Note: * Mandatory field

1 GENERAL INFORMATION
2 ADDRESS DETAILS

Application Type *

KYC Number

Account Type *

Name * (Same as ID proof)

Maiden Name (If any)

Father / Spouse Name*

Mother Name *

Date of Birth *

Gender *

Marital Status *

Citizenship *

ISO 3166 Country Code

Residential Status *

Occupation Type *

RESIDENCE FOR TAX PURPOSES IN JURISDICTION(S) OUTSIDE INDIA

ADDITIONAL DETAILS REQUIRED * (Mandatory only if section 2 is ticked)

ISO 3166 Country Code of Jurisdiction of Resident *

Tax Identification Number or equivalent
(If issued by jurisdiction) *

Place / City of Birth *

ISO 3166 Country Code of Birth *

PROOF OF IDENTITY (PoI) AND PROOF OF ADDRESS (PoA)*

Identity Proof Type*

Identification Number*

Proof Available*

Proof of Address*

Identification Number*

Proof Available*

POI (front) Image*

File upload to be in JPG format
(not more than 200 KB).

(OR)

POI (Back) Image*

File upload to be in JPG format
(not more than 200 KB).

(OR)

Signature Image*

File upload to be in JPG format
(not more than 200 KB).

(OR)

COMMUNICATION DETAILS*

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)

POA (front) Image*

File upload to be in JPG format
(not more than 200 KB).

(OR)

POA (Back) Image*

File upload to be in JPG format
(not more than 200 KB).

(OR)

Address Type *

Proof of Address *

Proof Available*

POA Others

POA Measures Account

Address Line 1 *

Address Line 2

Address Line 3

Pin / Post Code *

ISO 3166 Country Code *

State / U.T Code *

State / U.T Code *

District *

District *

City / Town / Village *

4.2 CORRESPONDENCE / LOCAL ADDRESS DETAILS *

Same as Current / Permanent / Overseas Address details

Address Type *

POA Others

POA Measures Account

Address Line 1 *

Address Line 2

Address Line 3

Pin / Post Code *

ISO 3166 Country Code *

State / U.T Code *

State / U.T Code *

District *

District *

City / Town / Village *

CONTACT DETAILS

Tel. (Off)

Tel. (Res)

Mobile

Fax

Email ID

REMARKS (If any)

Date

Place

DETAILS OF RELATED PERSON

KYC VERIFIER DETAILS

Documents Received Certified Copies

KYC VERIFICATION CARRIED OUT BY

Date

Emp. Name

Emp. Code

Emp. Designation

Emp. Branch

INSTITUTION DETAILS

Name

Code

COMPLETE CONFIRMATION

Check & Submit to complete the form

Know Your Client (KYC)
Application Form (For Individuals Only)	Application No.:

A. Identify Details (please see guidelines overleaf)
Name of Applicant
Father's/Spouse Name
Gender		Marital Status
Date of Birth		Nationality
Res. Status
PAN / POI Number		Aadhaar Number
Proof of Identity submitted for PAN exempt cases
B. Address Details (please see guidelines overleaf)
Address for Correspondence

City / Town / Village			Pin Code
State			Country
Contact Details
Tel.(Off.)		Tel.(Res.)	Mobile:
Fax		E-Mail Id:
Proof of address to be provided by Applicant
Permanent Address of Resident Application if different from Above B1 OR Overseas Address (Mandatory) for Non-Resident Applicant

City / Town / Village			Pin Code
State			Country
Proof of address to be provided by Applicant
Any other information
DECLARATION			SIGNATURE OF APPLICANT
I hereby declare that the details furnished above are true and correct to the best of my/our 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 untrue or misleading or misrepresenting, I am/we are aware that I/we may be held liable for it. Place: Date:
FOR OFFICE USE ONLY			IPV DONE☐on d d / m m / y y y y
AMC/Intermediary name OR code ☐ (Originals Verified) Self Certified Document copies received ☐ (Attested) True copies of documents received Main Intermediary			Seal/Stamp of the intermediary should contain Staff Name Designation Name of the Organization Signature Date	Aadhaar eKYC with OTP Through AMC Portal
eKYC TxnID No. is

Contact Us

Karvy House, No. 46, 8-2-609/K,
Avenue 4, Street No. 1 Banjara Hills,
Hyderabad - 500 034.
Telangana, India.

Tel : (+91-40) 23312454, 23320751
Fax : (+91-40) 23311968

E-mail : info@karvy.com
Website : www.karvy.com

Quick Links

Group Websites

© KDMSL 2012. All Rights Reserved.