nsdl 10-12-2011 non individual - alankit...for non-individual with nsdl corporate office...

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ASSIGNMENTS LIMITED Part I - Know Your Client (KYC) Application Form (For Non Individuals) ANNEXURE - K

A. IDENTITY DETAILS Photograph

Name Of The Applicant

Date of Incorporation

Date of commencement of business

Place of incorporation

PAN

Registration No. (e.g. CIN)

Status (Please tick any one)

B. ADDRESS DETAILS

Correspondence Address

City/ District/ Village

Pin Code State

Country

Tel. (Off.)

Tel. (Res)

Mobile

Fax

Email ID

Specify the proof of address submitted for Correspondence Address

Registered Address (If Different from above)

City/ District/ Village

Pin Code State

Country

Specify the proof of address submitted for Permanent Address

C. OTHER DETAILS

Gross Annual Income Details (Please Specify)

Income Rs

Net-worth as on Date

(Net worth should not be older then 1 year)

Name, PAN, residential address and photographs of Promoters/Partners/ Karta/Trustees and whole time directors

DIN / DPIN / UID of Promoters/Partners/LLP Partners and whole time directors:

Please Specify, As Applicable

D. DECLARATION

I / we hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I/we 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 / we are aware that I / we may be held liable for it.

Name & Signature of the Authorised Signatory(ies) Date

FOR OFFICE USE ONLY

(Originals verified) True copies of documents received

(Self-Attested) Self Certified Document copies received

Signature of the Authorised Signatory

Date Seal/Stamp of the Intermediary

Details of Promoters/ Partners/ Karta/ Trustees and whole time directors forming a part of Know Your Client (KYC)Application Form for Non-Individuals

Sr. No. 1

Name

Relationship with Applicant(i.e. promoters, whole time directors etc.)

PAN

Residential / Registered Address

DIN/ UID

Photograph

Sr. No. 2

Name

Relationship with Applicant(i.e. promoters, whole time directors etc.)

PAN

Residential / Registered Address

DIN/ UID

Photograph

Sr. No. 3

Name

Relationship with Applicant(i.e. promoters, whole time directors etc.)

PAN

Residential / Registered Address

DIN/ UID

Photograph

Name & Signature of the Authorised Signatory(ies) Date

1. Identity of the applicant(s) is verified “in Person” a. Alankit Assignments Ltd. Intermediary ID - P2080 b. Branch / Service Centre _______________________________________ c. Staff Name __________________________________________________ Emp. Code _____________________ Signature ___________________ d. Date ___________________ Place _____________________

ALANKIT ASSIGNMENTS LIMITED PART II - ACCOUNT OPENING FORM (For Individuals)

ANNEXURE - K

Serial No. Receipt No. :............................................... Cash / Cheque No..................................... Rs.................................................................. OPENED BY............................................... VERIFIED BY.............................................

Client ID (To be filled by participant)

Date

A) Details of Account holder(s):

Sole / First Holder Name

PAN

Second Holder Name

PAN

Third Holder Name

PAN

B) Type Of Account

C) For HUF, Association of Persons (AOP), Partnership Firm, Unregistered Trust, etc. Although the account is opened in the name of the Karta, partner(s), trustee(es) etc., The name & PAN of the HUF, Association of Persons (AOP), Partnership Firm, Unregistered Trust, etc., should be Mentioned below:

a. Name

b. PAN

D) In case of FIIs/ Others(as may be applicable)

RBI Approval Reference Number

RBI Approval date

SEBI Registration No. (For FIIs)

E) Bank Details

Bank Account Type

Bank Account Number

Bank Name

Branch Address

City/ District/ Village

Pin Code State

Country

MICR Number

IFSC Code

F) Clearing Member Details (to be filled up by Clearing Members only)

1. Name of the Stock Exchange

2. Name of Clearing Corporation/ Clearing House

3. Clearing Member ID

4. SEBI Registration Number

5. Trade Name

6. CM-BP-ID (to be filled up by Participant)

G) Standing Instruction

1. We authorise you to receive credits automatically into our account.

Yes

No

2. Account to be operated through Power of Attorney (PoA)

Yes

No

3. SMS Alert facility

First Holder

Yes

No

Second Holder

Yes

No

Third Holder

Yes

No

Declaration The rules and regulations of the Depository and Depository Participants pertaining to an account which are in force now have been read by us and we have understood the same and we agree to abide by and to be bound by the rules as are in force from time to time for such accounts. We here by declare that the details furnished above are true and correct to the best of my/our knowledge and belief and we 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, We are aware that we may be held liable for it. Authorised Signatories (Enclose a Board Resolution for Authorised Signatories)

Holder Name Signature(s)

First Holder

First Signatory ......................................................... ................................................

Second Signatory ......................................................... ...........................................

Third Signatory ......................................................... .............................................

Other Holder

Second Holder ........................................................... .........................................

Third Holder ........................................................... .........................................

Mode of Operation for Sole/First holder (In case of joint holdings, all the holders must sign)

Any one Singly

jointly by

As per resolution

Other (Please Specify)

NOTES:

1. In case of additional signatures, separate annexures should be attached to the applicationform.

2. Thumb impressions and signatures other than English or Hindi or any of the other languagenot contained in the 8th Schedule of the Constitution of India must be attested by a Magistrateor a Notary Public or a Special Executive Magistrate.

3. Strike off whichever is not applicable.