Common Application Form (For Lumpsum and SIP)

Please read product labelling details available on cover page and the instructions before filling up the Application
form. Tick (ü) whichever is applicable, strike out whichever is not required.

All sections should be completed in English and in BLOCK LETTERS with blue or black ink only.
Distributor / Broker ARN Sub-Broker Code Sub-Broker ARN EUIN* LG Code RIA Code++

Upfront commission shall be paid directly by the investor to the AMFI registered Distributors based on the investors’ assessment of various factors including the service rendered by the distributor.
*I/We hereby confirm that the EUIN box has been intentionally left blank by me / us as this transaction is executed without any
interaction or advice by the employee / relationship manager / sales person of the above distributor / sub broker or notwithstanding
the advice of in-appropriateness, if any, provided by the employee / relationship manager / sales person of the distributor / sub broker.
++ I/We, have invested in the Scheme(s) of your Mutual Fund under Direct Plan. I/We hereby give you my/our consent to First / Sole Applicant
share/provide the transactions data feed/ portfolio holdings/ NAV etc. in respect of my/our investments under Direct Plan / Guardian / POA Holder
of all Schemes Managed by you, to the above mentioned Mutual Fund Distributor / SEBI-Registered Investment Adviser. / Authorised Signatory Second Applicant / POA Holder Third Applicant / POA Holder

TRANSACTION CHARGES for I confirm that I am a first time investor across Mutual Funds. (Rs. 150 deductible as Transaction Charge and payable to the Distributor)
Rs. 10,000 and above (ü any one) I confirm that I am an existing investor across Mutual Funds. (Rs. 100 deductible as Transaction Charge and payable to the Distributor)
The details in our records under the Folio number mentioned alongside
1. EXISTING INVESTOR'S FOLIO NUMBER Folio No. will apply for this application.
2. APPLICANT’S information (Non-Individual investors please fill Ultimate Beneficial Owner (UBO) details and submit with Application Form.
SOLE / FIRST APPLICANT'S PERSONAL DETAILS (Please fill in ALPHABETS and use one box for on alphabet, leaving one box blank between two words, as it
apears in your PAN Card Mr. Ms. M/s. Minor
Name: First Middle Last
(Please mention Name as per PAN Card)
Date of Birth* / Incorporation PAN / PEKRN KYC Identification Number (KIN) GSTIN
D D M M Y Y Y Y
* Required for 1st holder/Minor
Guardian Details Mr. Ms. (in case of First / Sole Applicant is a Minor) / Name of Contact Person (incase of non-individual Investors)
Name: First Middle Last
(Please mention Name as per PAN Card)
Date of Birth PAN / PEKRN KYC Identification Number (KIN) Mobile No.
D D M M Y Y Y Y

For Investment "on behalf of Minor" Birth Certificate School Certificate Passport Other Relationship with Minor (Mandatory) Father Mother Court Appointed Legal Guardian
Mailing Address
City State Pin Code (Mandatory)
Country STD Code Tel. Off.

Overseas Address (Mandatory for NRI / FII Applicant)

Country                Zip Code
GO GREEN (Default mode of Communication) Mobile E-Mail
Status (Please ü) Self Spouse Dependent Children Dependent Parents
Wherever email ID is registered an electronic Statement of Account (e-SOA) will be shared with the investor. In case you want to receive a physical statement, please request for the same separately
Investors are advised to give their email IDs or that of their family member and not third party so that the important communication from the Fund reaches them directly and in SMS. This will also prevent any unintended
consequences that can arise out of providing third party email ids.
Tax Status: Individual Non-Individual
Resident NRI-Repatriation NRI-Non Repatriation Sole-Proprietorship Minor Company Trust Society / Club Partnership / LLP AOP / BOI FPI Non Profit Organisation
NRI-Minor PIO / OCI HUF Others (Please Specify) Bank Government Body Others (Please Specify)
Occupation: Private Sector Service Public Sector Service Government Service Student Professional Housewife Business Retired Agriculturist Proprietorship
Defence Others (Please Specify)
Gross Annual Income (v) Below 1 Lac 1-5 Lacs 5-10 Lacs   10-25 Lacs > 25 Lacs - 1 Crore  > 1 Crore OR Net worth v
Politically Exposed Person (PEP) Status : I am PEP  I am Related to PEP  Not Applicable
Second Applicant's Details Mode of Holding (please ü) Joint# Anyone or Survivor (# Default, in case of more than one applicant and not ticked)
Name: Mr. Ms. First Middle Last
(Please mention Name as per PAN Card)
Date of Birth PAN / PEKRN KYC Identification Number (KIN) Mobile No.
D D M M Y Y Y Y

Occupation Pvt. Sector Service Pub. Sector Service Gov. Service Housewife Student Professional Housewife Business Retired Defence Agriculturist Forex Dealer Others
Gross Annual Income (v) Below 1 Lac 1-5 Lacs 5-10 Lacs    10-25 Lacs   > 25 Lacs - 1 Crore   > 1 Crore OR Net worth v
Politically Exposed Person (PEP) Status : I am PEP  I am Related to PEP  Not Applicable
Third Applicant's Details
Name: Mr. Ms. First Middle Last
(Please mention Name as per PAN Card)
Date of Birth PAN / PEKRN KYC Identification Number (KIN) Mobile No.
D D M M Y Y Y Y

Occupation Pvt. Sector Service Pub. Sector Service Gov. Service Housewife Student Professional Housewife Business Retired Defence Agriculturist Forex Dealer Others
Gross Annual Income (v) Below 1 Lac 1-5 Lacs 5-10 Lacs    10-25 Lacs   > 25 Lacs - 1 Crore   > 1 Crore OR Net worth v
Politically Exposed Person (PEP) Status : I am PEP  I am Related to PEP  Not Applicable
3. POWER OF ATTORNEY (PoA) HOLDER DETAILS (If the investment is being made by a Constituted Attorney, please furnish the details of PoA Holder)
First / Sole Applicant Second Applicant Third Applicant)
Mr. Ms. M/s. Others Name of PoA Holder

PAN KYC Identification Number (KIN)

Enclosed PAN card proof KYC Confirmation proof) Signature of PoA Holder

ACKNOWLEDGEMENT SLIP (To be filled in by the Applicant)

Application form received for purchase of units, subject to realization, verification and conditions
Mr. / Ms. / M/s.
Instrument No. Dated Drawn on Bank Account No. Amount (Rs.) Scheme / Plan / Option ISC Stamp, Date & Signature
 4. Investment & PAYMENT DETAILS : (Mandatory)
FOR ZERO BALANCE FOLIO & LUMPSUM : Please fill details below
Zero Balance Lumpsum (please fill details below)
Scheme Name: Baroda BNP Paribas Amount (R)
Cheque No./UMRN: Bank Account No. Payment Mode: Cheque NEFT RTGS OTM
For SIP / Multiple SIP : Please fill details below and also fill SIP form
For Multiple SIP - investment can be made upto four Schemes with a single instrument. Multiple SIP Schemes to be mentioned in the below table and single instrument for the total consolidated amount favouring Baroda BNP
Mutual Fund to be provided. Mention First SIP Cheque Details below and in SIP Form.
Scheme Name Plan Option Amount
1. Baroda BNP Paribas Direct / Regular R
2. Baroda BNP Paribas Direct / Regular R
3. Baroda BNP Paribas Direct / Regular R
4. Baroda BNP Paribas Direct / Regular R
Total Amount (In Words) Total Amount (In Figures)
Cheque No./UMRN: Bank: Account No. Payment Mode: Cheque NEFT RTGS OTM
Payment Type : Non-Third Party Payment Third Party Payment (Please attach "Third Party Declaration Form")

5. DEMAT Account details

National Securities Depository Ltd. Depository Participant Name
Central Depository Services (India) Ltd. DP ID No. Beneficiary Account No.
Investor willing to invest in Demat option, may provide a copy of the DP Statement enabling us to match the Demat details as stated in the Application Form. In case the form is not filled, the default option will be physical mode.
6. FIRST HOLDER'S BANK ACCOUNT DETAILS (Mandatory)
Bank Name
Ac. no. (In Figures) A/c. Type Savings Current NRE NRO FCNR
Ac. no. (In Words)
Branch Address
State City Pin Code
MICR Code (9 Digit No. next to your Cheque No.) IFSC Code (11 Digit No. appearing on Cheque)

Example for filling the Account No. 1 3 5 7 in words One Three Five Seven (Please attach copy of cancelled cheque)

7. FATCA DETAILS For Individual (Mandatory) Non Individual investors including HUF should Mandatorily fill separate FATCA detail form
Details under Foreign Tax Laws: First / Sole Applicant / Guardian Second Applicant Third Applicant PoA
Place & Country of Birth
Nationality Indian US Others (Please Specify) Indian US Others (Please Specify) Indian US Others (Please Specify)
Address Type Residential Registered Office Business Residential Registered Office Business Residential Registered Office Business
Are you a tax resident (i.e. are you assessed for Tax) in any other country outside India? Yes No (If Yes, please provide information below)
Country of Tax Residency
Tax Identification Number or Functional Equivalent
Identification Type (TIN or Other, please specify)
If TIN is not available, please tick Reason A B C (Please Specify) Reason A B C (Please Specify) Reason A B C (Please Specify)
Reason A: The country where Account Holder is liable to pay tax does not issue TIN to its residents Reason B: No TIN Required (Select this only if the authorities of the respective country of tax residents do not
require the TIN to be collected) Reason C: others, please specify the reason above
8. NOMINATION - MANDATORY, even if no intention to nominate. Minor & PoA holder cannot nominate and should not fill this section
1. I/We do not wish to nominate SIGNATURE(S) First / Sole Applicant Second Applicant Third Applicant

2. Having read and understood the instruction for Nomination, I / We hereby nominate the person(s) more particularly described hereunder in respect of the Units under the Folio held by me/us in the event of my death.
Nominee Name Relationship Date of Birth^ Allocation %# Guardian Signature^
Nominee 1

Nominee 2

Nominee 3
^ In case Nominee is minor. # Please indicate the percentage of allocation / share for each of the nominees in whole numbers only without any decimals making a total of 100 per cent.
9. DECLARATION & SIGNATURES
I / We hereby confirm and declare as under:- I / We am / are not prohibited from accessing capital markets under any order / ruling / judgment etc., of any regulation, including SEBI. My application is in compliance with applicable Indian and foreign laws. I / We
have neither received nor been induced by any rebate or gifts, directly or indirectly in making this investment. I am / we are not a US person, within the meaning of the United States Securities Act, 1933, as amended from time to time; and that I am / we are not
applying on behalf of or as proxyholders of a person who is a US person. I am/ We are competent under the applicable laws and duly authorised where required,to make this investment in the above mentioned scheme. I / We have read, understood and hereby
agree to comply with the terms and conditions of the scheme related documents including the provisions of the section of 'Who cannot Invest' and apply for allotment of Units of the Scheme(s) of Baroda BNP Paribas Mutual Fund (‘Fund’). I/We hereby confirm that
the proposed investment is being made from known, identifiable and legitimate sources of funds /income of mine only and I am / we are the rightful beneficial owner(s) of the funds and the resulting investments therefrom. The above mentioned investment does
not involve and is not designed for the purpose of any contravention or evasion of any Act, Rules, Regulations, Notifications or Directions or of the provisions of any law in India including but not limited to The Income Tax Act, the Prevention of Money Laundering
Act, 2002, The Prevention of Corruption Act, 1988 and /or any other relevant rules / guidelines notified in this regard or applicable laws enacted by the Government of India / any other regulatory body from time to time. I / we hereby understand and agree that
if any of the aforesaid disclosures made / information provided by me / us is found to be contradictory or non-reliable to the above statements or if I / we fail to provide adequate and complete information, the AMC / Mutual Fund / Trustees reserve the right to
not create a folio / account, reject the application / withhold the investments made by me / us and / or make disclosures and report the relevant details to the competent authority and take such other actions as may be required to comply with the applicable law
as the AMC / Mutual Fund / Trustees may deem proper at their sole option.
I / We hereby authorise the Fund, AMC and its Agents to disclose my / our details including investment details to my / our bank(s) / Fund’s bank(s) and / or Distributor / Broker / Investment Advisor and to verify my / our bank details provided by me / us, or to
disclose to such service providers as deemed necessary for conduct of business. I / We confirm that I / We do not have any existing Micro SIP / Investments which together with the current application will result in aggregate investments exceeding Rs. 50,000/- in
a financial year or a rolling period of one year. I / We will indemnify the Fund, AMC, Trustee, RTA and other intermediaries in case of any dispute regarding the eligibility, validity and authorization of my / our transactions.
The ARN holder (AMFI registered Distributor) has disclosed to me / us all the commissions (in the form of trail commission or any other mode), payable to him / them for the different competing Schemes of various Mutual Funds from amongst which the Scheme is
being recommended to me / us. I / WE HEREBY CONFIRM THAT I / WE HAVE NOT BEEN OFFERED / COMMUNICATED ANY INDICATIVE PORTFOLIO AND / OR ANY INDICATIVE YIELD BY THE FUND / AMC / ITS DISTRIBUTOR FOR THIS INVESTMENT.
I / We declare that the information provided in this form is, to the best of my knowledge and belief, accurate and complete and further agree to furnish such other further/additional information as may be required by the Baroda BNP Paribas Asset Management
India Pvt Ltd (AMC) / Fund. I further undertake to advise the AMC / Mutual Fund/ Trustees promptly of any change in circumstance which causes the information contained herein to become incorrect and to provide the AMC /Mutual Fund/ Trustees with a suitably
updated self-declaration within 30 days of such change in circumstances.
I hereby declare that the AMC / Fund can provide my information to any institution / tax authorities / governmental body for the purpose of ensuring appropriate withholding from the account or any proceeds in relation thereto.
To receive physical annual statements and scheme wise abridged report please tick here (ü)
Additional declaration for NRIs only : I / We confirm that I am / We are Non-Resident of Indian Nationality / Origin and I / We hereby confirm that the funds for subscription have been remitted from abroad through normal banking channels or from funds in my
/ our Non-Resident External / Ordinary Account / FCNR Account.
Additional declaration for Foreign Nationals Resident in India only: I/We will redeem my / our entire investment/s before I / We change my / our Indian residency status. I / We shall be fully liable for all consequences (including taxation) arising out of the
failure to redeem on account of change in residential status.
Additional declaration for NRIs / PIO / OCIs only: I / We am / are not prohibited from accessing capital markets under any order / ruling / judgment etc., of any regulation, including SEBI. I / We confirm that my application is in compliance with applicable Indian
and foreign laws. please (ü) Yes No If yes, (ü) Repatriation basis Non-Repatriation basis
Dated First / Sole Applicant / Guardian /
Second Applicant / POA Holder Third Applicant / POA Holder
POA Holder / Authorised Signatory

BNP Paribas Asset Management India Private Limited Simply send **SMS to 9212 132763 to avail the below facilities
Crescenzo, 7th Floor, G-Block, Bandra Kurla Complex, Mumbai – 400051, Maharashtra, India. Balance SMS BAL <space> last 6 digits of Folio No.
Email Id- service@barodabnpparibasmf.in Board line no.- 022 69209600 • Toll Free no.- 1800 2670 189 NAV SMS NAV <space> last 6 digits of Folio No.
Fax no.- 022 69209 460/470 Website URL- www.barodabnpparibasmf.in Statement thru Email SMS ESOA <space> last 6 digits of Folio No.
CIN no.- U65991MH2003PTC142972 Last 3 Transactions SMS Transaction <space> last 6 digits of Folio No.
**SMS charges as per service provider applicable.
 SIP REGISTRATION CUM NACH MANDATE FORM
Please read product labelling details available on cover page and the instructions before filling up the Application Form.
Tick (ü) whichever is applicable, strike out whichever is not required.
Please (ü) SIP Registration  SIP Cancellation   SIP - Change in Scheme  SIP - Change in Bank Details
Distributor / Broker ARN Sub-Broker Code Sub-Broker ARN EUIN* LG Code RIA Code++

Upfront commission shall be paid directly by the investor to the AMFI registered Distributors based on the investors’ assessment of various factors including the service rendered by the distributor.
*I/We hereby confirm that the EUIN box has been intentionally left blank by me / us as this transaction is executed without
any interaction or advice by the employee / relationship manager / sales person of the above distributor / sub broker or
notwithstanding the advice of in-appropriateness, if any, provided by the employee / relationship manager / sales person
of the distributor / sub broker. First / Sole Applicant
++ I/We, have invested in the Scheme(s) of your Mutual Fund under Direct Plan. I/We hereby give you my/our consent to / Guardian / POA Holder
share/provide the transactions data feed/ portfolio holdings/ NAV etc. in respect of my/our investments under Direct Plan / Authorised Signatory Second Applicant / POA Holder Third Applicant / POA Holder
of all Schemes Managed by you, to the above mentioned Mutual Fund Distributor / SEBI-Registered Investment Adviser.
TRANSACTION CHARGES for I confirm that I am a first time investor across Mutual Funds. (Rs. 150 deductible as Transaction Charge and payable to the Distributor)
Rs. 10,000 and above (ü any one) I confirm that I am an existing investor across Mutual Funds. (Rs. 100 deductible as Transaction Charge and payable to the Distributor)

1. APPLICANT’S information (Mandatory, if left blank, the application is liable to be rejected)

Folio No. Name of Sole / First Unit Holder First Name Middle Name Last Name
PAN/PEKRN Details (mandatory) *If the First Applicant is a Minor, please state the details of Guardian. Please attach PAN proof.
First/Sole Applicant   Second Applicant   Third Applicant

2. SYSTEMATIC INVESTMENT PLAN DETAILS   SIP MULTI SIP

Frequency (Please ü) Daily SIP Weekly SIP Monthly SIP Quarterly SIP
Scheme Name SIP Amount SIP Date / Day (For Start Date Perpetual* End Date Top Up Top Up Frequency
Weekly Amount

Baroda BNP Paribas DD or DAY MM/YYYY MM/YYYY Half Yearly Yearly

Baroda BNP Paribas DD or DAY MM/YYYY MM/YYYY Half Yearly Yearly

Baroda BNP Paribas DD or DAY MM/YYYY MM/YYYY Half Yearly Yearly

Baroda BNP Paribas DD or DAY MM/YYYY MM/YYYY Half Yearly Yearly

Total Amount (in Words) Total Amount (in Figures)

1st SIP Cheque Details Cheque No. Date D D M M Y Y Y Y Amount: * Default

For Multi SIP - SIP can be registered in maximum four Schemes with a single instrument. 1st SIP Cheque should be the total consolidated amount across all SIPs and should be favouring Baroda BNP Paribas Mutual Fund

3. DECLARATION
This is to inform that I/We have registered for the RBI's Electronic Clearing Service (Debit Clearing) / Direct Debit /Standing Instruction and that my payment towards my investment in Baroda BNP Paribas Mutual Fund shall
be made from my/our below mentioned bank account with your bank. I/We authorise the representative carrying this ECS (Debit Clearing) / Direct Debit / Standing Instruction mandate Form to get it verified & executed. I/We
hereby declare that the particulars given above are correct and express my willingness to make payments referred above through participation in ECS (Debit Clearing) / Direct Debit /Standing Instruction. If the transaction
is delayed or not effected at all for reasons of incomplete or incorrect information, I/We would not hold the user institution responsible. I /We will also inform Baroda BNP Paribas Mutual Fund / Baroda BNP Paribas Asset
Management India Limited, about any changes in my bank account. I/We have read and agreed to the terms and conditions mentioned overleaf.
I/We undertake to keep sufficient funds in the funding account on the date of execution of standing instruction. I hereby declare that the particulars given above are correct and complete. If the transaction is delayed or not
effected at all for reasons of incomplete or incorrect information, I would not hold the Mutual Fund or the Bank responsible. If the date of debit to my/ our account happens to be a non business day as per the Mutual Fund,
execution of the SIP will happen on the day of holiday and allotment of units will happen as per the Terms and Conditions listed in the Offer Document of the Mutual Fund. Bank shall not be liable for, nor be in default by
reason of, any failure or delay in completion of its obligations under this Agreement, where such failure or delay is caused, in whole or in part, by any acts of God, civil war, civil commotion, riot, strike, mutiny,revolution,
fire, flood, fog, war, lightening, earthquake, change of Government policies, Unavailability of Bank's computer system, force majeure events, or any other cause of peril which is beyond Bank’s reasonable control and which
has the effect of preventing the performance of the contract by the Bank. I/We acknowledge that no separate intimation will be received from Bank in case of non-execution of the instructions for any reasons whatsoever.

Signature(s)

First Applicant / Guardian / POA Holder /

Authorised Signatory Second Applicant / POA Holder Third Applicant / POA Holder

UMRN Date D D M M Y Y Y Y
OTM Debit Mandate for
Sponsor Bank Code Utility Code
NACH/Direct Debit
Tick () I/We hereby authorize BARODA BNP PARIBAS MUTUAL FUND to debit (tick) SB CA SB-NRE SB-NRO CC Other
CREATE 
MODIFY Bank a/c number
CANCEL
with Bank Name of customers bank IFSC or MICR

an amount of Rupees
FREQUENCY Mthly Qtly H-Yrly Yrly As & when presented DEBIT TYPE Fixed Amount Maximum Amount
PAN Phone No.

Folio Email ID
I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank.
PERIOD
From D D M M Y Y Y Y
Signature Primary Account holder Signature of 1st Joint holder Signature of 2nd Joint holder
To 3 1 1 2 2 0 9 9
Or Until Cancelled 1. Name as in bank records 2. Name as in bank records 3. Name as in bank records
This is to confirm that the declaration has been carefully read, understood and made by me/us. I am authorizing the User entity/ Corporate to debit my account, based on the instructions as agreed and signed by me.
I have understood that I am authorized to cancel / amend this mandate by appropriately communicating the cancellation / amendment request to the User entity / corporate of the bank where I have authorized the debit.
 CENTRAL KYC REGISTRY | Know Your Customer (KYC) Application Form | Individual / Related Person
Important Instructions:
A) Fields marked with ‘*’ are mandatory fields. F) Please read section wise detailed guidelines I instructions at the end.
B) Tick ‘”’ wherever applicable. G) List of State I U.T code as per Indian Motor Vehicle Act, 1988 is available at the end.
C) Please fill the form in English and in BLOCK letters. H) List of two character ISO 3166 country codes is available at the end.
D) Please fill the date in DD-MM-YYYY format. I) KYC number of applicant is mandatory for update application.
E) For particular section update, please tick (ü) in the box section number and strike off the J) The ‘OTP based E-KYC’ check box is to be checked for accounts opened using OTP based
sections not required to be updated. E-KYC in non-face to face mode

For office use only Application Type* New   Update   Delete

(To be filled by financial institution) KYC Number* (Mandatory for KYC update request)
Account Type* Normal   Minor   Aadhaar OTP based E-KYC (in non-face to face mode)

1. PERSONAL DETAILS*    DETAILS OF RELATED PERSON (Please refer instructions at the end)
Addition of Related Person Deletion of Related Person Updation KYC Number of Related Person (if available*)
Related Person Type* Guardian of Minor  Assignee Authorized Representative
Prefix First Name Middle Name Last Name
Name* (same as ID proof)
Maiden Name
Father I Spouse Name
Mother Name

Date of Birth* D D / M M / Y Y Y Y

Gender* M-Male F-Female T-Transgender

Marital Status* Married Unmarried Others
Citizenship* IN- Indian Others (ISO 3166 Country Code
Residential Status* Resident Individual Non Resident Indian Foreign National Person of Indian Origin
Occupation Type* S-Service Private Sector Public Sector Government Sector
O-Others Professional Self Employed Retired Housewife Student
B-Business X-Not Categorised

PAN* Form 60 furnished

2. PROOF OF IDENTITY AND ADDRESS* (Please refer instruction B at the end)

I. Certified copy of OVD or equivalent e-document of OVD or OVD obtained through digital KYC process needs to be submitted (anyone of the following OVDs)
Photo
A- Passport Number

B- Voter ID Card

C- Driving Licence

D-NREGA Job Card

E-National Population Register Letter

F-Proof of Possession of Aadhaar

II. E-KYC Authentication

III. Offline verification of Aadhaar

Address
Line 1*
Line 2
Line 3 City / Town / Village*
District* Pin/Post Code* State/ UT Code ISO 3166 Country Code*

3. CURRENT ADDRESS DETAILS (Please refer instruction B at the end)

Same as above mentioned address (In such cases address details as below need not be provided)
I. Certified copy of OVD or equivalent e-document of OVD or OVD obtained through digital KYC process needs to be submitted (anyone of the following OVDs)

A- Passport Number

B- Voter ID Card

C- Driving Licence

D-NREGA Job Card

E-National Population Register Letter

F-Proof of Possession of Aadhaar

II. E-KYC Authentication

III. Offline verification of Aadhaar

IV. Deemed Proof of Address - Document Type code

V. Self Declaration
Address
Line 1*
Line 2
Line 3 City / Town / Village*
District* Pin/Post Code* State/ UT Code ISO 3166 Country Code*

4. CONTACT DETAILS (All communications will be sent to Mobile number/ Email-ID provided) (Please refer instruction Cat the end)

Mobile - Tel. (Off) - Tel. (Res) -

Email ID

5. REMARKS (If any)

6. 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. lncase 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. [Signature / ThumbImpression]

I hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/email address.

D D / M M / Y Y Y Y Signature I Thumb Impression of Applicant

Date: Place:

7. ATTESTATION I FOR OFFICE USE ONLY

Documents Received Certified Copies E-KYC data received from UIDAI Data received from Offline verification Digital KYC Process
Equivalent e-document Video Based KYC

KYC VERIFICATION CARRIED OUT BY INSTITUTION DETAILS

Date D D / M M / Y Y Y Y Name

Emp.Name Code

Emp.Code

Emp. Designation
[Institution Stamp]

[Employee Signature]

In-Person Verification (IPV) Carried Out by INSTITUTION DETAILS

Date D D / M M / Y Y Y Y Name

Emp.Name Code

Emp.Code Emp. Branch

Emp. Designation

[Institution Stamp]
[Employee Signature]
 CENTRAL KYC REGISTRY I Instructions I Check list I Guidelines for filling Individual KYC Application Form
A Clarification I Guidelines on filling ‘Personal Details’ section
1 Name: The name should match the name as mentioned in the Proof of Identity submitted failing which the application is liable to be rejected.
2 One the following is mandatory: Mother’s name, Spouse’s name, Father’s name.

B Clarification I Guidelines on filling ‘Current Address details’ section

1 In case of deemed PoA such as utility bill, etc. or self declaration, the document need not be uploaded on CKYCR
2 PoA to be submitted only if the submitted Pol does not have current address or address as per Pol is invalid or not in force.
3 State I U.T Code and Pin I Post Code will not be mandatory for Overseas addresses.
4 In Section 2, one of I, II , and Ill is to be selected. In case of online E-KYC authentication , II is to be selected.
5 In Section 3, one of I, II , Ill and IV is to be selected. In case of online E-KYC authentication, II is to be selected.
6 List of documents for ‘Deemed Proof of Address’:

Document Code Description

01 Utility bill which is not more than two months old of any service provider (electricity, telephone, post-paid mobile phone, piped gas, water bill).
02 Property or Municipal tax receipt.
03 Pension or family pension payment orders (PPOs) issued to retired employees by Government Departments or Public Sector Undertakings, if they contain the
address.
04 Letter of allotment of accommodation from employer issued by State Government or Central Government Departments, statutory or regulatory bodies, public
sector undertakings, scheduled commercial banks, financial institutions and listed companies and leave and licence agreements with such employers allotting
official accommodation.

7 Regulated Entity (RE) shall redact (first 8 digits) of the Aadhaar number from Aadhaar related data and documents such as proof of possession of Aadhaar, while uploading on CKYCR.
8 “ Equivalent e-document” means an electronic equivalent of a document, issued by the issuing authority of such document with its valid digital signature including documents issued to the
digital locker account of the client as per rule 9 of the Information Technology (Preservation and Retention of Information by Intermediaries Providing Digital Locker Facilities) Rules, 2016.
9 ‘Digital KYC process’ has to be carried out as stipulated in the PML Rules, 2005.
10  Es may use the Self Declaration check box where Aadhaar authentication has been carried out successfully for a client and client wants to provide a current address, different from the
R
address as per the identity information available in the Central Identities Data Repository

C Clarification I Guidelines on filling ‘Contact details’ section

1 Please mention two- digit country code and 10 digit mobile number (e.g. for Indian mobile number mention 91 -9999999999).
2 Do not add ‘O’ in the beginning of Mobile number.

D Clarification I Guidelines on filling ‘Related Person details’ section

1 Provide KYC number of related person, if available.

E Clarification on Minor
1 Guardian details are optional for minors above 10 years of age for opening of bank account only
2 However, in case guardian details are available for minor above 10 years of age, the same (or CKYCR number of guardian) is to be uploaded.
 List of Two-Digit state / U.T Codes as per Indian Motor Vehicle Act, 1988

State / U.T Code State / U.T Code State / U.T Code

Andaman & Nicobar AN Himachal Pradesh HP Pondicherry PY
Andhra Pradesh AP Jammu & Kashmir JK Punjab PB
Arunachal Pradesh AR Jharkhand JH Rajasthan RJ
Assam AS Karnataka KA Sikkim SK
Bihar BR Kerala KL Tamil Nadu TN
Chandigarh CH Lakshadweep LD Telangana TS
Chattisgarh CG Madhya Pradesh MP Tripura TR
Dadra and Nagar Haveli DN Maharashtra MH Uttar Pradesh UP
Daman & Diu DD Manipur MN Uttarakhand UA
Delhi DL Meghalaya ML West Bengal WB
Goa GA Mizoram MZ Other XX
Gujarat GJ Nagaland NL
Haryana HR Orissa OR

List of ISO 3166 Two-Digit Country Code

Country Country Country Country

Country Code Country Code Country Code Country Code
Afghanistan AF Dominican Republic DO Libya LY Saint Pierre and Miquelon PM
Aland Islands AX Ecuador EC Liechtenstein LI Saint Vincent and the Grenadines VC
Albania AL Egypt EG Lithuania LT Samoa WS
Algeria DZ El Salvador SV Luxembourg LU San Marino SM
American Samoa AS Equatorial Guinea GQ Macao MO Sao Tome and Principe ST
Andorra AD Eritrea ER Macedonia, the former Yugoslav Republic of MK Saudi Arabia SA
Angola AO Estonia EE Madagascar MG Senegal SN
Anguilla AI Ethiopia ET Malawi MW Serbia RS
Antarctica AQ Falkland Islands (Malvinas) FK Malaysia MY Seychelles SC
Antigua and Barbuda AG Faroe Islands FO Maldives MV Sierra Leone SL
Argentina AR Fiji FJ Mali ML Singapore SG
Armenia AM Finland FI Malta MT Sint Maarten (Dutch part) SX
Aruba AW France FR Marshall Islands MH Slovakia SK
Australia AU French Guiana GF Martinique MQ Slovenia SI
Austria AT French Polynesia PF Mauritania MR Solomon Islands SB
Azerbaijan AZ French Southern Territories TF Mauritius MU Somalia SO
Bahamas BS Gabon GA Mayotte YT South Africa ZA
Bahrain BH Gambia GM Mexico MX South Georgia and the South Sandwich GS
Islands
Bangladesh BD Georgia GE Micronesia, Federated States of FM South Sudan SS
Barbados BB Germany DE Moldova, Republic of MD Spain ES
Belarus BY Ghana GH Monaco MC Sri Lanka LK
Belgium BE Gibraltar GI Mongolia MN Sudan SD
Belize BZ Greece GR Montenegro ME Suriname SR
Benin BJ Greenland GL Montserrat MS Svalbard and Jan Mayen SJ
Bermuda BM Grenada GD Morocco MA Swaziland SZ
Bhutan BT Guadeloupe GP Mozambique MZ Sweden SE
Bolivia, Plurinational State of BO Guam GU Myanmar MM Switzerland CH
Bonaire, Sint Eustatius and Saba BQ Guatemala GT Namibia NA Syrian Arab Republic SY
Bosnia and Herzegovina BA Guernsey GG Nauru NR Taiwan, Province of China TW
Botswana BW Guinea GN Nepal NP Tajikistan TJ
Bouvet Island BV Guinea-Bissau GW Netherlands NL Tanzania, United Republic of TZ
Brazil BR Guyana GY New Caledonia NC Thailand TH
British Indian Ocean Territory IO Haiti HT New Zealand NZ Timor-Leste TL
Brunei Darussalam BN Heard Island and McDonald Islands HM Nicaragua NI Togo TG
Bulgaria BG Holy See (Vatican City State) VA Niger NE Tokelau TK
Burkina Faso BF Honduras HN Nigeria NG Tonga TO
Burundi BI Hong Kong HK Niue NU Trinidad and Tobago TT
Cabo Verde CV Hungary HU Norfolk Island NF Tunisia TN
Cambodia KH Iceland IS Northern Mariana Islands MP Turkey TR
Cameroon CM India IN Norway NO Turkmenistan TM
Canada CA Indonesia ID Oman OM Turks and Caicos Islands TC
Cayman Islands KY Iran, Islamic Republic of IR Pakistan PK Tuvalu TV
Central African Republic CF Iraq IQ Palau PW Uganda UG
Chad TD Ireland IE Palestine, State of PS Ukraine UA
Chile CL Isle of Man IM Panama PA United Arab Emirates AE
China CN Israel IL Papua New Guinea PG United Kingdom GB
Christmas Island CX Italy IT Paraguay PY United States US
Cocos (Keeling) Islands CC Jamaica JM Peru PE United States Minor Outlying Islands UM
Colombia CO Japan JP Philippines PH Uruguay UY
Comoros KM Jersey JE Pitcairn PN Uzbekistan UZ
Congo CG Jordan JO Poland PL Vanuatu VU
Congo, the Democratic Republic of the CD Kazakhstan KZ Portugal PT Venezuela, Bolivarian Republic of VE
Cook Islands CK Kenya KE Puerto Rico PR Viet Nam VN
Costa Rica CR Kiribati KI Qatar QA Virgin Islands, British VG
Cote d'Ivoire !Côte d'Ivoire CI Korea, Democratic People's Republic of KP Reunion !Réunion RE Virgin Islands, U.S. VI
Croatia HR Korea, Republic of KR Romania RO Wallis and Futuna WF
Cuba CU Kuwait KW Russian Federation RU Western Sahara EH
Curacao !Curaçao CW Kyrgyzstan KG Rwanda RW Yemen YE
Cyprus CY Lao People's Democratic Republic LA Saint Barthelemy !Saint Barthélemy BL Zambia ZM
Czech Republic CZ Latvia LV Saint Helena, Ascension and Tristan da Cunha SH Zimbabwe ZW
Denmark DK Lebanon LB Saint Kitts and Nevis KN
Djibouti DJ Lesotho LS Saint Lucia LC
Dominica DM Liberia LR Saint Martin (French part) MF