DEMAT ACCOUNT OPENING FORM (KC/KRA/CKC) INDIVIDUAL Important Instructions : A) Fields marked with ' ' are mandatory fields. B) Please fill the form in English and in CAPITAL letters.) C) Please read section wise detailed guidelines / instructions at the end. D) For particular section update, please tick ( ) in the box available before the section number and strike off the sections not required to be updated For office use only Application Type* New Update KC Number (Mandatory for KC update request) (To be filled by financial institution) Account Type* rmal Simplified (for low risk customers) - L Small - S. PERSONAL DETAILS (Please refer insturction A at the end) Name*(Same as ID Proof) Maiden Name (If any*) Father / Spouse Name* Mother Name* Prefix Prefix Prefix Prefix First Name First Name First Name First Name Middle Name Middle Name Middle Name Middle Name Last Name Last Name Last Name Last Name Date of Birth* Gender* Marital Status* Citizenship* Residential Status* Occupation Type* D D M M PHOTO M - Male F - Female T-Transgender. Married Unmarried Others IN - Indian Others (ISO 66 Country) Code ) Resident Individual n Resident Indian Foreign National Person of Indian Origin S-Service ( Private Sector Public Sector Government Sector ) O-Others ( Professional Self Employed Retired Housewife Student) B-Business X-t Categorised /7 Signature / Thumb Impression of Applicant. PROOF OF INDENTIT (POI)* (Please refer instruction C at the end) (Certified copy of any one of the following Proof of Identity [Pol] needs to be submitted) A - Passport Number B - Voter ID Card D - Driving Licence Passport Expiry Date C - PAN Card Driving Licence Expiry Date D D M M D D M M E - UID (Aadhaar) F - NREGA Job Card Z - Others (any document notified by the central government) S - Simplified Measures Account - Document Type Code Identification Number Identification Number. PROOF OF ADDRESS (PoA)*. CURRENT / PERMANENT ADDRESS DETAILS (Please see Instruction D at the end) (Certified copy of any one of the following Proof of Address [PoA] needs to be submitted) Address Type* Proof of Address* Residential / Business Passport Residential Driving Licence Business UID (Aadhaar) Registered Office Voter Identity Card Unspecified NREGA Job Card Address Line * Line Simplified Measures Account - Document Type code Others Line District* City / Town / Village* PIN / Post Code* State / U.T. Code* ISO 66 Country Code*. CORRESPONDENCE / LOCAL ADDRESS DETAILS* (Please see instruction E at the end) Same as Currect / Permanent Address details (In case of multiple correspondence / local addresses. Please fill 'Annexure A' Line * Line Line District* City / Town / Village* PIN / Post Code* State / U.T. Code* ISO 66 Country Code*
4. FATCA & CRS Information (Tick if Applicable) RESIDENCE FOR TAX PURPOSES IN JURISDICTIONS(S) OUTSIDE INDIA (Please refer instruction B at the end) ADDITIONAL DETAILS REQUIRED* (Mandatory only if above option4 is ticked) Tax Identification Number or equivalent (If issued by jurisdiction)* Place / City of Birth* Country of Birth* Address : Line * Line * Line * District State* ISO 66 Country Code of Jurisdiction of Residence* ISO 66 Country Code of Birth* City / Town / Village* ZIP / Post / Code* ISO 66 Country Code* 5. CONTACT DETAILS (All communications will be sent on provided Mobile no. / Email-ID) (Please refer instruction F at the end) Tel. (off) Mob. Tel. (Res) Email ID FAX 6. DETAILS OF RELATED PERSON (In case of additional related persons, please fill 'Annexure B' (please refer instruction G at the end) Addition of Related Person Deletion of Related Person KC Number of Related Person (if available*) Related Person Type* Guardian of Minor Assignee Authorized Representative (If KC number and name are provided, below details of section 6 are optional) Name* Prefix First Name Middle Name Last Name PROOF OF IDENTIT (Pol) OF RELATED PERSON* (Please see instruction (H) at the end) A - Passport Number B - Voter ID Card D - Driving Licence E - UID (Aadhaar) Z - Others (any document notified by the central government) S - Simplified Measures Account - Document Type code Passport Expiry Date D D M M C - PAN Card Driving Licence Expirty Date D D M M F - NREGA Job Card Identification Number Identification Number 7. REMARKS (If any) 8. APPLICANT DECLARATION I hereby declare that the details furnished above are true and correct to the best of my knowledge and bellef 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 am aware that I may be held liable for it. My personal KC details may be shared with central KC Registry. I hereby consent to receiving information from Central KC Registry through SMS/Email on the above registered number/email ID. I have understood the information requirements (read along with FATCA & CRS instructions) and hereby confirm that the information provided by me is true, correct, and complete and updated. I also confirm that I have read and understood the FATCA / CRS / CBDT Terms and Conditions and hereby accept the same. I, the holder of Aadhaar, hereby give my consent to The Mehsana Urban Co. Op. Bank Ltd. to obtain my Aadhaar number, Name, Other demographic information and Fingerprint / Iris / OTP for authentication with UIDAI. The Mehsana Urban Co. Op. Bank Ltd. has informed me that my identity information would only be used for KC/CKC/eKC and also informed that my biometrics will not be stored / shared and will be submitted to CIDR only for the purpose of authentication. Place : Date : /7 D D M M Signature / Thumb impression of Applicant 9. ATTESTATION AND IN PERSON VERIFICATION (IPV) DETAIL / FOR OFFICE USE ONL Documents Received Certified Copies Original True Copies IPV AND KC VERIFICATION CARRIED OUT B INSTITUTION DETAIL Date of IPV / Attestation Emp. Name Emp. Code Emp. Designation Emp. Branch D D M M Name THE MEHSANA URBAN CO. OP. BANK LTD. Code IN 0 5 8 (MI ID - A6) Sign. of Person who has done IPV/KC Attestation Institution Stamp
PART II - ACCOUNT OPENING FORM (FOR INDIVIDUALS) BSDA Form : 9 REGULAR The Mehsana Urban Co-Operative Bank Limited (MUCB) (Multi State - Scheduled Bank) Head Office : Urban Bank Road, Mehsana-8400. Phone : (076) 5908, 568 Fax : (076) 4506 E-mail: demat@mucbank.com Website : www.mucbank.com I/We request you to open a depository account in my/our name as per the following details (Please fill all the details in CAPITAL LETTERS only) DP ID - IN 0466 CLIENT-ID (To be filled by Participant) Date D D M M Details of Account Holder (s) : Risk Category: Low Medium High Account Holder(s) Sole / First Holder Second Holder Third Holder Name PAN Mobile. E-mail ID Declaration : I/We hereby declare that the aforesaid mobile no. and/or E-mail ID belongs to me or my family members (Spouse, dependent children and dependent parents) Occupation (Please tick any one and give brief details) Private Sector Public Sector Government Service Business Agriculturist Retired Housewife Student Private Sector Public Sector Government Service Business Agriculturist Retired Housewife Student Private Sector Public Sector Government Service Business Agriculturist Retired Housewife Student Professional Others (Please Specify) Professional Others (Please Specify) Professional Others (Please Specify) Brief details For HUF, Association of Persons (AOP), Partnership Firm, Unregistered Trust, etc., although the account is opened in the name of the natural persons, the name & PAN of HUF, Association of Persons (AOP), Partnership Firm, Unregistered Trust etc., should be mentioned below : a) name b) PAN Type of account Ordinary Resident Qualified Foreign Investor Margin NRI-Repatriable Foreign National NRI-n Repatriable Promoter Others (Please specify) 4 Gross Annual Income Details Income Range per annum (please tick any one) Below ` Lac ` - ` 5 Lac ` 5 - ` 0 Lac ` 0 - ` 5 Lac More than ` 5 Lac 5 In Case of NRIs/Foreign Nationals RBI Approval Reference Number RBI Approval Date 6 Bank Details 4 Bank Account Type Bank Account Number Bank Name Branch Address Savings Account Current Account Others (Please specify) THE MEHSANA URBAN CO. OP. BANK LTD. City/Town/Village PIN Code State Country INDIA 5 MICR Code 6 IFSC
7 Please tick, if applicable : Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP) Form : 9 8 Standing Instructions I/We authorise MUCB to receive credits automatically into my/our account. (if not indicated, Standing Instruction will be treated as 'es') es In case of Account to be operated through Power of Attorney (PoA) (*) SMS Alert Facility : Mandatory if you are giving Power of Attorney (PoA) es I/We would like to share the email ID with the RTA for receive the annual report, AGM tices and all other communication from Issuers & RTAs in physical form (if not indicated, Standing Instruction will be treated as '') es 4 I/We request MUCB to enable Standing Instruction for Auto Pledge Confirmation (if not indicated, Standing Instruction will be treated as '') es 5 SMS Alert facility : [Mandatory if you are giving Power of Attorney (PoA) Ensure that the mobile number is provided in the KC Application Form] (if not indicated, Standing Instruction will be treated as 'es') Sr.. Sole/First Holder Second Holder Holder es 6 Mode of receiving Statement of Account [Tick any one] Third Holder Physical Form Electronic Form [Read te 5 and ensure that email ID is provided in KC Application Form] 9 Guardian Details (Where sole holder is a minor) : [For account of a minor, two KC Application Forms must be filled i.e. one for the guardian and another for the minor (to be signed by guardian)] Guardian Name PAN Relationship of guardian with minor 0. mination Option : I/We wish to make a nomination. (Details are provided at FORM 0) I/We do not wish to make a nomination. Standing Instruction for Debiting Charges Sir/Madam, I/We hereby authorise you to Debit my/our operative Bank A/c. with The Mehsana Urban Bank Co-Operative Bank Limited - Branch for all the charges relating to my/our demat account. Please treat this authorisation as irrevocable till further Instruction from my/our side is received in writing and duly acknowledged by you. Thanking ou ) /7 Signature Verified by ours Faithfully Emp. Name : ) ) Signature of Operative Bank A/c Emp. Signature & Bank Seal Declaration The rules and regulations of the SEBI, Depository and Depository Participants pertaining to an account which are in force now have been read by me/us and I/we have understood the same and I/we agree to abide by and to be bound by the rules as are in force from time to time for such accounts. 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 untrue or misleading or misrepresenting, I am/we are aware that I/we may be held liable for it. In case non-resident account, I/we also declare that I/we have complied and will continue to comply with FEMA regulations. I/we acknowledge to have read and received a copy of the documents i.e. "Rights and Obligations of the Beneficial Owner and Depository Participant",-and all other documents executed by me/us. 4
Sole / First Holder / Guardian (in case sole holder is minor) (Mr./Ms.) Second Holder (Mr./Ms.) Name (s) of holder (s) 4/7 Signature (s) holder Form : 9 Third Holder (Mr./Ms.) tes :. All communication shall be sent at the address of the Sole/First holder only.. Thumb impressions and signatures other than English or Hindi or any of the other language not contained in the 8th Schedule of the Constitution of India must be attested by a Magistrate or a tary Public or a Special Executive Magistrate.. Instruction related to nomination, are as below :. The nomination can be made only by individuals holding beneficiary owner accounts on their own behalf singly or jointly. n- individuals including society, trust, body corporate and partnership firm, karta of Hindu Undivided Family, holder of power of attorney cannot nominate. If the account is held jointly, all joint holders will sign the nomination form.. A minor can be nominated. In that event, the name and address of the Guardian of the minor nominee shall be provided by the beneficial owner.. The minee(s) shall not be a trust, society, body corporate, partnership firm, karta of Hindu Undivided Family or a power of Attorney holder, A nonresident Indian can be a minee, subject to the exchange controls in force, from time to time. 4. mination in respect of the beneficiary owner account stands rescinded upon closure of the beneficiary owner account. Similarly, the nomination in respect of the securities shall stand terminated upon transfer of the securities. 5. Transfer of securities in favour of a minee(s) shall be valid discharge by the depository and the Participant against the legal heir. 6. The Cancellation of nomination can be made by individuals only holding beneficiary owner accounts on their own behalf singly or jointly by the same persons who made the original nomination. n-individuals including society, trust, body corporate and partnership firm, karta of Hindu Undivided Family, holder of power of attorney cannot cancel the nomination. If the beneficiary owner account is held jointly, all joint holders will sign the cancellation form. 7. On cancellation of the nomination, the nomination shall stand rescinded and the depository shall not be under any obligation to transfer the securities in favour of the minee(s). 8. mination can be made upto three nominees in a demat account. In case of multiple nominees, the Client must specify the percentage of share for each nominee that shall total upto hundred percent, In the event of the beneficiary owner not indicating any percentage of allocation/share for each of the nominees, the default option shall be to settle the claims equally amongst all the nominees. 9. On request of Substitution of existing nominees by the beneficial owner, the earlier nomination shall stand rescinded. Hence, details of nominees as mentioned in the FORM 0 at the time of substitution will be considered. Therefore, please mention the complete details of all the nominees. 0.Copy of any proof of identity must be accompanied by original for verification or duly attested by any entity authorized for attesting the documents, as provide in Annexure D..Savings bank account details shall only be considered if the account is maintained with the same participant..dp ID and client ID shall be provided where demat details is required to be provided. 4. Strike off whichever is not applicable. ) Produce this acknowledgment slip to get account number. Important Instructions ) ou shall receive client master report once your account is activated. ou are advised to bring to our notice mistakes/errors, if any, in the client master report. ) ou shall also receive delivery instruction slip (DIS) book alongwith client master report. Please use requisition slip being sent with the DIS book for availing fresh DIS book in future. 4) As per the NSDL guidelines the client has to use requisition slip as mentioned in the above point for availing fresh DIS book. Please contact us in case of loss/misplace of DIS book/requisition slip. 5) Please follow all instructions printed on DIS carefully. 6) Please use IDeAS service offered by NSDL for access to your demat account statement through internet. 5
US person: es, is your Country of Tax Residency other than India es If 'es', please specify the details of all countries where your hold tax residency and its Tax Identification Number & type Tax Payer Identification Number (TIN or other, please specify) Signature of Holder D D M M 5/7 For Office use : Received by : Entered by : Verified by : Ref.. Date : / / Acknowledgement The Mehsana Urban Co-Operative Bank Limited (MUCB) (Multi State Scheduled Bank) Head Office : Urban Bank Road, Highway, Mehsana - 8400 Phone : 076-5908, Email ID : demat@mucbank.com, www.mucbank.com DP ID-IN0466 Received the application from Mr/Mrs. as the sole/first holder alongwith and as the second and third holders respectively for opening of a depository account. Please quote the DP ID & Client ID allotted to you in all your future correspondence. Date : D D M M Participant Stamp & Signature 6
THE MEHSANA URBAN CO. OP. BANK LIMITED (Multi State Scheduled Bank) Form : 0 FORM FOR NOMINATION / CANCELLATION OF N0MINATION Form : 0 Date DP ID I N 0 4 6 6 Client ID I/We with to make a nomination. [As per details given below] I/We wish to cancel the nomination made by me/us earlier and consequently all rights and liabilities in respect of beneficiary ownership in the securities held by me / us in the said account shall vest in me / us. [Strike off the nomination details below] mination Details I/We wish to make a nomination and do hereby nominate the following person(s) who shall receive all securities held in the depository by me/ us in the said beneficiary owner account in the event of my/our death. mination can be made upto three nominees in the account Name of the nominee(s) (Mr./Ms.) st Details of minee nd Details of minee rd Details of minee Share of each nominee Equally % % % [if not equally, please specify percentage] Relationship with the applicant (if Any) 4 Address of minee(s) Any odd lot after division shall be transferred to the first nominee mentioned in the form. PIN Code 5 Mobile/Telephone. of nominee(s) 6 Email ID of nominee(s) 7 minee Identification details- [Please tick any one of following and provide details of same] Photograph & Signature Aadhaar Proof of Identity PAN Saving Bank account no. Demat Account ID Sr. s. 8-4 should be filled only if nominee(s) is a minor : 8 Date of Birth [in case of minor nominee(s)] 9 Name of Guardian (Mr./Ms.) [in case of minor minee (s)] 0 Address of Guardian (s) 4 PIN Code Mobile/Telephone no. of Guardian Email ID of Guardian Relationship of Guardian with nominee Guardian Identification details - [Please tick any one of following and provide details of same] Photograph & Signature Aadhaar Proof of Identity PAN Saving Bank account no. Demat Account ID Sole / First Holder (Mr./Ms.) Second Holder (Mr./Ms.) Third Holder (Mr./Ms.) Name (s) of holder (s) 6/7 Signature (s) holder Name of the Witness Address of Witness Signature of Witness 7 Date D D M M
The Mehsana Urban Co-Operative Bank Limited (MUCB) (Multi State Scheduled Bank) Head Office : Urban Bank Road, Mehsana - 8400 Ph. : 076-5908, Email ID : demat@mucbank.com, www.mucbank.com TARIFF SHEET FOR CUSTOMERS Sir, Madam, Tariff will be applicable for the customer opting for the Regular Demat Account / Basic Services Demat Account (BSDA) DESCRIPTION OF CHARGES Account Opening Charges Account Closing Charges Annual Maintenance Charges (**) (AMC) Demat Charges I wish to Open a Regular Demat Account ` 8.00 (monthly) ` 0.00 per Instruction for Post / Courier DP ID : IN0466 I wish to Open a BSDA (**) Depository Remat Charges ` 5.00 for every 00 securities or part thereof or ` 50.00 per instruction. whichever is higher. Debit Transaction Credit Transaction Ad-hoc Statement Failed / Rejected instruction Delivery Issuance Slip (DIS) Pledge / Hypothecation (Creation / Closure / Invocation) Mutual Fund - Debit Transactions Conversion of Mutual Fund units represanted by SOA into dematerialised form Re-conversion of Mutual Fund units into SOA ` 5.00 for per Instruction ` 5.00 per page ` 5.00 per instruction ` 0.00 per booklet - DIS reissuance ` 40.00 per instruction ` 5.00 per instruction ` 0.00 per instruction for Post/courier ` 50.00 per instruction ` 40.00 per instruction ` 40.00 per booklet - DIS reissuance ` 50.00 per instruction Redemption of Mutual Fund units through Participants ` 5.00 per instruction Securities Deposit : Bank A/c should be opened with any of our branches with minimum balance of Rs. 000. tes: The value of shares & securities are calculated as per NSDL formula and rates. (**) BSDA account applicable only to eligible customers as per SEBI circulars. BSDA account on value of holding will be determined on billing day, account will be levied higher applicable AMC on value of holding exceeding such limit-as upto ` 50,000.00 - Nil, ` 50,00.00 to `,00,000.00 - ` 00.00, above `,00,000.00 - Charges for regular account will be applicable. In case of non-recovery of depository service charges due to non-payment or inadequate balance in your linked bank account, the depository services for your demat account are liable to be discontinue. Any request for resuming the services will be charged at ` 00.00 per request as activation charge and services will be resumed in a minimum of Three working days from the date of receipt of request with us and post payment of all dues including activation charged. In case of corporate accounts, Additional fees of ` 500.00 p.a. as per NSDL will be charged. The above charges are exclusive of Service Tax/GST/CESS levied and other taxes / statutory charges levied by Government bodies / statutory authorities from time to time, which will be charged as applicable. MUCB reserves the right to revise the depository Tariff from time to time and the same will be communicated to the customers with a notice of 0 days. The charges quoted above are for the services listed. Any service not quoted above will be charged separately. The operating instructions for the joint accounts must be signed by all the holders. The charges for processing of instruction submitted on the execution date (accepted at client's risk) will be additionally ` 5.00 per instruction. I/We Agree to pay the charge as set out herein above subject to any change therein from time to time and authorise you to debit all types of charges as per mandate given by you. 7/7 First Holder Second Holder Third Holder *All holders should must sign the application 8