CKYCR) (If married) D D M M Y Y Y Y. Specimen Signature (1) PNB XXX/16(25X4)SPP
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1 CKYCR) (If married) D D M M Y Y Y Y Specimen Signature - - PNB XXX/16(25X4)SPP (1)
2 Customer Type* a Emp.No. ).. n j. Blind. OPTIONAL INFORMATION :I / We Wish to share following information (YES / NO), if yes, Fill in the following information a. Educational Qualification a. Under Graduate b. Graduate c. post Graduate/Others.. b. Religion a. Hindu b. Muslim c. Sikh. Christian e. Others 2. TDS DETAILS TDS, If applicable : Yes/No If no, exemption reference No If, Yes, Whether Form15G/H* submitted: YES NO *Form15G for general category 15H for Senior Citizen 3. PROOF OF IDENTITY (POI)* TICK TYPE( Name of POI) Document No Date of Issue DD-MM-YYYY Date of Expiry DD-MM-YYYY A-Passport Number ( MUST FOR NRI) B-Voter Id Card C- PAN Card D-Driving Licence E-UID ( Aadhaar) F- NREGA Job Card Z- Others-$ ( Any document notified by Central government Identification No $ As Simplified measures for Low risk categorized customers, the following documents deemed to be officially valid documents for verifying the identity of customers (i) Identity Card with applicant s photograph issued by Central / State Government. Departments, Statutory / Regulatory Authorities, Public Sector Undertakings, Scheduled Commercial Banks, and Public Financial Institutions. (ii) Letter issued by a gazetted officer, with a duly attested photograph of the person. (Refer - ANNEXURE - CKYC R-IV - KYC DOCUMENTS) 4. PROOF OF ADDRESS (POA)* Current Permanent Overseas Address Details (Please refer instruction D at the end) (Certified copy of any one of the following P roof of Address (POA) needs to be submitted) Address Type* Residential/ Business Residential Business Registered Office Unspecified Proof of Address Passport Number Voter Id Card Driving Licence UID ( Aadhar) NREGA Job Card Others Pl. Specify... $ - Where simplified measures are applied for verifying for the limited purpose of proof of address the following additional documents are deemed to be officially valid documents (OVDs) : (I) Utility bill which is not more than two months old of any service provider (electricity, telephone, postpaid mobile phone, pipedgas, water bill); (ii) Property or Municipal Tax receipt; (iii) Bank account or Post Office savings bank account statement; (iv) Pension or family pension payment orders (PPOs)issued to retired employees by Government Departments or Public Sector Undertakings, if they contain the address; (v) Letter of allotment of accommodation from employer issued by State or Central Government departments, statutory or regulatory bodies,public sector undertakings, scheduled commercial banks,financial institutions and listed companies. Similarly, leave and license agreements with such employers allotting official accommodation; and (vi) Documents issued by Government departments of foreign jurisdictions and letter issued by Foreign Embassy or Mission in India. (Refer - ANNEXURE - CKYC R-IV - KYC DOCUMENTS) (2)
3 ADDRESS* INDIVIDUAL A O B A Office / Business Address (3)
4 5. CONTACT DETAILS ( All communications will be sent on provided Mobile No/ ID) ( Please refer instruction F at the end) Tel.(Off) - STD Mobile No (Registered) ID (Registered) Tel.(Res)STD Fax / STD 1.Country/ (ies) of Tax residency #.ISO 3166 Country code of jurisdiction of residence* Tax Identification % Number (TIN) or Equivalent Identification Residence Address Address Type: Type (TIN or 1- Residential or Business, % for Tax purpose Other, please (including City, 2- Residential, 3-Business, specify) State, Country and 4- Registered Office Pin code) Place/City of Birth* ISO 3166 Country code of Birth # To also include USA, where the individual is a citizen/ green card holder of USA % In case Tax Identification Number is not available, kindly provide functional equivalent$ 6(b) Certification Under penalty of perjury, I/we certify that: I understand that Punjab National Bank is relying on this information for the purpose of determining the status of the account holder named above in compliance with FATCA/CRS. Punjab National Bank is not able to offer any tax advice on FATCA or CRS or its impact on the account holder. I shall seek advice from professional tax advisor for any tax questions. I agree to submit a new form within 30 days if any information or certification on this form becomes incorrect. I agree that as may be required by domestic regulators/tax authorities, Punjab National Bank may also be required to report, reportable details to CBDT or other authorities/agencies or close or suspend my account, as appropriate. I have understood the information requirements of this Form (read along with the FATCA/CRS Instructions) and hereby confirm that the information provided by me on this Form including the taxpayer identification number is true, correct, and complete. I also confirm that I have read and understood the FATCA/CRS Terms and Conditions and hereby accept the same. Signature(s) Thumb Impression of Applicant (4)
5 7.DETAILS OF RELATED PERSON (In case of additional related persons, please fill Annexure B1) (please refer instruction G at the end) Addition of Related Person Deletion of Related Person KYC Number of Related Person (if available*) Related Person Type* Guardian of Minor Nominee Assignee Authorized Representative Beneficial Owner Beneficiary Prefix First Name Middle Name Last Name Name* KYC NUMBER (If KYC number and name are provided, below details of section ---- are optional) TICK TYPE (Name of POI) A-Passport Number ( MUST FOR NRI) Document No Date of Issue Date of Expiry D D M M Y Y Y Y D D M M Y Y Y Y B-Voter Id Card C- PAN Card D-Driving Licence E-UID ( Aadhar) F- NREGA Job Card Z- Others-$ ( Any document notified by Central government Identification No $-- As Simplified measures for Low risk categorized customers, the following documents deemed to be officially valid documents for verifying the identity of customers (i) Identity Card with applicant s photograph issued by Central / State Government. Departments, Statutary / Regulatory Authorities, Public Sector Undertakings, Scheduled Commercial Banks, and Public Financial Institutions. (ii) Letter issued by a gazetted officer, with a duly attested photograph of the person. 8. APPLICANT DECLARATION I hereby declare that the details furnished above in this form including details in Annexure A1, Annexure B1 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. I/we agree to be bound by the terms & conditions, Instruction etc as outlined in the Annexure CKYCR (I) to (IV) & Annexure FATCA (I) &(II) and by the rules of Punjab National Bank and RBI and any subsequent amendment(s). My personal / KYC details may be shared with Central KYC Registry I hereby consent to receiving information from Central KYC Registry through SMS/ on the above registered number/ address Date: Signature/Thumb Impression of Applicant Place:. Certified True Copies Notary RiskCategory: High risk Medium risk Low Risk 1. In person verification carried out by/ Identity 2. Details furnished in the form including, Annexure A1 & duly checked, copies of documents ( POI & POA and others) obtained & verified from original, Photo verified, Customers name checked with the barred list and Risk category verified & due diligence done by. 3. Information entered in the system by Name GBPA/ PF NO Signature 4. Entered Information Verified by (5)
6 1. Annexure A1-CORRESPONDENCE /LOCAL ADDRESS DETAILS(In case of multiple correspondence /local addresses) For Office Use Only (To be filled by Bank/Branch) APPLICATION TYPE*: NEW UPDATE ACCOUNT TYPE: N ORMAL SMALL KYC NUMBER* ( KYC NUMBER is Mandatory for KYC Update request) PROOF OF ADDRESS (POA)* 1.1 CORRESPONDENCE /LOCAL ADDRESS DETAILS* : (Please see instruction E at the end) Same as Current / Permanent /Overseas Address details 2. CONTACT DETAILS ( All communications will be sent on provided Mobile No/ ID) ( Please refer instruction F at the end) Tel.(Off) - STD Mobile No Tel.(Res) STD Fax / STD ID Annexure B1 - DETAILS OF RELATED PERSON (In case of additional related persons) For Office Use Only (To be filled by Bank/Branch) APPLICATION TYPE*: NEW UPDATE ACCOUNT TYPE: N ORMAL SMALL KYC NUMBER* ( KYC NUMBER is Mandatory for KYC Update request) 1. DETAILS OF RELATED PERSON (please refer instruction G at the end) Addition of Related Person Deletion of Related Person KYC Number of Related Person (if available*) Related Person Type* Guardian of Minor Nominee Assignee Authorized Representative Beneficial Owner Beneficiary Prefix First Name Middle Name Last Name Name* KYC NUMBER (If KYC number and name are provided, below details of section are optional) PROOF OF IDENTITY [POI] OF RELATED PERSON* (Please see instruction ( H) at the end) TICK TYPE ( Name of POI ) Document No Date of Issue Date of Expiry D D M M YYYY D D M M YYYY A- Passport Number B-Voter Id Card C- PAN Card D-Driving Licence E-UID ( Aadhar) F- NREGA Job Card Z- Others ( Any document Identification No notified by Central government Date : Signature/Thumb Impression of Applicant (6) Place :
7 FORM NO. 60 [ See second proviso to rule 114B] Form for declaration to be filed by an individual or a person (not being a company or firm) who does not have a permanent account number and who enters into any transaction specified in rule114b 1 First Name 3 Middle Name Surname Father s Name(in case of individual) Middle Name Surname First Name 4 Flat/ Room No. 5 Floor No. 2 Date of Birth/Incorporation of declarant D D M M Y Y Y Y 6 Name of premises 7 Block Name/ No. 8 Road/ Street/ Lane 9 Area/Locality 10 Town/ City 11 District 12 State 13 Pin code 14 Telephone Number (with STD code) 15 Mobile Number 16 Amount of transaction (Rs.) 17 Date of transaction D D M M Y Y Y Y 18 In case of transaction in joint names, numberof persons involved in the transaction 19 Mode of transaction: Cash, Cheque, Card, Draft/ Banker s Cheque, Online transfer, Other Aadhaar Number issued by UIDAI (if available) If applied for PAN and it is not yet generated enter date of application and acknowledgement number D D M M Y Y Y Y If PAN not applied, fill estimated total income (including income of spouse, minor child etc. as per section 64 of Income - tax Act,1961) for 22 the financial year in which the above transaction is held a Agricultural income (Rs.) b Other than agricultural income (Rs.) Details of document being produced in support of identify in Column 1 (Refer Instruction over leaf) Details of document being produced in support of address in Columns 4 to13 (Refer Instruction overleaf) Document code Document identification number Document identification number Verification Name and address of the authority issuing the document Name and address of the authority issuingthe document I, do hereby declare that what is stated above is true to the best of my knowledge and belief. I further declare that I do not have a Permanent Account Number and my/ our estimated total income (including income of spouse, minor child etc. as per section 64 of Income-tax Act,1961) computed in accordance with the provisions of Income-tax Act,1961 for the financial year in which the above transaction is held will be less than maximum amount not chargeable to tax. Verified today, the day of 20 Place: Note: (Signature of declarant) 1. Before signing the declaration, the declarant should satisfy him self that the information furnished in this form is true, correct and complete in all respects. Any person making a false statement in the declaration shall be liable to prosecution under section 277 of the Income - tax Act, 1961 and on conviction be punishable,- (i) in a case where tax sought to be evaded exceeds twenty - five lakh rupees, with rigorous imprisonment which shall not be less than six months but which may extend to seven years and with fine; (ii) in any other case, with rigorous imprisonment which shall not be less than three months but which may extend to two years and with fine 2. The person accepting the declaration shall not accepting the declaration where the amount of income of the nature referred to in item 22 b exceeds the maximum amount which is not chargeable to tax, unless PAN is applied for and column 21 is duly filled. (7)
8 Instruction: (1) Documents which can be produced in support of identity and address (not required if applied for PAN and item 20 is filled): - Sl. Nature of Document Document Proof of Proof of Code Identity Address A For Individuals and HUF 1. AADHA R card 01 Yes Yes 2. Bank/Post office passbook bearing photograph of the person 02 Yes Yes 3. Elector s photo identity card 03 Yes Yes 4. Ration/Public Distribution System card bearing photograph of 04 Yes Yes the person 5. Driving License 05 Yes Yes 6. Passport 06 Yes Yes 7. Pensioner Photo card 07 Yes Yes 8. National Rural Employment Guarantee Scheme(NREGS)Job 08 Yes Yes card B C 9. Caste or Domicile certificate bearing photo of the person 09 Yes Yes 10. Certificate of identity/address signed by a Member of Parliament or Member of Legislative Assembly or Municipal Councillor or a Gazetted Officer as per annexure A prescribed in Form 49A 10 Yes Yes 11. Certificate from employer as per annexure B prescribed in Form 49A 11 Yes Yes 12. Kisan passbook bearing photo 12 Yes No 13. Arm s license 13 Yes No 14. Central Government Health Scheme / Ex-servicemen Contributory Health Scheme card 14 Yes No 15. Photo identity card issued by the government./ Public Sector 15 Yes No Undertaking 16. Electricity bill (Not more than 3 months old) 16 No Yes 17. Landline Telephone bill (Not more than 3 months old) 17 No Yes 18. Water bill (Not more than 3 months old) 18 No Yes 19. Consumer gas card /book or piped gas bill(not more than 3 19 No Yes months old) 20. Bank Account Statement (Not more than 3 months old) 20 No Yes 21. Credit Card statement (Not more than 3 months old) 21 No Yes 22. Depository Account Statement (Not more than 3 months old) 22 No Yes 23. Property registration document 23 No Yes 24. All otment letter of accommodation from Government 24 No Yes 25. Passport of spouse bearing name of the person 25 No Yes 26. Property tax payment receipt (Not more than one year old) 26 No Yes For Association of persons (Trusts) Copy of trust deed or copy of certificate of registration issued by 27 Yes Yes Charity Commissioner For Association of persons (other than Trusts) or Body of Individuals or Local authority or Artificial Juridical Person) Copy of Agreement or copy of certificate of registration issued by 28 Yes Yes Charity commissioner or Registrar of Cooperative society or any other competent authority or any other document originating from any Central or State Government Department establishing identity and address of such person. (2) In case of a transaction in the name of a Minor, any of the above mentioned documents as proof of Identity and Address of any of parents/guardians of such minor shall be deemed to be the proof of identity and address for the minor declarant, and the declaration should be signed by the parent/guardian. (3) For HUF any document in the name of Karta of HUF is required. (4) In case the transaction is in the name of more than one person the total number of persons should be mentioned in Sl. No. 18 and the total amount of transaction is to be filled in Sl. No. 16. In case the estimated total income in column 22b exceeds the maximum amount not chargeable to tax the person should apply for PAN, fill out item 21 and furnish proof of submission of application. (8)
9 (9)
10 (10)
11 (11)
12 ANNEXURE - CKYC R-IV - KYC DOCUMENTS Description of Documents Certified copy of any one of the following officially valid document [ A certificate to the effect that Self-Certified copy has been verified from the original must be appended on the Self-Certified copy of the OVD) and copy verified from the original will be kept on record with AOF]. Proof of Identity and Address Passport 2. Permanent Account Number (PAN) Card 3. Voter s Identity Card issued by the Election Commission of India 4. Driving license 5. Job card issued by NREGA duly signed by an officer of the State Government. 6. The letter issued by the Unique Identification Authority of India (UIDAI) containing details of name, address and Aadhar number. Where simplified measures are applied for verifying the identity of customers (low risk categorized customers) the following documents shall be deemed to be officially valid documents: (iii) Identity Card with applicant s photograph issued by Central / State Government. Departments, Statutary / Regulatory Authorities, Public Sector Undertakings, Scheduled Commercial Banks, and Public Financial Institutions. (iv) Letter issued by a gazetted officer, with a duly attested photograph of the person. Where simplified measures are applied for verifying for the limited purpose of proof of address the following additional documents are deemed to be officially valid documents (OVDs) : (i) Utility bill which is not more than two months old of any service provider (electricity, telephone, postpaid mobile phone, piped gas, water bill); (ii) Property or Municipal Tax receipt; (iii) Bank account or Post Office savings bank account statement; (iv) Pension or family pension payment orders (PPOs) issued to retired employees by Government Departments or Public Sector Undertakings, if they contain the address; (v) Letter of allotment of accommodation from employer issued by State or Central Government departments, statutory or regulatory bodies, public sector undertakings, scheduled commercial banks, financial institutions and listed companies. Similarly, leave and license agreements with such employers allotting official accommodation; and (vi) Documents issued by Government departments of foreign jurisdictions and letter issued by Foreign Embassy or Missionin India. Note: A customeris required to submit only one OVD for both proof of identity and for proof of address as part of KYC procedure. If the OVD for proof of identity does not have the proof of address (for e.g. PAN Card), then the customer is required to submit another OVD for proof of address. (12)
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