KYC FORM
| 1. Name of the applicant | Recent passport size photograph and sign halfway across the form and the photo | 2. Father's/Spouse Name | 3. (a) Gender | (b) Marital Status | (c) Date Of Birth | 4. (a) Nationality | (b) Status | 5. (a) PAN Number | (b) Aadhaar Number | PAN Card | Aadhar Card | 1. Address | Proper Detailed Address | City/Town/Village | Pin Code | State | Country | 2. Specify Proof of address submitted for Residence/Correspondence Address | 3. Tel. (Res.) | Tel. (Off.) | Fax No. | Mobile No. | Email Id | 4. Permanent Address (If different from above. Mandatory for Non-Resident Applicant to specify overseas address,) | Consent | Date | Signature of the Applicant | A. IMPORTANT POINTS: | B. Proof of Identity (POI): - List of documents admissible as Proof of Identity: | C. Proof of Address (POA): - List of documents admissible as Proof of Address: | D. Exemptions/clarifications to PAN | E. List of people authorized to attest the documents: | Entry Date | Entry ID | User IP |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| UMANG LIMBACHIYA | eJX2gw3XrRuQ-Aadhhar-Card-Umang_unlocked.pdf | ASHOK | Male | Single | 09/03/1999 | INDIAN | Resident Individual | AWMPL3602K | 223621603208 | bW8IQ6p4wnm4-PAN-Card.pdf | oURFNJItp5mm-Aadhhar-Card-Umang_unlocked.pdf | Residence Address | VASAI WEST | MUMBAI | 401202 | MAHARASTRA | INDIA | ILUwL4OnziKt-Aadhhar-Card-Umang_unlocked.pdf | 7447720201 | 7447720201 | umanglimbachiya4096@gmail.com | checked |  |
checked | checked | checked | checked | checked | 26/07/2025 11:14 AM | 6 | 103.224.5.42 | ||||
| UMANG ASHOK KUMAR LIMBACHIYA | MvHYysaS1g2O-Aadhhar-Card-Umang_unlocked.pdf | ASHOK KUMAR | Male | Single | 09/03/1999 | INDIAN | Resident Individual | AWMPL3602K | 223621603208 | 4pYT3H20llDm-PAN-Card.pdf | 9BFQrzOXDcNf-Aadhhar-Card-Umang_unlocked.pdf | Residence Address | VASAI WEST | MUMBAI | 401202 | MAHARASTRA | INDIA | nnF6j3cDKgwU-Aadhhar-Card-Umang_unlocked.pdf | 7447720201 | 7447720201 | umanglimbachiya4096@gmail.com | checked |  |
checked | checked | checked | checked | checked | 26/07/2025 11:10 AM | 5 | 103.224.5.42 | ||||
| Amol Sadashio Sable |  |
Sadashio | Male | Married | INDIAN | Resident Individual | BFEPS5176K | 219283737737 | AH84o0PMvo09-Amol_Sable_signed_PAN.pdf |  |
Residence Address | 305, Varun C, DSK Vishwa, Dhayri, Pune 411041 | Pune | 411041 | MH | India |  |
9422884264 | 9422884264 | amolsable@gmail.com | checked |  |
checked | checked | checked | checked | checked | 27/03/2025 10:53 AM | 4 | 115.114.136.188 | |||||
| Heet acharya |  |
Yatin | Male | Single | Indian | Resident Individual | EOBPA6858M | 895655408450 |  |
 |
Residence Address | Rajkot | Rajkot | 360001 | Gujrat | India |  |
9974806934 | 9974806934 | 9974806934 | heetacharya@gmail.com | Rajkot | checked | 01/01/2025 |  |
checked | checked | checked | checked | checked | 01/01/2025 08:46 AM | 2 | 2401:4900:361e:b39b:a84a:8b3b:5a4b:db6d | ||
| fsfsf |  |
gsageshsee | Male, Female | Married | 12/09/2005 | egdsgds | Resident Individual | hshrdjh | hrdhrjmj | D9ZNjQVGrVKS-KYC-Application-Form-for-Individual-1.pdf |  |
Residence Address | tdhjrj | yheryhk | yeru ki,k | t4yhejkm, | yjkm,k | 1iUtdKPQixzn-KYC-Application-Form-for-Individual.pdf | yruj | yhujyjmmn | yh | yhtfg | h yhxrh | checked |  |
checked | checked | checked | checked | checked | 09/12/2024 09:35 AM | 1 | 150.107.241.245 |
