language not contained in the 8 th Schedule ofthe Constitution of India must be attested by a Magistrate or a Notary Public or a Special Executive Magistrate.3. Instructions related to nomination, are as below:I. The nomination can be made only by individuals holding beneficiary owner accounts on their own behalf singly or jointly.Non- individuals including society, trust, body corporate, partnership firm, karta of Hindu Undivided Family, holder ofpower of attorney cannot nominate. If the account is held jointly all joint holders will sign the nomination form.II. A minor can be nominated. In that event, the name and address of the Guardian of the minor nominee shall be provided bythe beneficial owner.III. The Nominee shall not be a trust, society, body corporate, partnership firm, karta of Hindu Undivided Family or a power ofAttorney holder. A non-resident Indian can be a Nominee, subject to the exchange controls in force, from time to time.IV. Nomination in respect of the beneficiary owner account stands rescinded upon closure of the beneficiary owner account.Similarly, the nomination in respect of the securities shall stand terminated upon transfer of the securities.V. Transfer of securities in favour of a Nominee shall be valid discharge by the depository and the Participant against the legalheir.VI. The cancellation of nomination can be made by individuals only holding beneficiary owner accounts on their own behalfsingly or jointly by the same persons who made the original nomination. Non- individuals including society, trust, bodycorporate, partnership firm, karta of Hindu Undivided Family, holder of power of attorney cannot cancel the nomination. Ifthe beneficiary owner account is held jointly, all joint holders will sign the cancellation form.VII. On cancellation of the nomination, the nomination shall stand rescinded and the depository shall not be under any obligationto transfer the securities in favour of the Nominee.4. Strike off whichever is not applicable.= = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =PAYMENT INSTRUCTIONC4

[For New Accounts]Option for opening Basic Services Demat Account (BSDA)To,THE KARUR VYSYA BANK LTDIN303382DEMATCELLSECOND FLOORNo 29, RANGAN STREETT. NAGAR, CHENNAI 600017Date D D M M Y Y Y YWith reference to my / our application for opening a depository account, I/ We request you to open my / our depository account as a BSDA as per the following details:NamePANSole / First HolderSecond HolderThird HolderI/We have read and understood the Securities and Exchange Board of India'sguidelines for facility for a BSDA. I/We hereby declare that I/we am/areeligible to open a depository account as a BSDA holder and undertake tocomply with the requirements specified by Securities and Exchange Board ofIndia (SEBI) or any such authority for such facility from time to time. I/Wealso understand that in case I/We at any point of time do not meet theeligibility as a BSDA holder, my / our aforesaid account is liable to beconverted to regular account.1_________________________2______________________ 3__________________Signature(s) of Account Holder(s)