DORMANT

DORMAT
DORMANT ACTIVATION
ACTIVATION ANDAND KNOW
KNOW YOURCLIENT
YOUR CLIENT (KYC)
(KYC) Application Form - For Individual
TRADING CODE DP CODE
Cholamandalam Securities Limited NEW UPDATE REQUEST (Please tick  the appropriate)
Please fill this form in ENGLISH and in BLOCK LETTERS
(Please tick  the box on left margin of appropriate row where CHANGE/CORRECTION is required and provide the details in the corresponding row)

Normal Minor Aadhar OTP based E-KYC

(in non-face to face mode)
D
A IDENTITY DETAILS
1. Name of the Applicant

2. Father’s/Spouse Name
3. Mother's Name
3a.Gender Male Female 3b.Matrial status Single Married 3c. Date of Birth D D M M Y Y Y Y

4a.Nationality Indian Other (Please society) .................................................................

4b.Status Resident Individual Non Resident Foreign National
5a. PAN
5b. Unique Indetification Number (UID) Aadhaar, if any: Last 4 digits only

6. Specify Proof of Indentity submitted PAN card Other (Please specify) ............................................................
B
D
B ADDRESS DETAILS
1. Address for Correspondence

City /Town / Village Pin Code

State Country

2. Specify the Proof of Address submitted for Correspondences Address:

3. Contact Details
Tel. (Off.) Mobile No.
Tel. (Res.) Addl. Mobile No.
E-Mail Id.
4. Permanent Address (if different from above or overseas address, mandatory for Non - Resident Applicant

City /Town / Village Pin Code

State Country
5. Specify the Proof of Address submitted for Permanent Address:
6. Declaration for Moblie No and Email ID: I/we hereby declare that I/we do not have mobile no. / email id
I/we do not wish to register my/our mobile no. / e-mail Id.

D
C OTHER DETAILS

D D M M Y Y Y Y

3. Please tick, if applicable: Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP)
4. Any other information:

D DECLARATION FOR USING THE SAME MOBILE NUMBER AND EMAIL

I hereby declare that being a Spouse Dependent Parent Dependent Children of Mr. /Ms.
shall use the same mobile number and email id
linked to his/her trading account and
DP Account .
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 E BANK ACCOUNT(S) DETAILS “I / We wish to update the Bank details as Default ( both trading and DP) Additional in my trading account”
No. Bank Name, Branch Add. & Tel. No. MICR No. A/c Type Account No. IFSC Code

(I) Photocopy of the cancelled cheque having the name of the account holder where the cheque (iii) Photo copy if the Pass Book having name and address of the B.O. (or)
book is issued, (or) (iv) Letter from the Bank.
(ii) Photo copy of the Bank Statement having name and address of the B.O.
In case of options (ii), (iii) and (iv) above, MICR code of the branch should be present / mentioned on the document.

F DEPOSITORYACCOUNT(S) DETAILS “I / We wish to update the DP details as: Default or additional in my trading account”
Sr. No. Depository Participant Name DP ID No. DPAccount No. Depository Name

1 NSDL / CDSL
2 NSDL / CDSL
Shares bought by you will be transferred to your DPA/c stated by you at Sr. No. 1
(ii) Enclose DP Client master copy or recent DP holding statement with self- attestation

G FATCA DECLARATION
Is your Country of Tax Residency other than India - Yes No
If 'Yes' please specify the details of all countries where you hold tax residency and its Tax identification Number & type
Tax payer Identification Number / Identification Type
Sl. No. Country of Tax Residency # Functional Equivalent [TIN or other, please specify]

# to include all countries other than India, where investor is Citizen / Resident / Green card Holder / Tax Resident in those respective countries especially of USA

H ADDITIONAL DETAILS
I / we wish to receive all statements and reports through Email Yes No
Specify your Email if, if applicable:
Whether you wish to avail of the facility of internet trading/wireless technology (please specify) Yes No
Number of years of Investment/Trading Experience: years
Any other information

I APPLICANT DECLARATION *Second & third holder signature applicable for update required details in DP account
1. 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 true or misleading or misrepresenting, I am / we are aware that I / we may be held liable for it.
2. I/We confirm having read/been explained and understood the contents of the document on policy and procedures of the stock broker and the tariff sheet
3. If/We further confirm having read and understood the contents of the 'Rights and Obligations' document(s) and Risk Disclosure Document'. I/We do hereby agree to be bound by such
provisions as outlined in these documents. I/We have also been informed that the standard set of documents has been displayed for Information on stock broker's designated website,
www.cholawealthdirect.com
4. I /We hereby consent to receiving information from KRA and Central KYC Registry through SMS/Email on the above registered number/email address.
Date: ................................... Place: ......................................................................
Sole/First Holder *Second Holder *Third Holder

J ATTESTATION / FOR OFFICE USE ONLY

Certified Copies KYC data received from (NDA) Data received from Offline verification
Digital KYC process Equivalent e-document
IN PERSON AND KYC VERIFICATION CARRIED OUT BY INSTITUTION DETAILS

I N 1 7 6 4

18-2-2020