CKYC FI Registration Form

Central Registry of Securitisation Asset Reconstruction and Security Interest of India
Institution Registration Form

Instructions: 1. All fields marked with (*) are mandatory. Institution should ensure that no mandatory field is left blank and all details are complete and correct.
2. All pages of the application form and supporting documents needs to be duly attested by Compliance Officer/Nodal Officer/Authorised Signatory.
To,
CERSAI - Central Registry of Securitisation Asset Reconstruction and Security Interest of India
Tower – 1, Office Block, 4th Floor, Plate-A,
(Adjacent to Ring Road), NBCC, Kidwai Nagar East, New Delhi –110023
Dear Sir / Madam,

Subject: CKYC Registration reference - (Please enter the Registration reference number/ Institution code)
We are desirous of registering with Central KYC Registry and are furnishing the details as under:
Institution Details
Name of the
Institution* (Please refer footnote - instruction A)
Regulator*  RBI  SEBI  IRDA  PFRDA 
Institution Type* (Please refer footnote - instruction B)
Registration
Number* (Please refer footnote - instruction C)
CIN (if available*) (Please refer footnote - instruction D)

PAN*
Website
Registered Line 1
Address*
Line 2
Line 3
City/Town
State/U.T PIN Code
Country
Correspondence Line 1
Address*
 same as registered Line 2
address
Line 3
City/Town
State/U.T PIN Code
Country
Head of the Name
Institution* Designation
Email-Id
Tel- No. Fax No.
Central KYC Registry | Confidential to recipient 1

Details of Nodal Name
Officer * Designation
Email-Id
Tel- No. Fax No.

Mobile No.
Remarks if any
Footnotes:
A) Invoice will be generated in the name provided by the institution.
B) Institution type :
a. Registered under RBI - PSU Bank /Foreign Bank /Cooperative Bank /Regional Rural Bank /Private Bank /Housing Finance Company /Foreign Exchange Business /Full
Fledged Money changer/ Non-Bank – PPI/ Non-Banking Financial Company/ Payment Bank / Payment System Operator
b. Registered under SEBI –Trading Member /Depositary Participant /Mutual Fund /Venture Capital Funds /Alternative Investment Funds/ Custodian/ Clearing Member/
Investment Advisor/ Portfolio Management Service
c. Registered under IRDA – Life Insurance/General Insurance
d. Registered under PFRDA – POP /Aggregators/NPS Trust/CRA
C) Registration number and identification number issued by regulator/Central Govt. /State Govt.
D) CIN is mandatory if available.

CKYC User Administrator - 1
Name*
Date of Birth* Gender*
Nationality*
Proof of Identity* (any one)  PAN  Passport  Voter ID Card  Driving Licence  Aadhaar
Employee Code* Certified copy of photo identity card issued by the institution needs to be submitted
Department* Specialization (if any)
Designation*
Office Address* Line 1
Line 2
Line 3
City/Town
PIN Code State/U.T
Country
Email-Id
Mobile No.
Tel- No. Fax No.
Any other information
Date* Place*
Signature*
[Signature]

CKYC User Administrator - 2
Name*
Date of Birth* Gender*
Nationality*
Proof of Identity* (any one)  PAN  Passport  Voter ID Card  Driving Licence  Aadhaar
Employee Code* Certified copy of photo identity card issued by the institution needs to be submitted
Department* Specialization (if any)
Designation*
Office Address* Line 1
Line 2
Line 3
City/Town
PIN Code State/U.T
Country
Email-Id
Mobile No.
Tel- No. Fax No.
Any other information
Date* Place*
Signature*
[Signature]

Declaration by Compliance Officer/Nodal Officer/Authorised Signatory*
I Shri/Smt. _________________________________________ Son/Daughter of ____________________________________
holding the position of _______________________________ have been authorized by the institution vide order/resolution
dated ________________ and 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 on their occurrence. 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
same and the consequences thereof.
Date* Place*
[Signature*] [Institution Official Seal*]
Document Checklist*  Duly Signed institution registration form

 Regulator License/Certificate/Notification
 PAN Card of the entity
 Corporate Identification Number (in case regulator issues multiple licenses to
an entity)
 Registration Certificate (In case of Co-operative Banks/societies)
 Authorization letter by Competent Authority for Admin users (should be
signed by the authorized signatory/director etc.)
 Certified copy of the proof of the identity of the Admin users
 Certified copy of photo identity card of the Admin users issued by the
institution (in case photo ids are not issued by the institution to employees, a
letter duly signed by the authorized signatory mentioning the same would be
required along with the photographs of the admin users)
Please include the copy of the mail received upon testing signoff in the document
set. Kindly submit the complete document set to CERSAI, Delhi only once testing has
been completed. (The checklist submission option is available post login to the Test
environment https://testbed.ckycindia.in under the Administration tab.)
Note: In case, the present registered office address is different from the one mentioned
on the licence /certificate/registration copy, provide the latest CIN copy or an address
proof with the present address.
CERSAI Official Use

Uploaded On Received On Verified By Authorised By
FI Code Allotted Virtual Account No. Admin credentials Archival details

Admin 1 :
Admin 2 :

CKYC FI Registration Form

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Central Registry of Securitisation Asset Reconstruction and Security Interest of India

Institution Registration Form

Dear Sir / Madam,

CIN (if available*) (Please refer footnote - instruction D)

Tel- No. Fax No.

Central KYC Registry | Confidential to recipient 1

Tel- No. Fax No.

Central KYC Registry | Confidential to recipient 2

Central KYC Registry | Confidential to recipient 3

Central KYC Registry | Confidential to recipient 4

[Signature] [Institution Official Seal]

Document Checklist*  Duly Signed institution registration form

CERSAI Official Use

FI Code Allotted Virtual Account No. Admin credentials Archival details

Central KYC Registry | Confidential to recipient 5

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