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    Kyc Format BPC

    Uploaded by

    revathy
    This document is a "Know Your Customer" (KYC) form used to collect personal information from customers applying for an LPG connection. It requests details such as name, address, date of birth, photo ID, address proof, and contact information. The form notes that fields marked with an asterisk are mandatory. It provides instructions for filling out the form, including acceptable forms of photo ID, address proof, and their corresponding category codes. Signatures from both the customer and distributor are required upon verification of supporting documents.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Kyc Format BPC

    Uploaded by

    revathy
    400 views2 pages
    This document is a "Know Your Customer" (KYC) form used to collect personal information from customers applying for an LPG connection. It requests details such as name, address, date of birth, photo ID, address proof, and contact information. The form notes that fields marked with an asterisk are mandatory. It provides instructions for filling out the form, including acceptable forms of photo ID, address proof, and their corresponding category codes. Signatures from both the customer and distributor are required upon verification of supporting documents.

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    Original Title

    Kyc Format Bpc

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    This document is a "Know Your Customer" (KYC) form used to collect personal information from customers applying for an LPG connection. It requests details such as name, address, date of birth, photo ID, address proof, and contact information. The form notes that fields marked with an asterisk are mandatory. It provides instructions for filling out the form, including acceptable forms of photo ID, address proof, and their corresponding category codes. Signatures from both the customer and distributor are required upon verification of supporting documents.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    400 views2 pages

    Kyc Format BPC

    Uploaded by

    revathy
    This document is a "Know Your Customer" (KYC) form used to collect personal information from customers applying for an LPG connection. It requests details such as name, address, date of birth, photo ID, address proof, and contact information. The form notes that fields marked with an asterisk are mandatory. It provides instructions for filling out the form, including acceptable forms of photo ID, address proof, and their corresponding category codes. Signatures from both the customer and distributor are required upon verification of supporting documents.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Form KYC Version 3 - 2014-BPC

    Know Your Customer(KYC) Form

    (To be filled in black ink with BLOCK LETTERS. Fields marked with * are mandatory)
    ( For Instructions to fill form please see overleaf)

    1) Personal Details

    Paste your photo


    here

    (Mr./Mrs./Ms) *
    First Name*
    Middle Name
    Last name*

    bakyaraj
    s
    02.06.1981

    53465260
    c) Date of Birth*
    114603
    D D M M Y Y YY
    sivagnanam
    manimegalai
    d) Close Relative
    Fathers /Spouse Name*
    23/1
    first
    Mothers name*
    2) Address for LPG connection
    Contact
    Information
    kulathu /vaikal,
    chinthamani
    Proof of Address ( POA) category Code*
    P ramanathapuram
    O A
    641645
    House/ Flat #, Name*
    Floor No*
    coimbatore
    tamilnadu
    Housing Complex/Building
    Land
    9626445292
    - Mark
    Street/Road Name
    bakyarajmech@yahoo.co.in
    City/Town/Village *
    Pin Code*
    BPBPB6924D
    District *
    State*
    TAMILNADU
    31/G/0145607
    Phone #* : Mobile No
    Landline #
    b) Gas Consumer Number*
    Distributor Code*

    Email id
    3) Other Relevant Details
    POI Category Code*

    a) Proof of Identity (POI)


    P O I

    Card Number*
    b) Ration Card Details if Available
    State Of Issue
    Ration Card Number
    Declaration: I hereby declare that the information provided by me above is true and correct to the best of my knowledge and
    belief. I also confirm that in the event of any information provided by me is found incorrect / is incomplete and also in the event
    of any violation of Government Regulation related to the supply and distribution of LPG, IOC/BPC/HPC will be within its right to
    discontinue supply of LPG cylinders to me, forfeit of security deposit and levy of penal charges as per the policy and guidelines
    and may initiate legal action applicable under provisions.

    Name & Signature *


    Date:_______________________________________________________________________________________________________
    To be filled by Dealer/Distributor
    I confirm having verified the photocopies of documents above against their originals.
    Consumer Number (If allotted):
    Signature of Distributor
    Date:
    Name of Distributorship
    -----------------------------------------------------------------------Tear Off ----------------------------------------------------------------------------Acknowledgement
    I/We, hereby, confirm receipt of duly filled in KYC form along with copy relevant POI, POA documents from
    Name _______________________________Consumer no (if applicable)_________________ on______________
    Signature and Seal of Distributor

    Instructions for Filling KYC Form


    Fields marked with * are mandatory and must be filled in by person submitting KYC
    1 a)
    Name
    Name to be entered as given in Photo ID Proof
    1 b)
    Gas Consumer
    Mandatory for consumers already using LPG from IOC/BPC/HPC
    Number &
    Distributor Code
    1 c)
    Date of Birth
    Mandatory to provide Date of Birth
    1 d)
    Details of Close
    Father or Spouse name is mandatory. Please strike off whichever is not
    Relative
    applicable.
    2
    Proof Of Address
    At least copy of one of the documents listed below should be attached and
    ( POA)
    category mentioned in the form. The Address to be entered against the
    relevant fields exactly as it appears in the POA. Person submitting KYC is
    required to produce the original of document for verification by the distributor.

    3 a)

    Proof of Identity
    (POI)

    List of documents

    Category Code

    Aadhaar (UID)
    Driving License
    Lease agreement
    Voter ID
    Telephone/Electricity /Water bill
    Passport
    Self-declaration attested by a Gazetted officer.
    Ration Card
    Flat allotment/possession letter
    House registration document
    LIC Policy
    Bank/Credit Card Statement

    POA01
    POA02
    POA03
    POA04
    POA05
    POA06
    POA07
    POA08
    POA09
    POA10
    POA11
    POA12

    At least copy of one of the documents listed below should be attached and
    category mentioned in the form. Consumer is required to produce the original
    of the document for verification by the distributor.
    List of documents
    Aadhaar Number (UID)
    Passport Number
    PAN Card Number
    Voter ID Card
    ID card Issued By Central/State
    Driving License

    Category Code
    POI01
    POI02
    POI03
    POI04
    POI05
    POI06

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