Ph : / Sub: - Change of Address / Bank Details / Nominee Address / PAN No. CHANGE OF ADDRESS. address : address :

Transcription

1 APPLICATION FOR CHANGE IN CLIENT DETAILS To The Manager Karur Vysya Bank Ltd Demat Cell, Second Floor No 29, Rangan Street, T. Nagar Chennai REQ NO. DATE DP ID Ph : / Sub: - Change of Address / Bank Details / Nominee Address / PAN No. CHANGE OF ADDRESS OLD CORRES / PERMANENT ADDRESS NEW CORRES / PERMANENT ADDRESS I N Tel No. Tel No. address : address : CHANGE OF BANK DETAILS CHANGE IN NOMINEE ADDRESS SB/ CURRENT ACCOUNT NO NAME OF THE BANK BRANCH ADDRESS MICR NO Enclose a copy of the Cheque Leaf TEL No. address We hereby authorise (Name) sign to convey the information to THE KARUR VYSYA BANK LTD. SIGNATURE OF 1 ST HOLDER SIGNATURE OF 2 ND HOLDER SIGNATURE OF 3 RD HOLDER ACCEPTED BY (BARANCH STAMP) FOR OFFICE USE ONLY REQ CREATED BY AUTORISED BY ACKNOWLEDGEMENT SLIP CHANGE OF ADDRESS/ BANK DETAILS / NOMINEE ADDRESS / PAN NO CLIENT ID DATE BRANCH SEAL DP.ID IN303382

2 Please fill this form in ENGLISH and in BLOCK LETTERS A. IDENTITY DETAILS Annexure - J PART I - KNOW YOUR CLIENT (KYC) APPLICATION FORM (For Individuals) THE KARUR VYSYA BANK LTD - DEMAT CELL SECOND FLOOR No.29, RANGAN STREET, T. NAGAR, CHENNAI PHONE : / 74 C1 1st Holder DP ID : IN MIID : P0750 Please affix your recent passport size photograph 1 Name of the Applicant 2 Father s / Husband s Name Signature Across 3 a) Gender 4 a) Nationality 5 a) PAN Male Female b) Marital status Single Married Indian Other (Please specify, ) b) Aadhaar Number, if any c) of Birth b) Status Resident Individual Non Resident Foreign National 6 Specify the proof of identity submitted PAN card Any other (Please specify; ) B. ADDRESS DETAILS Correspondence Address Residence Address 1 Residence / Correspondence Address 3 Contact Details 2 Specify the proof of address submitted for Residence / correspondence address Tel. (Off.) Fax No. ID Tel. (Res.) Mobile No. Permanent Address (If different 4 from above. Mandatory for Non-Resident Applicant to specify overseas address) C. 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. 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 it. C2 Signature of the Applicant

3 FOR OFFICE USE ONLY Sr. No. 1 Particulars Originals verified and Self-Attested Document copies received In-Person-Verification (IPV) details : 2 a) Name of the person doing IPV b) Designation c) Name of Organization d) Signature E1 e) Name & Signature of the Authorised Signatory E2 Seal/Stamp of the intermediary

4 2nd Holder Please fill this form in ENGLISH and in BLOCK LETTERS A. IDENTITY DETAILS Annexure - J PART I - KNOW YOUR CLIENT (KYC) APPLICATION FORM (For Individuals) THE KARUR VYSYA BANK LTD - DEMAT CELL SECOND FLOOR No.29, RANGAN STREET, T. NAGAR, CHENNAI PHONE : / 74 C1 DP ID : IN MIID : P0750 Please affix your recent passport size photograph 1 Name of the Applicant 2 Father s / Husband s Name Signature Across 3 a) Gender 4 a) Nationality 5 a) PAN Male Female b) Marital status Single Married Indian Other (Please specify, ) b) Aadhaar Number, if any c) of Birth b) Status Resident Individual Non Resident Foreign National 6 Specify the proof of identity submitted PAN card Any other (Please specify; ) B. ADDRESS DETAILS Correspondence Address Residence Address 1 Residence / Correspondence Address 3 Contact Details 2 Specify the proof of address submitted for Residence / correspondence address Tel. (Off.) Fax No. ID Tel. (Res.) Mobile No. Permanent Address (If different 4 from above. Mandatory for Non-Resident Applicant to specify overseas address) C. 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. 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 it. C2 Signature of the Applicant

5 FOR OFFICE USE ONLY Sr. No. 1 Particulars Originals verified and Self-Attested Document copies received In-Person-Verification (IPV) details : 2 a) Name of the person doing IPV b) Designation c) Name of Organization d) Signature E1 e) Name & Signature of the Authorised Signatory E2 Seal/Stamp of the intermediary