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KYC

For Non-Individuals

M/s CAPITAL RESEARCH SERVICES

KNOW YOUR CLIENT (KYC) APPLICATION FORM

Please fill this form in ENGLISH and in BLOCK LETTERS.

Sign across it

  1. IDENTITY DETAILS
  2. Name of the Applicant:
  3. Date of incorporation: ———— (dd/mm/yyyy) & Place of incorporation: ——————-
  4. Date of commencement of business: —————————————————————–
  5. a. PAN: ——————————————————————————————————-
  6. Registration No. (E.g. CIN):————————————————————–
  7. Status: ——————————— (   ) Private Limited Co.

(   ) Public Ltd. Co.

(   ) Body Corporate

(   ) Partnership

(   ) Trust

(   ) Charities

(   ) NGOs

(   ) FI

(   ) FII

(   ) HUF

(   ) AOP

(   ) Bank

(   ) Government Body

(   ) Non-Government Organization

(   ) Defence

(   ) Establishment

(   ) BOI

(   ) Society

( ) LLP

—————————————————-Others (please specify) Private Limited Co.

  1. ADDRESS DETAILS

 Address for correspondence: ——————————-

City/town/village: —————————————-

Pin Code: ————————————————-

State: ——————————————————

Country: —————————————————

  1. Contact Details:

Tel. (Off.) ————————–

Tel. (Res.) ————————-

Mobile No.: ———————–

Fax: ———————————-

Email id: ———————————

  1. Specify the proof of address submitted for correspondence address: —————————————————————
  2. Registered Address (if different from above): ——————————-

City/town/village: —————————————————————————

Pin Code: ——————————————————————————-

State: ———————————————————————————–

Country: ——————————————————————————–

  1. Specify the proof of address submitted for registered address: —————————————————————————————————————————————————-
  2. OTHER DETAILS

 Gross Annual Income Details (please specify):———————————-Below Rs 1 Lac

1-5 Lac

5-10 Lac

10-15 Lac

  1. Net-worth Amount ————————————————————–

Net-worth Date as on ———————————————————- (dd/mm/yyyy)

(*Net worth should not be older than 1 year)

  1. Name, PAN, residential address and photographs of Promoters/Partners/Karta/Trustees and whole

time directors:——————————————————————————————————————————————————————————————————————————————————————————————————————————————–

  1. DIN/UID of Promoters/Partners/Karta and whole time directors: ————————————————————————————————————————————————————————————————————————————————————————
  2. Please tick, if applicable, for any of your authorized

Signatories/Promoters/Partners/Karta/Trustees/whole time directors:

(       ) Politically Exposed Person (PEP)

(         ) Related to Politically Exposed Person (PEP)

  1. Any other information:——————————————————————————————————————————————————————————————————————————————————————————————————————————-

DECLARATION

I/We hereby declare that the details furnished above are true and correct to the best of my/ourknowledge and belief and I/we undertake to inform you of any changes therein, immediately. In caseany of the above information is found to be false or untrue or misleading or misrepresenting, I am/weare aware that I/we may be held liable for it.

_____________________________________

Name & Signature of the Authorised Signatory

Date: ___________ (dd/mm/yyyy)