Skip Navigation Links
APPLICATION TYPE:
Client Code Allocated : FOR INDIVIDUAL
 

KNOW YOUR CLIENT (KYC) APPLICATION FORM
 
Please fill this form in ENGLISH and in BLOCK LETTERS.
Fields Mark with ( * ) are Mandatory.
 
A. IDENTITY DETAILS
1.Name of the Applicant :
2.Father’s / Spouse Name :
3. a. Gender : b. Marital Status : c. Date of Birth: (dd/mm/yyyy)  
4.a. Nationality : b. Status:
5. a. PAN : b . UID No.
6.Specify The Proof Of Identity Submitted :
B. ADDRESS DETAILS
1.Address for correspondence :
City/Town/Village: PIN: State: Country:
2. Contact Details: Tel.(Off): Tel.(Res.): Mobile No:
FAX : Email id :  
3. Specify the proof of address submitted for correspondence address :
4. Permanent Address (if different from above or overseas address, mandatory for Non-ResidentApplicant):
City/Town/Village: PIN: State: Country:
5. Specify the proof of address submitted for Permanent address :
C. OTHER DETAILS
1.GrossAnnual Income Details (please specify): Income Range per
2.Net-worth as on (date) (Net worth should not be older than 1 year)
3.Occupation (please tick any one and give brief details):
Others
4. Please tick, if applicable :
 

TRADING ACCOUNT RELATED DETAILS

A. BANK ACCOUNT(S) DETAILS
For Individuals & Non-individuals
Bank Name Branch Address Bank Account No.
Account Type : Others
IFSC Code : MICR Code :
B. DEPOSITORY ACCOUNT(S) DETAILS
Depository Participant Name Depository Name Beneficiary Name DP ID Beneficiary ID (BO ID)
 
     
C. TRADING PREFERENCES
* Please sign in the relevant boxes where you wish to trade. The segment not chosen should be struck off by the client.
 
Exchanges Segments
NSE
Signature
Signature
Signature
Signature
Commodity Signature
 
Note: If in future, the client wants to trade on any new segment / new exchange, separate authorization/letter should be taken from the client by the stock broker.
D. PASTACTIONS
Details of any action / proceedings initiated / pending / taken by SEBI / Stock exchange / other authority against the applicant / constituent or its Partners/promoters/ whole time directors / authorized person in charge of dealing in securities during the last 3 years :
E. DEALINGS THROUGH SUB-BROKERS AND OTHER STOCK BROKERS
  • If clients dealing through the sub-broker, provide the following details :
Sub-broker’s Name : SEBI Registration number:
Registered office address
Ph : Fax : Website :
  • Whether dealing with any other stock broker/sub-broker (if case dealing with multiple stock brokers/ sub brokers, provide details of all)
Name of stock broker Name of Sub Broker, if any
Client Code : Exchange :
Details of dispute / dues pending from / to such stock broker/ sub-broker
F. ADDITIONAL DETAILS
Whether you wish to receive physical contract note (PCN) or Electronic Contract Note (ECN) (please specify) :
Specify your Email id, if applicable :
Whether you wish to avail of the facility of internet trading / wireless technology (please specify) :
Number of years of Investment / Trading Experience :
In case of non-individuals, name, designation, PAN, UID, signature, residential address and photographs of person authorized to deal in securities on behald of company firm / others :
Any other information :
G. INTRODUCER DETAILS (Optional)
Introducer Code : Name of the Introducer :
Status of the Introducer:
Others, please specify
Address and phone no. of the Introducer:
H. NOMINATION DETAILS ( for individuals only)
Name of the Nominee: Relationship with the Nominee:
PAN of Nominee: Date of Birth of Nominee:  
Address and phone no. of the Introducer :
 
If Nominee is a minor, details of Guardian
 
Name of guardian: Address and phone no. of Guardian:
 
Witnesses (Only applicable in case the account holder has made nomination)
 
Name Name
Address Address
I. UPLOAD DOCUMENTS FOR REVIEW
1.Pan Card
2.Address Proof
3.Bank Statement
4.Cancelled Cheque
5.Income Proof