Please fill all the details in CAPITAL LETTERS and BLACK INK only. Fields with (STAR) are MANDATORY
(For Office use only) Date :
Br. Code : Branch : _________________________ Bar Code No.:
Status Cust. ID No. : Code : Primary Account number (For linking joint holder cust id) Appl. No.
Customer Relationship Form for new customers (In case of joint applicants, each applicant to fill a separate form)
(A) PERSONAL DETAILS
Applicant Mr. Ms. Dr. Name:
Mother’s Maiden Name: Marital Status: Single Married
Father's Name: Gender: / / TG
Date of Birth: Category : SC ST OBC Others
PAN : Form 60 / Form 61 Nationality, If other than India : _________________________
(Fill in annexed Form 60/61) UID/ (Aadhaar No.): Relation with Primary Applicant : _____________________________________
(B) COMMUNICATION ADDRESS
House No/Building Name:
Street Details: / Locality: Land mark: City: State: Country : PIN (please specify if other than India)
Tel. No. : STD Code: (O) STD Code: (O)
Mobile No.:
Email ID :
(C) PERMANENT ADDRESS (Office address can not be permanent address)
(If no, below fields are mandatory)
House No/Building Name:
Street Details: / Locality: Land mark: City: State: Country : PIN (please specify if other than India)
(D) KNOW YOUR CUSTOMER DOCUMENT (KYC)
1. Identity proof : Expiry Date
(Only for ID Proof wherever applicable)
2. Address proof :
(E) KYC CERTIFICATION
I have met Mr./ Ms. ________________________________________________ in person at his/ her residence/ office/ others (please specify) ____________________________________________ and confirm that I have verified the copies of the Identity and address documents (as applicable) against originals as produced by the applicant. I also confirm that the form has been signed by the applicant in my presence. Name and Designation of the Bank Official authorising opening of the Account________________________________
Date: ______________________ Employee No.: ______________________ Signature of Bank Official: ______________________
(F) CUSTOMER PROFILE
1. Occupation a) If Salaried, employed with Proprietorship Partnership Pvt. Ltd. Public Ltd. Public Sector Government Multinational Others b) If Self Employed, and If in Business, nature of Business Manufacturing Trading Services Retailing Agriculture Stock Broker Real Estate Shroffs and Moneylenders Others If Professional, type of Profession Doctor CA/CS Lawyer Architect Consultant Engineer Others c) If Others House Wife Retired Student d) If Agri Allied/Farmer, Nil <=5 acres > 5 acres details of landholding 2. Education Under Graduate Graduate Post Graduate Professional 3. Gross Annual Income (`) Nil < 1Lac 1Lac - 5 Lacs 5 Lacs - 10 Lacs 10 Lacs - 15 Lacs 15 Lacs - 20 Lacs 20Lacs - 25 Lacs 25 Lacs - 50 Lacs 50 Lacs - 1 Cr < 1 Cr
(G) To be filled by those who do not have either PAN
FORM NO. 60 FORM NO. 61
[See second proviso to rule 114B] [See proviso to clause (a) of rule 114C (1)] Form of declaration to be filed by a person who does not have a permanent Form of declaration to be filed by a person who has agriculture income and account number and who enters into any transaction specified in rule 114B is not in receipt of any other income chargeable to income-tax in respect of transactions specified rule 114B 1. Full name and address of the declarant 1. Full name and address of the declarant 2. Particulars of transaction 3. Amount of the transaction 2. Particulars of transaction 4. Are you assessed to tax? Yes No 3. Details of the documents being produced in support of 5. If yes, (I) Details of Ward/Circle/Range where the last return of address in column (1) Yes No income was filed I hereby declare that my source of income is from agriculture and (ii) Reasons for not having permanent account I am not required to pay income-tax on any other income, if any. number: Date: 6. Details of the document being produced in support of address Place: in column (1) Signature of the declarant
VERIFICATION (To be filled along with Form 60/61*
I, ______________________________________________________________________, do hereby declare that what is stated above is true to the best of my knowledge and belief. Verified today, the ________________________________ day of _________________________, ___________________________ Place : _______________________________ Date : _____________________________________
Signature of the declarant
FATCA /CRS DECLARATION
US person (Liable to tax in US) Yes No US Citizenship Yes No Country of birth : If US person is ‘No’ and Country of birth is ‘US’, Relinquishment of citizenship submitted Yes, else specify reason:
TIN 1.: TIN 1.: TIN 2.: TIN 2.:
issuing Country issuing Country Country of residence for Tax purpose Self-Certification: I confirm that I am not a US person/not a resident for Tax purpose in any country other than India, though one or more parameters suggest my relation with the country outside India. Therefore, I am providing the following document as proof of my citizenship and residency in India.
Passport Election Id Card PAN Card Driving License UIDAI Letter NREGA job card Signature
BSR CODE - BSM to fill based on the occupation and gender details filled in AOF OCCUPATION MALE FEMALE OCCUPATION MALE FEMALE Agri Allied / Farmers Business 41141 41142 41441 41442 (Landholding Nil, <=5 acres, > 5 acres) (Shroffs / Moneylenders, Stock Brokers, Dealers in Bullion) Business Salaried (Manufacturing, Trading, Services, Retailing, Agriculture, (Proprietorship, Partnership, Pvt. Ltd., Real Estate) 41241 41242 Public Ltd., Public Sector, Government, 41341 41342 Professional Multinational, Wage salary earners, (Doctor, CA/CS, Lawyer, Architect, Consultant, Engineer) Others) Housewife, Retired, Student
