‡mvbvjx e¨vsK wjwg‡UW kvLv wnmve †Lvjvi Av‡e`b dig e¨w³ wnmve
...........................................
ZvwiL t .....................................
wnmve b¤^i t ............................................... MÖvn‡Ki AvB.wW. b¤^i t.................................
Dc-gnve¨e¯’vcK/mnKvix gnve¨e¯’vcK/e¨e¯’vcK ‡mvbvjx e¨vsK wjwg‡UW ...........................kvLv| g‡nv`q, Avwg/Avgiv Avcbvi kvLvq wbgœiƒc GKwU wnmve †Lvjvi Rb¨ Av‡e`b KiwQ| AbyMÖnc~e©K Avgvi/Avgv‡`i e¨env‡ii Rb¨ ..................................cvZvi GKwU †PK ewn mieivn Ki‡eb| Avgvi/Avgv‡`i we¯—vwiZ Z_¨ wb‡gœ cÖ`vb Kijvg t 1. wnmv‡ei bvg t .............................................................................................................................. 2. wnmv‡ei cÖKvi (wUK w`b) t
mÂqx
PjwZ
Gm.wU.wW.
¯’vqx
FC
RFCD
NFCD
Ab¨vb¨.... 3. gy`ªv (wUK w`b) t
UvKv
Wjvi
BD‡iv
cvDÛ
Ab¨vb¨ ................
4. wnmve cwiPvjbv msµvš— †Nvlbv (wUK w`b) t
GKKfv‡e
‡hŠ_fv‡e
‡h †Kvb GKRb
Ab¨vb¨........... 5. MÖvn‡Ki Ab¨vb¨ e¨vsK wnmve (hw` _v‡K) t e¨vs‡Ki bvg
kvLv
cwiPvjbvK…Z wnmv‡ei cÖK…wZ (wUK wPý w`b)
K .............................. K .........................
Rgv wnmve
FY wnmve
Ab¨vb¨
L ..............................
L .........................
Rgv wnmve
FY wnmve
Ab¨vb¨
M ..............................
M .........................
Rgv wnmve
FY wnmve
Ab¨vb¨
6. cwiPq`vbKvixi Z_¨t K. bvg
t......................................................................................................
L. wcZv/¯^vgxi bvg
t......................................................................................................
M. gvZvi bvg
t......................................................................................................
N. wVKvbv- eZ©gvb
t......................................................................................................
¯’vqx
t......................................................................................................
O. wnmve bs
t......................................................................................................
P. kvLvi bvg
t......................................................................................................
Q. ¯^v¶i (ZvwiLmn)
t.....................................................†Uwj‡dvb b¤^i..............................
7. cÖv_wgK Rgv
t cwigvb t............................................................................................
8. Gd.wW.Avi msµvš— Z_¨
t cwigvb t....................................................gy`ªv t.................................
†gqv`Kvj
t
bevq‡bi †¶‡Î
t
Avmj Ges my` bevqb Ki“b
ïaygvÎ Avmj bevqb Ki“b
ïaygvÎ Avmj bevqb Ki“b, my` ..............................b¤^i wnmv‡e Rgv Ki“b
cÖ‡hvR¨ b‡n|
gvm
eQi
w`b| †gqv`c~wZ©i ZvwiL t........................
9. we‡kl ¯‹xg msµvš— Z_¨ t ¯‹x‡gi bvg t............................................................................................................................... ¯‹x‡gi ‡gqv` t.....................GKKvjxb Rgv/wKw¯—i cwigvb t.................. wKw¯—i msL¨v (evwl©K) t............... ‡gqv`v‡š— cÖ‡`q t.........................................................gvwmK cÖ‡`q t..............................................
bwgbxi Av‡jvKwPÎ (d‡Uv) (MÖvnK KZ…©K mZ¨vwhZ
10. bwgwbx msµvš— Z_¨ t Avwg/Avgiv GB wnmv‡ei A_© Avgvi/Avgv‡`i g„Zz¨i ci wbgœv³fv‡e wb‡gœv³ e¨w³/e¨w³‡`i‡K cÖ`v‡bi Rb¨ g‡bvbxZ Kijvg| Avwg/Avgiv Dwj−wLZ g‡bvbqb †h †Kvb mgq evwZj ev cwieZ©‡bi AwaKvi msi¶Y Kwi| Avwg/Avgiv GB g‡g© Av‡iv m¤§wZ Ávcb KiwQ †h, Avgvi/Avgv‡`i wb‡`©kbv †gvZv‡eK †jb‡`‡b e¨vsK †Kvbfv‡e `vqe× n‡ebv| bwgbx/bwgbx‡`i bvg
t (1)..............................(2)...................................(3)..............................
Rb¥ ZvwiL/eqm
t...............................................................................................................
wcZvi bvg
t...............................................................................................................
gvZvi bvg
t...............................................................................................................
¯^vgx/¯¿xi bvg
t...............................................................................................................
bwgbx/bwgbx‡`i
t (K) eZ©gvb wVKvbv t................................................................................... (L) ¯’vqx wVKvbv
t...................................................................................
‡ckv
t...............................................................................................................
wnmveavixi mv‡_ m¤úK©
t...............................................................................................................
As‡ki cwigvb (%)
t...............................................................................................................
RvZxq cwiPqcÎ b¤^i
t...............................................................................................................
*(†Kvb Awbevmx‡K bwgbx Kiv n‡j H Awbevmx mswk−ó wnmv‡ei A_© cÖvc¨ n‡j cÖvß A_© we‡`‡k †cÖi‡Yi †¶‡Î we`¨gvb ˆe‡`wkK gy`ªv wbqš¿b AvB‡bi wewa weavb cÖ‡hvR¨ n‡e|)
11. GK ev GKvwaK wnmveavix bvevjK n‡j t Avwg wbgœewY©Z wnmveavixi ˆea AwffveK wnmv‡e GB g‡g© †Nvlbv KiwQ †h, wnmveavix bvevjK| Zvi cÖ‡qvRbxq Z_¨ mshy³ di‡g cÖ`vb Kiv n‡jv| wnmveavix mvevjK bv nIqv ch©š— wKsev Avgvi KZ…©K cieZ©x †Nvlbv bv †`qv ch©š— wnmvewU ˆea AwffveK wnmv‡e Avgvi ¯^v¶‡i cwiPvwjZ n‡e| K. wnmveavix (bvevjK) Gi bvg t....................................................................................................... L. Awffve‡Ki bvg t.............................................................. bvevj‡Ki mv‡_ m¤úK© t........................ (bvevjK Ges AwffveK - Df‡qi Rb¨B Òe¨w³ msµvš— Z_¨vejxÓ dig c~iY Ki‡Z n‡e Ges Dfq di‡gB Awffve‡Ki ¯^v¶i Ki‡Z n‡e|)
12. A‡_©i Drm t.................................................................................................................................. 13. †Nvlbv I ¯^v¶i t Avwg/Avgiv GB g‡g© wbðqZv cÖ`vb KiwQ †h, Avwg/Avgiv wnmve msµvš— hveZxq wbqgvejx/kZ©vejx c‡owQ Ges D³ wbqgvejx/kZ©vejx †g‡b Pj‡Z eva¨ _vKe| Avwg/Avgiv ¯^Áv‡b †NvlYv KiwQ †h, Dc‡ivwj−wLZ Z_¨vw` mZ¨| Avcbvi Pvwn`v †gvZv‡eK cÖ`Ë Z‡_¨i AwZwi³ mswk−ó †h †Kvb cÖ‡qvRbxq Z_¨vw`/`wjjvw` mieivn Kie|
Av‡e`bKvixi bvg, ¯^v¶i I ZvwiL
e¨vs‡Ki e¨env‡ii Rb¨ ‡PK ewn b¤^i..................................Bmy¨i ZvwiL.............................Kg©KZ©vi ¯^v¶i................................... gš—e¨ t ......................... ......................... wnmve †Lvjvi Kg©KZ©v bvghy³ mxjmn ¯^v¶i I ZvwiL
......................... ......................... Aby‡gv`bKvix Kg©KZ©v bvghy³ mxjmn ¯^v¶i I ZvwiL
Av‡jvKwPÎ
............................. e¨vsK / e¨vsK wjt ....................... kvLv wnmve †Lvjvi dig t e¨w³ msµvš— Z_¨vejx GB digwU cyiYc~e©K e¨w³ I Ae¨w³K wnmv‡ei g~j As‡ki mv‡_ mshy³ Ki‡Z n‡e|
wnmve b¤^i t ...............................................
ZvwiL t .....................................
MÖvn‡Ki AvB.wW. b¤^i t................................. 1. MÖvn‡Ki bvg
t......................................................................................
2. wnmv‡ei mv‡_ m¤úK© (bx‡P cÖ‡hvR¨ †¶‡Î wUK w`b) t
1g Av‡e`bKvix
2q Av‡e`bKvix
3q Av‡e`bKvix
WvB‡i±i
Askx`vi
bvevjK
AwffveK
G¨vUb©x †nvìvi
wmM‡bUwiR
Ab¨vb¨ ......................... 3. wcZvi bvg
t......................................................................................
4. gvZvi bvg
t......................................................................................
5. ¯^vgx/¯¿xi bvg
t......................................................................................
6. RvZxqZv
t......................................................................................
7. Rb¥ ZvwiL
t......................................................................................
8. wj½ (wUKv w`b)
t
9. †ckv (c`exmn)
t......................................................................................
10. RvZxq cwiPqcÎ b¤^i
t......................................................................................
11. cvm‡cvU© b¤^i (hw` _v‡K)
t......................................................................................
12. U¨v· AvBwW b¤^i (TIN) (hw` _v‡K)
t......................................................................................
13. WªvBwfs jvB‡mÝ b¤^i (hw` _v‡K)
t......................................................................................
14. eZ©gvb wVKvbv (Avev¯’j)
t......................................................................................
15. ¯’vqx wVKvbv
t......................................................................................
16. †ckvMZ wVKvbv
t......................................................................................
17. †hvMv‡hvM
t
cyi“l
gwnjv
‡Uwj‡dvbt
evmvt....................................
Awdmt.............................
‡gvevBjt................................
B-‡gBjt................................
d¨v·t..............................
18. †µwWU KvW© msµvš— Z_¨t Bmy¨Kvix cÖwZôvb I KvW© b¤^i (hw` KvW© e¨enviKvix nb) t 1|............................................................ 2|............................................................ 19| †iwm‡WÝ ó¨vUvm (wUK w`b) t
†iwm‡W›U
bb-‡iwm‡W›U
(cÖ‡qvRbxq †¶‡Î e¨vsK MvBWjvBÝ di G·‡PÄ Uªvb‡RKkbm Gi wb‡`©kbv AbymiY K‡i Z_¨ msMÖn Ki‡e)
¯^v¶i (ZvwiLmn)
MÖvnK cwiwPwZ m¤úwK©Z dig (KYC Profile Form)t (we‡kl ¯‹xg/¯’vqx Avgvb‡Zi †¶‡Î cÖ‡hvR¨)
1. wnmv‡ei bvg t 2. wnmv‡ei aiY t 3. wnmve ev m~Î (Reference) b¤^i t 4. wnmve †Lvjvi Kg©KZ©vi bvg t 5. Znwe‡ji Drm wK ? Znwe‡ji Drm wKfv‡e wbwðZ Kiv n‡q‡Q ? (cÖ‡hvR¨ †¶‡Î) t
6. wnmv‡ei cÖK…Z myweav‡fvMx (Beneficial Owner) m¤úwK©Z Z_¨vw` (†K¤úvbxi †¶‡Î wbqš¿bKvix †kqvi †nvìvi Ges 20% ev Gi AwaK GKK †kqvi †nvìvi Gi we¯—vwiZ Z_¨vw`) t.............................................. ................................................................................................................................. 7.
cvm‡cvU© b¤^i .....................................d‡UvKwc M„nxZ wKbv? t nu¨v / bv (cÖ‡hvR¨ †¶‡Î)
8.
‡fvUvi AvBwW KvW© b¤^i.........................d‡UvKwc M„nxZ wKbv? t nu¨v / bv (cÖ‡hvR¨ †¶‡Î)
9.
RvZxq cwiPqcÎ b¤^i............................d‡UvKwc M„nxZ wKbv? t nu¨v / bv (cÖ‡hvR¨ †¶‡Î)
10.
wU AvBGb ..........................................d‡UvKwc M„nxZ wKbv? t nu¨v / bv (cÖ‡hvR¨ †¶‡Î)
11.
f¨vU †iwRt b¤^i...................................d‡UvKwc M„nxZ wKbv? t nu¨v / bv (cÖ‡hvR¨ †¶‡Î)
12.
WªvBwfs jvB‡mÝ b¤^i.............................d‡UvKwc M„nxZ wKbv? t nu¨v / bv (cÖ‡hvR¨ †¶‡Î)
13.
MÖvnK wK K‡ib ?
MÖvn‡Ki †ckv we¯—vwiZ eY©bv Ki“b t
gš—e¨ (hw` _v‡K) t
(* GB As‡k Subjective we‡ePbvq MÖvnK‡K SuywK m¤ú‡K© gš—e¨ Kiv †h‡Z cv‡i)
---------------------------------------------wnmve †Lvjvi Kg©KZ©v/wi‡jkbkxc g¨v‡bRv‡ii bvg, ¯^v¶i (mxjmn) I ZvwiLt
--------------------------------------------Aby‡gv`bKvix Kg©KZ©vi bvg, ¯^v¶i (mxjmn) I ZvwiLt
m¤¢ve¨ †jb‡`‡bi AbygwZ gvÎv (Transaction Profile) t 1. wnmv‡ei bvg t 2. wnmv‡ei aiY t 3. wnmve ev m~Î (Reference) b¤^i t weeiY
‡jb‡`‡bi msL¨v (gvwmK)
m‡e©v”P †jb‡`‡bi A¼ (cÖwZwU †jb‡`‡bi)
‡gvU cwigvb (gvwmK)
Rgvt bM` Rgv (AbjvBbmn) UªvÝdvi/ BÝUªy‡g›U Gi gva¨‡g Rgv d‡ib †iwgU¨vÝ Rgv ißvbx n‡Z Avq Ab¨vb¨ (wbw`©ófv‡e) .................... †gvU m¤¢ve¨ Rgv D‡Ëvjbt bM` Rgv (AbjvBbmn/G.wU.Gg mn) UªvÝdvi/ BÝUªy‡g›U Gi gva¨‡g cwi‡kva d‡ib †iwgU¨vÝ D‡Ëvjb Avg`vbx eve` e¨q Ab¨vb¨ (wbw`©ófv‡e) .................... †gvU m¤¢ve¨ D‡Ëvjb 4. †jb‡`bK…Z A‡_©i Drm t ............................................................................................. Avwg/Avgiv wbgœ¯^v¶iKvix(MY) G g‡g© wbðqZv cÖ`vb KiwQ †h, m¤¢ve¨ †jb‡`‡bi AbywgZ gvÎv Avgvi/cÖwZôv‡bi ¯^vfvweK cÖK…Z †jb‡`b| Avwg/Avgiv Av‡iv wbðqZv cÖ`vb KiwQ †h, cÖ‡qvRb‡ev‡a Avwg/Avgiv m¤¢ve¨ †jb‡`‡bi AbywgZ gvÎv ms‡kvab/ nvjbvMv` Kie|
¯^v¶i t
¯^v¶i t
bvg
bvg
t
t
c`ex t
c`ex t
ZvwiL t
ZvwiL t
‡mvbvjx e¨vsK wjwg‡UW I‡qR Avb©vm© ¯‹x‡gi AvIZvq ˆe‡`wkK gy`ªvi GKvD›U †jb‡`‡bi wbwgË
Ó¶gZv cÎÓ e¨e¯’vcK/mnKvix gnve¨e¯’vcK/Dc-gnve¨¯’vcK ‡mvbvjx e¨vsK wjwg‡UW ...................................kvLv ......................................... evsjv‡`k|
‰e‡`wkK gy`ªv wnmve bstWjvi/cvDÛ/BD‡iv.......... ZvwiLt...........................20
Rbve, Avgvi/Avgv‡`i bv‡g Avcbvi e¨vs‡K I‡qR Avb©vm© ¯‹x‡gi AvIZvq †h ˆe‡`wkK gy`ªv wnmve †Lvjv n‡q‡Q/†Lvjv n‡e, Zvi m~Î a‡i Avwg Rbve /†eMg _________________________________________________________ wcZv/¯^vgx ___________________________________________________________________________ gvZv ___________________________________________________________) †K wb¤^wjwLZ Kvh©vejx Avgvi c¶ n‡Z Kivi R‡b¨ KZ©„Z¡ I `vwqZ¡ w`jvg| 1|
eZ©gvb wVKvbv (bwgbx) ____________________________________________________________ ____________________________________________________________ ‡Uwj‡dvb b¤^i (hw` _v‡K) _________________________________________________________ 2| ¯’vqx wVKvbv (bwgbx) _____________________________________________________________ _____________________________________________________________ 3| bwgbxi mv‡_ wnmveavixi m¤úK© _____________________________________________________ wZwb evsiv‡`kx bvMwiK Ges Zvi mwn wb‡gœ cÖ`Ë n‡jv, ˆe‡`wkK gy`ªv wbqš¿Y AvBbvbyhvqx Avgvi D³ wnmv‡e †jb‡`b Kivi ¶gZv †`qv n‡jv| we‡klZt wb‡gœv³ KvR¸wj Ki‡ebt(1)
(2)
(3)
K) bwgbx †h †Kvb mg‡q DB_Wªqv‡ji gva¨‡g ˆe‡`wkK gy`ªvi mgcwigvY evsjv‡`kx UvKv D‡Ëjb Ki‡Z cvi‡eb| L) Avg`vbx Kivi cviwg‡Ui `iLv¯— Ki‡eb Ges Zvnv †Wwjfvix wb‡eb| M) AvMvg B‡¤úvU© cviwgU Bm¨y Kivi Rb¨ e¨vs‡K Avgvi ˆe‡`wkK gy`ªvi wnmve †WweU (weKjb) Kivi KZ©„Z¡ w`‡Z cvi‡eb| N) Bb‡Wvm©‡g‡›Ui gva¨‡g D³ AvMvg B‡¤úvU© cviwgU n¯’vš—i Ki‡Z cvi‡eb Ges cÖ‡qvR‡b AvBbvbyqvqx Gi Dci †h †Kvb ai‡Yi Kvh© Ki‡Z cvi‡eb| O) AvMvg B‡¤úvU© cviwgU mv‡iÛv‡ii gva¨‡g B‡¤úvU© jvB‡mÝ Gi Rb¨ Av‡e`b Ki‡Z cvi‡eb Ges jvB‡mÝ dig mwn Ki‡Z I MÖnY Ki‡Z Ges D³ jvB‡mÝ Gi gva¨‡g ÓFYcÎÓ Bmy¨ Ki‡Z cvi‡eb| K) GB wnmve n‡Z †h †Kvb As‡Ki UvKv Avgvi ev bwgbx we‡`‡k ågY D‡Ï‡k¨ ˆe‡`wkK gy`ªv wbqš¿Y AvBb Abyhvqx D‡Ëvjb Ki‡Z cvi‡eb| L) wbw`©ó AvBb †gvZv‡eK D³ wnmve n‡Z c„w_exi †h †Kvb †`‡k UvKv †cÖiY Ki‡Z cvi‡eb| M) D³ wnmv‡ei UvKv wj‡qb ev e܇Ki gva¨‡g e¨vsK nB‡Z FY wb‡Z cvi‡eb Ges GZ‡`¨‡Ï‡k¨ e¨vs‡Ki mwnZ cÖ‡qvRbxq `wjj cÎvw` m¤úv`b Ki‡Z cvi‡eb| WªvdU, †PK A_ev Ab¨ wb‡`©kvejx mg~n, wej Ae G·‡PÄ, cÖwgRwi †bvU A_ev Ab¨ wb‡Mvwk‡qej Bb÷y‡g›U mg~n A_ev wiwmU mg~n Avwg /Avgvi c¶ n‡Z Zv‡K Bb‡Wvm© Kivi ¶gZv cÖ`vb Kijvg|
D³ ¶gZvcÖvß e¨w³ hw` e¨vs‡Ki Kv‡Q †Kvb A_© †`bv _v‡K A_ev Avgvi c¶ n‡Z KR© MÖnY K‡i _v‡K †m KR© ev †`bv e¨vs‡Ki mvaviY Kvh© c×wZi Aš—M©Z ‡nvK ev bv †nvK Avwg Dnvi R‡b¨ `vqx _vKe| hw` Dnv bwgbxi †Kvb ΓwU (Default) A_ev Ae‡njv A_ev RvwjqvwZi Kvi‡YI nq Avwg Dnvi Rb¨ `vqx _vKe| Dc‡iv³ ¶gZv ZZw`b ch©š— ejer _vK‡e hZw`b ch©š— Avwg Avcbv‡K wjwLZfv‡e GB ¶gZvcÎ evwZj bv Kwi Ges GZ`msµvš— wPwV Avcbvi Kv‡Q bv †cuŠQvq| Avcbvi wek¦¯— (L) bwgbxi bgybv ¯^v¶i) Dc‡iv³ ¯^v¶i mZ¨vwqZ Kwijvg
(K) (GKvD›U †nvìvi)
(K) (GKvD›U †nvìv‡ii ¯^v¶i)
e¨e¯’vcK
d-110
‡mvbvjx e¨vsK wjwg‡UW kvLv
wnmveavixi ÷¨v¤ú mvBR Qwe
wnmveavix e¨w³/cÖwZôv‡bi bvgt wnmve cwiPvjbvKvixi bvg
wb‡`©kvejx (hw` _v‡K)
wnmv‡ei cÖK„wZ......................... b¤^it ‡hŠ_ wnmveavixi ÷¨v¤ú mvBR Qwe
‡hŠ_ wnmveavixi ÷¨v¤ú mvBR Qwe
¯^v¶i
Aby‡gvw`Z Kg©KZ©vi ¯^v¶i I mxj
