CENTRAL KYC REGISTRY

Know Your Customer (KYC) Application Form for Individual

Form Type

Primary Applicant

Name* (Same as ID proof) Mr. Mohammad Tufail Hasan

Maiden Name (If any*)

Father Name*

Mother Name* Saira khatoon

Passport Expiry Date 22 07 2028 Required if Passport provided as Identity/Address Proof

Driving License Expiry Date Required if Driving License provided as Identity/Address Proof

Occupation Type* g Private Sector

c
d
e
f g Public Sector
c
d
e
f g
c
d
e
f Government Sector g Business
c
d
e
f c Professional
d
e
f
g
c Self Employed
d
e
f
g c Retired
d
e
f
g c
d
e
f
g Housewife b Student
c
d
e
f
g

DECLARATION
I hereby declare that the details furnished above are true and correct to the best of my/our 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/We am/are aware that I/we may be held liable for it.
My personal / KYC details may be shared with Central KYC Registry
I hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/email address
Signature of
Date Place:
Primary Applicant

1st Joint Applicant

Name* (Same as ID proof)

Maiden Name (If any*)

Father Name*

Mother Name*

Passport Expiry Date Required if Passport provided as Identity/Address Proof

Driving License Expiry Date Required if Driving License provided as Identity/Address Proof

Occupation Type* g Private Sector

c
d
e
f g Public Sector
c
d
e
f g
c
d
e
f Government Sector g Business
c
d
e
f c Professional
d
e
f
g
c Self Employed
d
e
f
g c Retired
d
e
f
g c
d
e
f
g Housewife c Student
d
e
f
g
DECLARATION
I hereby declare that the details furnished above are true and correct to the best of my/our 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/We am/are aware that I/we may be held liable for it.
My personal / KYC details may be shared with Central KYC Registry
I hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/email address
Signature of
Date Place:
1st Joint Applicant

2nd Joint Applicant

Name* (Same as ID proof)

Maiden Name (If any*)

Father Name*

Mother Name*

Passport Expiry Date Required if Passport provided as Identity/Address Proof

Driving License Expiry Date Required if Driving License provided as Identity/Address Proof

Occupation Type* g
c
d
e
f Private Sector g
c
d
e
f Public Sector g
c
d
e
f Government Sector g
c
d
e
f Business c
d
e
f
g Professional

c
d
e
f
g Self Employed c
d
e
f
g Retired c
d
e
f
g Housewife c
d
e
f
g Student

DECLARATION
I hereby declare that the details furnished above are true and correct to the best of my/our 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/We am/are aware that I/we may be held liable for it.
My personal / KYC details may be shared with Central KYC Registry
I hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/email address
Signature of
Date Place:
2nd Joint Applicant
 3rd Joint Applicant

Name* (Same as ID proof)

Maiden Name (If any*)

Father Name*

Mother Name*

Passport Expiry Date Required if Passport provided as Identity/Address Proof

Driving License Expiry Date Required if Driving License provided as Identity/Address Proof

Occupation Type* g
c
d
e
f Private Sector g
c
d
e
f Public Sector g
c
d
e
f Government Sector g
c
d
e
f Business c
d
e
f
g Professional

c
d
e
f
g Self Employed c
d
e
f
g Retired c
d
e
f
g Housewife c
d
e
f
g Student

DECLARATION
I hereby declare that the details furnished above are true and correct to the best of my/our 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/We am/are aware that I/we may be held liable for it.
My personal / KYC details may be shared with Central KYC Registry
col-70I hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/email
address Signature of
3rd Joint Applicant
Date Place:

FOR OFFICE USE ONLY

Documents Received c
d
e
f
g Certified Copies

KYC VERIFICATION CARRIED OUT BY

Identity Verification c
d
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f
g Done Date

Emp. Name :

Emp. Code :

Emp. Designation :
Employee Signature
Emp. Branch: