KNOW YOUR CLIENT APPLICATION FORM (KYC) - FOR INDIVIDUAL

Please fill this update / modification form in ENGLISH & in BLOCK LETTERS

A. IDENTITY DETAILS (Please see guidelines overleaf)

1. Name of the Applicant: (As appearing in supporting Identification document)
Name

First

Father/ Husband Name:

2. (a) Gender:

First

Male

3. Nationality:
Indian
4. Status: (Please )
5. (a) PAN

Female

(b) Marital Status:

Middle

Last

Middle

Last

Single

Married

(c) Date of Birth:

Please affx
size Photograph and
sign across it

D D M M Y Y Y Y

(Please specify)

Other
Resident

Non Resident

Foreign National (Passport copy mandatory for NRIs & Foreign Nationals)

( Please enclose a duly attested copy of your PAN card)

(b) Unique Identifcation No. (UID)/ Aadhar

(Please )

6. Specify the proof of Identity submitted

UID (Aadhar)

Passport

Voter ID

Driving License

(Please see guideline D overleaf)

Others

B. ADDRESS DETAILS (Please see guidelines overleaf)

1. Resident / Correspondence Address
:

City/ Town/ Village:

PIN Code:

State:

Country:

2. Contact Details: Tel (Off) :

Mobile No.:

(I S D) (S

(I S D) (STelT(Res)
D):
(I S D) (SFaxTNo.:D)

(I S D) (S T D)
T D)

E-mail ID:
3. Proof of address to be provided by Applicant. Please submit ANY ONE of the following valid documents & tick () against the document attached.
Passport

Driving License

Voter Identity Card

Latest Bank A/c Statement/Passbook

Ration Card

*Latest Gas Bill

*Latest Electricity Bill

*Latest Telephone Bill (only Land Line)

Document No. :

Date of Issue:

Issuing Authority :

Validity/Expiry date of proof of address submitted

D D M M Y Y Y Y

Registered Lease/Sale Agreement of Residence

(Please specify)
Others
Place of Issue :

D D M M Y Y Y Y

*Not more than 3 Months old.

4. Permanent Address of Resident Applicant if different from above B1 Overseas Address (Mandatory) for Non-Resident Applicant

City/ Town/ Village:

PIN Code:

State:

Country:

5. Proof of address to be provided by Applicant. Please submit ANY ONE of the following valid documents & tick () against the document attached.
(Please specify)
Passport
Driving License
Voter Identity Card
Latest Bank A/c Statement/Passbook
Registered Lease/Sale Agreement of Residence
Ration Card

*Latest Gas Bill

*Latest Telephone Bill (only Land Line)

*Latest Electricity Bill

Document No. :

Date of Issue:

Issuing Authority :

Validity/Expiry date of proof of address submitted

D D M M Y Y Y Y

Others
Place of Issue :

D D M M Y Y Y Y

*Not more than 3 Months old.

SIGNATURE OF APPLICANT

DECLARATION
I hereby declare that the details furnished above are true and correct to the best of my
knowledge and belief and I undertake 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.
Place:

Date:

FOR OFFICE USE ONLY

India Infoline Limited
Code: 1100044700
(Originals verified) Self certified Documents copies received.
(Attested) True copies of Documents received.

Staff Name
Designation
Signature
Date

IPV Done

on

Seal/Stamp of IIFL

Staff Name
Designation
Signature
Date

D D MM Y Y Y Y