BCB Brokers Pvt. Ltd.
Providence
®
Know Your Customer (KYC) Application Form
1. Personal Details
PAN
*
Prefix
First Name
*
Middle Name
Last Name
*
Name
* (Same as ID Proof)
-
Mr.
Mrs.
Ms.
DD
MM
YYYY
Date of Birth
*
-
-
1.1 Additional Identity Details
Citizenship
*
Code - Country
AF - Afghanistan
AX - Aland Island
AL - Albania
DZ - Algeria
AS - American Samoa
AD - Andorra
AO - Angola
AI - Anguilla
AQ - Antarctica
AG - Antigua and Barbuda
AR - Argentina
AM - Armenia
AW - Aruba
AU - Australia
AT - Austria
AZ - Azerbaijan
BS - Bahamas
BH - Bahrain
BD - Bangladesh
BB - Barbados
BY - Belarus
BE - Belgium
BZ - Belize
BJ - Benin
BM - Bermuda
BT - Bhutan
BO - Bolivia, Plurinational State of
BQ - Bonaire, Sint Eustatius and Saba
BA - Bosnia and Herzegovina
BW - Botswana
BV - Bouvet Island
BR - Brazil
IO - British Indian Ocean Territory
BN - Brunei Darussalam
BG - Bulgaria
BF - Burkina Faso
BI - Burundi
CV - Cabo Verde
KH - Cambodia
CM - Cameroon
CA - Canada
KY - Cayman Islands
CF - Central African Republic
TD - Chad
CL - Chile
CN - China
CX - Christmas Island
CC - Cocos (Keeling) Islands
CO - Colombia
KM - Comoros
CG - Congo
CD - Congo, the Democratic Republic of the
CK - Cook Islands
CR - Costa Rica
CI - Cote d'Ivoire !Côte d'Ivoire
HR - Croatia
CU - Cuba
CW - Curacao !Curaçao
CY - Cyprus
CZ - Czech Republic
DK - Denmark
DJ - Djibouti
DM - Dominica
DO - Dominican Republic
EC - Ecuador
EG - Egypt
SV - El Salvador
GQ - Equatorial Guinea
ER - Eritrea
EE - Estonia
ET - Ethiopia
FK - Falkland Islands (Malvinas)
FO - Faroe Islands
FJ - Fiji
FI - Finland
FR - France
GF - French Guiana
PF - French Polynesia
TF - French Southern Territories
GA - Gabon
GM - Gambia
GE - Georgia
DE - Germany
GH - Ghana
GI - Gibraltar
GR - Greece
GL - Greenland
GD - Grenada
GP - Guadeloupe
GU - Guam
GT - Guatemala
GG - Guernsey
GN - Guinea
GW - Guinea-Bissau
GY - Guyana
HT - Haiti
HM - Heard Island and McDonald Islands
VA - Holy See (Vatican City State)
HN - Honduras
HK - Hong Kong
HU - Hungary
IS - Iceland
IN - India
ID - Indonesia
IR - Iran, Islamic Republic of
IQ - Iraq
IE - Ireland
IM - Isle of Man
IL - Israel
IT - Italy
JM - Jamaica
JP - Japan
JE - Jersey
JQ - Jordan
KZ - Kazakhstan
KE - Kenya
KI - Kiribati
KP - Korea, Democratic People's Republic of
KR - Korea, Republic of
KW - Kuwait
KG - Kyrgyzstan
LA - Lao People's Democratic Republic
LV - Latvia
LB - Lebanon
LS - Lesotho
LR - Liberia
LY - Libya
LI - Liechtenstein
LT - Lithuania
LU - Luxembourg
MO - Macao
MK - Macedonia, the former Yugoslav Republic of
MG - Madagascar
MW - Malawi
MY - Malaysia
MV - Maldives
ML - Mali
MT - Malta
MH - Marshall Islands
MQ - Martinique
MR - Mauritania
MU - Mauritius
YT - Mayotte
MX - Mexico
FM - Micronesia, Federated States of
MD - Moldova, Republic of
MC - Monaco
MN - Mongolia
ME - Montenegro
MS - Montserrat
MA - Morocco
MZ - Mozambique
MM - Myanmar
NA - Namibia
NR - Nauru
NP - Nepal
NL - Netherlands
NC - New Caledonia
NZ - New Zealand
NI - Nicaragua
NE - Niger
NG - Nigeria
NU - Niue
NF - Norfolk Island
MP - Northern Mariana Islands
NO - Norway
OM - Oman
PK - Pakistan
PW - Palau
PS - Palestine, State of
PA - Panama
PG - Papua New Guinea
PY - Paraguay
PE - Peru
PH - Philippines
PN - Pitcairn
PL - Poland
PT - Portugal
PR - Puerto Rico
QA - Qatar
RE - Reunion !Réunion
RO - Romania
RU - Russian Federation
RW - Rwanda
BL - Saint Barthelemy !Saint Barthélemy
SH - Saint Helena, Ascension and Tristan da Cunha
KN - Saint Kitts and Nevis
LC - Saint Lucia
MF - Saint Martin (French part)
PM - Saint Pierre and Miquelon
VC - Saint Vincent and the Grenadines
WS - Samoa
SM - San Marino
ST - Sao Tome and Principe
SA - Saudi Arabia
SN - Senegal
RS - Serbia
SC - Seychelles
SL - Sierra Leone
SG - Singapore
SX - Sint Maarten (Dutch part)
SK - Slovakia
SI - Slovenia
SB - Solomon Islands
SO - Somalia
ZA - South Africa
GS - South Georgia and the South Sandwich Islands
SS - South Sudan
ES - Spain
LK - Sri Lanka
SD - Sudan
SR - Suriname
SJ - Svalbard and Jan Mayen
SZ - Swaziland
SE - Sweden
CH - Switzerland
SY - Syrian Arab Republic
TW - Taiwan, Province of China
TJ - Tajikistan
TZ - Tanzania, United Republic of
TH - Thailand
TL - Timor-Leste
TG - Togo
TK - Tokelau
TO - Tonga
TT - Trinidad and Tobago
TN - Tunisia
TR - Turkey
TM - Turkmenistan
TC - Turks and Caicos Islands
TV - Tuvalu
UG - Uganda
UA - Ukraine
AE - United Arab Emirates
GB - United Kingdom
US - United States
UM - United States Minor Outlying Islands
UY - Uruguay
UZ - Uzbekistan
VU - Vanuatu
VE - Venezuela, Bolivarian Republic of
VN - Viet Nam
VG - Virgin Islands, British
VI - Virgin Islands, U.S.
WF - Wallis and Futuna
EH - Western Sahara
YE - Yemen
ZM - Zambia
ZW - Zimbabwe
Residential Status
*
-
Resident Individual
Non Resident Indian
Foreign National
Person of Indian Origin
Occupation Type
*
-
S - Service
O - Others
B - Business
X - Not Categorised
Occupation Sub Type
*
-
Private Sector
Public Sector
Government Sector
Occupation Sub Type
*
-
Professional
Self Employed
Retired
Housewife
Student
Gender
*
-
M - Male
F - Female
T - Transgender
Marital Status
*
-
M - Married
U - Unmaried
O - Others
Prefix
First Name
*
Middle Name
Last Name
*
Maiden Name
* (if any)
-
Mr.
Mrs.
Ms.
Father's Name
*
-
Mr.
Mrs.
Ms.
Spouse Name
* (if any)
-
Mr.
Mrs.
Ms.
Mother's Name
*
-
Mr.
Mrs.
Ms.
2. Residence For Tax Purposes in Jurisdiction(s) Outside India
(if applicable)
Additional Details Required
*
(Mandatory if Section 2 is Ticked)
ISO 3166 Country Code of Jurisdiction of Residence
*
Code - Country
AF - Afghanistan
AX - Aland Island
AL - Albania
DZ - Algeria
AS - American Samoa
AD - Andorra
AO - Angola
AI - Anguilla
AQ - Antarctica
AG - Antigua and Barbuda
AR - Argentina
AM - Armenia
AW - Aruba
AU - Australia
AT - Austria
AZ - Azerbaijan
BS - Bahamas
BH - Bahrain
BD - Bangladesh
BB - Barbados
BY - Belarus
BE - Belgium
BZ - Belize
BJ - Benin
BM - Bermuda
BT - Bhutan
BO - Bolivia, Plurinational State of
BQ - Bonaire, Sint Eustatius and Saba
BA - Bosnia and Herzegovina
BW - Botswana
BV - Bouvet Island
BR - Brazil
IO - British Indian Ocean Territory
BN - Brunei Darussalam
BG - Bulgaria
BF - Burkina Faso
BI - Burundi
CV - Cabo Verde
KH - Cambodia
CM - Cameroon
CA - Canada
KY - Cayman Islands
CF - Central African Republic
TD - Chad
CL - Chile
CN - China
CX - Christmas Island
CC - Cocos (Keeling) Islands
CO - Colombia
KM - Comoros
CG - Congo
CD - Congo, the Democratic Republic of the
CK - Cook Islands
CR - Costa Rica
CI - Cote d'Ivoire !Côte d'Ivoire
HR - Croatia
CU - Cuba
CW - Curacao !Curaçao
CY - Cyprus
CZ - Czech Republic
DK - Denmark
DJ - Djibouti
DM - Dominica
DO - Dominican Republic
EC - Ecuador
EG - Egypt
SV - El Salvador
GQ - Equatorial Guinea
ER - Eritrea
EE - Estonia
ET - Ethiopia
FK - Falkland Islands (Malvinas)
FO - Faroe Islands
FJ - Fiji
FI - Finland
FR - France
GF - French Guiana
PF - French Polynesia
TF - French Southern Territories
GA - Gabon
GM - Gambia
GE - Georgia
DE - Germany
GH - Ghana
GI - Gibraltar
GR - Greece
GL - Greenland
GD - Grenada
GP - Guadeloupe
GU - Guam
GT - Guatemala
GG - Guernsey
GN - Guinea
GW - Guinea-Bissau
GY - Guyana
HT - Haiti
HM - Heard Island and McDonald Islands
VA - Holy See (Vatican City State)
HN - Honduras
HK - Hong Kong
HU - Hungary
IS - Iceland
IN - India
ID - Indonesia
IR - Iran, Islamic Republic of
IQ - Iraq
IE - Ireland
IM - Isle of Man
IL - Israel
IT - Italy
JM - Jamaica
JP - Japan
JE - Jersey
JQ - Jordan
KZ - Kazakhstan
KE - Kenya
KI - Kiribati
KP - Korea, Democratic People's Republic of
KR - Korea, Republic of
KW - Kuwait
KG - Kyrgyzstan
LA - Lao People's Democratic Republic
LV - Latvia
LB - Lebanon
LS - Lesotho
LR - Liberia
LY - Libya
LI - Liechtenstein
LT - Lithuania
LU - Luxembourg
MO - Macao
MK - Macedonia, the former Yugoslav Republic of
MG - Madagascar
MW - Malawi
MY - Malaysia
MV - Maldives
ML - Mali
MT - Malta
MH - Marshall Islands
MQ - Martinique
MR - Mauritania
MU - Mauritius
YT - Mayotte
MX - Mexico
FM - Micronesia, Federated States of
MD - Moldova, Republic of
MC - Monaco
MN - Mongolia
ME - Montenegro
MS - Montserrat
MA - Morocco
MZ - Mozambique
MM - Myanmar
NA - Namibia
NR - Nauru
NP - Nepal
NL - Netherlands
NC - New Caledonia
NZ - New Zealand
NI - Nicaragua
NE - Niger
NG - Nigeria
NU - Niue
NF - Norfolk Island
MP - Northern Mariana Islands
NO - Norway
OM - Oman
PK - Pakistan
PW - Palau
PS - Palestine, State of
PA - Panama
PG - Papua New Guinea
PY - Paraguay
PE - Peru
PH - Philippines
PN - Pitcairn
PL - Poland
PT - Portugal
PR - Puerto Rico
QA - Qatar
RE - Reunion !Réunion
RO - Romania
RU - Russian Federation
RW - Rwanda
BL - Saint Barthelemy !Saint Barthélemy
SH - Saint Helena, Ascension and Tristan da Cunha
KN - Saint Kitts and Nevis
LC - Saint Lucia
MF - Saint Martin (French part)
PM - Saint Pierre and Miquelon
VC - Saint Vincent and the Grenadines
WS - Samoa
SM - San Marino
ST - Sao Tome and Principe
SA - Saudi Arabia
SN - Senegal
RS - Serbia
SC - Seychelles
SL - Sierra Leone
SG - Singapore
SX - Sint Maarten (Dutch part)
SK - Slovakia
SI - Slovenia
SB - Solomon Islands
SO - Somalia
ZA - South Africa
GS - South Georgia and the South Sandwich Islands
SS - South Sudan
ES - Spain
LK - Sri Lanka
SD - Sudan
SR - Suriname
SJ - Svalbard and Jan Mayen
SZ - Swaziland
SE - Sweden
CH - Switzerland
SY - Syrian Arab Republic
TW - Taiwan, Province of China
TJ - Tajikistan
TZ - Tanzania, United Republic of
TH - Thailand
TL - Timor-Leste
TG - Togo
TK - Tokelau
TO - Tonga
TT - Trinidad and Tobago
TN - Tunisia
TR - Turkey
TM - Turkmenistan
TC - Turks and Caicos Islands
TV - Tuvalu
UG - Uganda
UA - Ukraine
AE - United Arab Emirates
GB - United Kingdom
US - United States
UM - United States Minor Outlying Islands
UY - Uruguay
UZ - Uzbekistan
VU - Vanuatu
VE - Venezuela, Bolivarian Republic of
VN - Viet Nam
VG - Virgin Islands, British
VI - Virgin Islands, U.S.
WF - Wallis and Futuna
EH - Western Sahara
YE - Yemen
ZM - Zambia
ZW - Zimbabwe
Tax Identification Number or equivalent
(if issued by jurisdiction)*
Place / City of Birth
Country of Birth
(ISO 3166 Country Code)
Code - Country
AF - Afghanistan
AX - Aland Island
AL - Albania
DZ - Algeria
AS - American Samoa
AD - Andorra
AO - Angola
AI - Anguilla
AQ - Antarctica
AG - Antigua and Barbuda
AR - Argentina
AM - Armenia
AW - Aruba
AU - Australia
AT - Austria
AZ - Azerbaijan
BS - Bahamas
BH - Bahrain
BD - Bangladesh
BB - Barbados
BY - Belarus
BE - Belgium
BZ - Belize
BJ - Benin
BM - Bermuda
BT - Bhutan
BO - Bolivia, Plurinational State of
BQ - Bonaire, Sint Eustatius and Saba
BA - Bosnia and Herzegovina
BW - Botswana
BV - Bouvet Island
BR - Brazil
IO - British Indian Ocean Territory
BN - Brunei Darussalam
BG - Bulgaria
BF - Burkina Faso
BI - Burundi
CV - Cabo Verde
KH - Cambodia
CM - Cameroon
CA - Canada
KY - Cayman Islands
CF - Central African Republic
TD - Chad
CL - Chile
CN - China
CX - Christmas Island
CC - Cocos (Keeling) Islands
CO - Colombia
KM - Comoros
CG - Congo
CD - Congo, the Democratic Republic of the
CK - Cook Islands
CR - Costa Rica
CI - Cote d'Ivoire !Côte d'Ivoire
HR - Croatia
CU - Cuba
CW - Curacao !Curaçao
CY - Cyprus
CZ - Czech Republic
DK - Denmark
DJ - Djibouti
DM - Dominica
DO - Dominican Republic
EC - Ecuador
EG - Egypt
SV - El Salvador
GQ - Equatorial Guinea
ER - Eritrea
EE - Estonia
ET - Ethiopia
FK - Falkland Islands (Malvinas)
FO - Faroe Islands
FJ - Fiji
FI - Finland
FR - France
GF - French Guiana
PF - French Polynesia
TF - French Southern Territories
GA - Gabon
GM - Gambia
GE - Georgia
DE - Germany
GH - Ghana
GI - Gibraltar
GR - Greece
GL - Greenland
GD - Grenada
GP - Guadeloupe
GU - Guam
GT - Guatemala
GG - Guernsey
GN - Guinea
GW - Guinea-Bissau
GY - Guyana
HT - Haiti
HM - Heard Island and McDonald Islands
VA - Holy See (Vatican City State)
HN - Honduras
HK - Hong Kong
HU - Hungary
IS - Iceland
IN - India
ID - Indonesia
IR - Iran, Islamic Republic of
IQ - Iraq
IE - Ireland
IM - Isle of Man
IL - Israel
IT - Italy
JM - Jamaica
JP - Japan
JE - Jersey
JQ - Jordan
KZ - Kazakhstan
KE - Kenya
KI - Kiribati
KP - Korea, Democratic People's Republic of
KR - Korea, Republic of
KW - Kuwait
KG - Kyrgyzstan
LA - Lao People's Democratic Republic
LV - Latvia
LB - Lebanon
LS - Lesotho
LR - Liberia
LY - Libya
LI - Liechtenstein
LT - Lithuania
LU - Luxembourg
MO - Macao
MK - Macedonia, the former Yugoslav Republic of
MG - Madagascar
MW - Malawi
MY - Malaysia
MV - Maldives
ML - Mali
MT - Malta
MH - Marshall Islands
MQ - Martinique
MR - Mauritania
MU - Mauritius
YT - Mayotte
MX - Mexico
FM - Micronesia, Federated States of
MD - Moldova, Republic of
MC - Monaco
MN - Mongolia
ME - Montenegro
MS - Montserrat
MA - Morocco
MZ - Mozambique
MM - Myanmar
NA - Namibia
NR - Nauru
NP - Nepal
NL - Netherlands
NC - New Caledonia
NZ - New Zealand
NI - Nicaragua
NE - Niger
NG - Nigeria
NU - Niue
NF - Norfolk Island
MP - Northern Mariana Islands
NO - Norway
OM - Oman
PK - Pakistan
PW - Palau
PS - Palestine, State of
PA - Panama
PG - Papua New Guinea
PY - Paraguay
PE - Peru
PH - Philippines
PN - Pitcairn
PL - Poland
PT - Portugal
PR - Puerto Rico
QA - Qatar
RE - Reunion !Réunion
RO - Romania
RU - Russian Federation
RW - Rwanda
BL - Saint Barthelemy !Saint Barthélemy
SH - Saint Helena, Ascension and Tristan da Cunha
KN - Saint Kitts and Nevis
LC - Saint Lucia
MF - Saint Martin (French part)
PM - Saint Pierre and Miquelon
VC - Saint Vincent and the Grenadines
WS - Samoa
SM - San Marino
ST - Sao Tome and Principe
SA - Saudi Arabia
SN - Senegal
RS - Serbia
SC - Seychelles
SL - Sierra Leone
SG - Singapore
SX - Sint Maarten (Dutch part)
SK - Slovakia
SI - Slovenia
SB - Solomon Islands
SO - Somalia
ZA - South Africa
GS - South Georgia and the South Sandwich Islands
SS - South Sudan
ES - Spain
LK - Sri Lanka
SD - Sudan
SR - Suriname
SJ - Svalbard and Jan Mayen
SZ - Swaziland
SE - Sweden
CH - Switzerland
SY - Syrian Arab Republic
TW - Taiwan, Province of China
TJ - Tajikistan
TZ - Tanzania, United Republic of
TH - Thailand
TL - Timor-Leste
TG - Togo
TK - Tokelau
TO - Tonga
TT - Trinidad and Tobago
TN - Tunisia
TR - Turkey
TM - Turkmenistan
TC - Turks and Caicos Islands
TV - Tuvalu
UG - Uganda
UA - Ukraine
AE - United Arab Emirates
GB - United Kingdom
US - United States
UM - United States Minor Outlying Islands
UY - Uruguay
UZ - Uzbekistan
VU - Vanuatu
VE - Venezuela, Bolivarian Republic of
VN - Viet Nam
VG - Virgin Islands, British
VI - Virgin Islands, U.S.
WF - Wallis and Futuna
EH - Western Sahara
YE - Yemen
ZM - Zambia
ZW - Zimbabwe
3. Proof Of Identity (PoI)
(if applicable)
(Certified copy of
any one
of the following Proof of Identity[POI] Needs to be submitted)
A - Passport Number
Passport Expiry Date
-
-
B - Voter ID Card
D - Driving Licence
Driving Licence Expiry Date
-
-
E - UID (Aadhar)
F - NREGA Job Card
Z - Others
(any document notified by the central government)
Identification Number
S - Simplified Measures Account
Document Type Code
-
01
02
Identification Number
4. Proof Of Address (PoA)
*
Current / Permanent / Overseas Address Details
(Certified copy of
any one
of the following Proof of Address[POA] Needs to be submitted)
Address Type
*
-
Residential / Business
Residential
Business
Unspecified
Proof of Address
*
-
Passport
Driving Licence
UID (Aadhaar)
Voter ID
NREGA Job Card
Other (any document notified by Govt. of India)
Simplified Measures Document
Type Code
*
-
01
02
03
04
05
06
Address
Line 1
*
Line 2
Line 3
City/Town/Village
*
District
*
Pin/Post Code
*
State / UT Code
*
AN - Andaman & Nicobar
AP - Andhra Pradesh
AR - Arunachal Pradesh
AS - Assam
BR - Bihar
CH - Chandigarh
CG - Chattisgarh
DN - Dadra and Nagar Haveli
DD - Daman & Diu
DL - Delhi
GA - Goa
GJ - Gujarat
HR - Haryana
HP - Himachal Pradesh
JK - Jammu & Kashmir
JH - Jharkhand
KA - Karnataka
KL - Kerala
LD - Lakshadweep
MP - Madhya Pradesh
MH - Maharashtra
MN - Manipur
ML - Meghalaya
MZ - Mizoram
NL - Nagaland
OR - Orissa
PY - Pondicherry
PB - Punjab
RJ - Rajasthan
SK - Sikkim
TN - Tamil Nadu
TS - Telangana
TR - Tripura
UP - Uttar Pradesh
UA - Uttarakhand
WB - West Bengal
XX - OTHER
ISO 3166 Country Code
*
AF - Afghanistan
AX - Aland Island
AL - Albania
DZ - Algeria
AS - American Samoa
AD - Andorra
AO - Angola
AI - Anguilla
AQ - Antarctica
AG - Antigua and Barbuda
AR - Argentina
AM - Armenia
AW - Aruba
AU - Australia
AT - Austria
AZ - Azerbaijan
BS - Bahamas
BH - Bahrain
BD - Bangladesh
BB - Barbados
BY - Belarus
BE - Belgium
BZ - Belize
BJ - Benin
BM - Bermuda
BT - Bhutan
BO - Bolivia, Plurinational State of
BQ - Bonaire, Sint Eustatius and Saba
BA - Bosnia and Herzegovina
BW - Botswana
BV - Bouvet Island
BR - Brazil
IO - British Indian Ocean Territory
BN - Brunei Darussalam
BG - Bulgaria
BF - Burkina Faso
BI - Burundi
CV - Cabo Verde
KH - Cambodia
CM - Cameroon
CA - Canada
KY - Cayman Islands
CF - Central African Republic
TD - Chad
CL - Chile
CN - China
CX - Christmas Island
CC - Cocos (Keeling) Islands
CO - Colombia
KM - Comoros
CG - Congo
CD - Congo, the Democratic Republic of the
CK - Cook Islands
CR - Costa Rica
CI - Cote d'Ivoire !Côte d'Ivoire
HR - Croatia
CU - Cuba
CW - Curacao !Curaçao
CY - Cyprus
CZ - Czech Republic
DK - Denmark
DJ - Djibouti
DM - Dominica
DO - Dominican Republic
EC - Ecuador
EG - Egypt
SV - El Salvador
GQ - Equatorial Guinea
ER - Eritrea
EE - Estonia
ET - Ethiopia
FK - Falkland Islands (Malvinas)
FO - Faroe Islands
FJ - Fiji
FI - Finland
FR - France
GF - French Guiana
PF - French Polynesia
TF - French Southern Territories
GA - Gabon
GM - Gambia
GE - Georgia
DE - Germany
GH - Ghana
GI - Gibraltar
GR - Greece
GL - Greenland
GD - Grenada
GP - Guadeloupe
GU - Guam
GT - Guatemala
GG - Guernsey
GN - Guinea
GW - Guinea-Bissau
GY - Guyana
HT - Haiti
HM - Heard Island and McDonald Islands
VA - Holy See (Vatican City State)
HN - Honduras
HK - Hong Kong
HU - Hungary
IS - Iceland
IN - India
ID - Indonesia
IR - Iran, Islamic Republic of
IQ - Iraq
IE - Ireland
IM - Isle of Man
IL - Israel
IT - Italy
JM - Jamaica
JP - Japan
JE - Jersey
JQ - Jordan
KZ - Kazakhstan
KE - Kenya
KI - Kiribati
KP - Korea, Democratic People's Republic of
KR - Korea, Republic of
KW - Kuwait
KG - Kyrgyzstan
LA - Lao People's Democratic Republic
LV - Latvia
LB - Lebanon
LS - Lesotho
LR - Liberia
LY - Libya
LI - Liechtenstein
LT - Lithuania
LU - Luxembourg
MO - Macao
MK - Macedonia, the former Yugoslav Republic of
MG - Madagascar
MW - Malawi
MY - Malaysia
MV - Maldives
ML - Mali
MT - Malta
MH - Marshall Islands
MQ - Martinique
MR - Mauritania
MU - Mauritius
YT - Mayotte
MX - Mexico
FM - Micronesia, Federated States of
MD - Moldova, Republic of
MC - Monaco
MN - Mongolia
ME - Montenegro
MS - Montserrat
MA - Morocco
MZ - Mozambique
MM - Myanmar
NA - Namibia
NR - Nauru
NP - Nepal
NL - Netherlands
NC - New Caledonia
NZ - New Zealand
NI - Nicaragua
NE - Niger
NG - Nigeria
NU - Niue
NF - Norfolk Island
MP - Northern Mariana Islands
NO - Norway
OM - Oman
PK - Pakistan
PW - Palau
PS - Palestine, State of
PA - Panama
PG - Papua New Guinea
PY - Paraguay
PE - Peru
PH - Philippines
PN - Pitcairn
PL - Poland
PT - Portugal
PR - Puerto Rico
QA - Qatar
RE - Reunion !Réunion
RO - Romania
RU - Russian Federation
RW - Rwanda
BL - Saint Barthelemy !Saint Barthélemy
SH - Saint Helena, Ascension and Tristan da Cunha
KN - Saint Kitts and Nevis
LC - Saint Lucia
MF - Saint Martin (French part)
PM - Saint Pierre and Miquelon
VC - Saint Vincent and the Grenadines
WS - Samoa
SM - San Marino
ST - Sao Tome and Principe
SA - Saudi Arabia
SN - Senegal
RS - Serbia
SC - Seychelles
SL - Sierra Leone
SG - Singapore
SX - Sint Maarten (Dutch part)
SK - Slovakia
SI - Slovenia
SB - Solomon Islands
SO - Somalia
ZA - South Africa
GS - South Georgia and the South Sandwich Islands
SS - South Sudan
ES - Spain
LK - Sri Lanka
SD - Sudan
SR - Suriname
SJ - Svalbard and Jan Mayen
SZ - Swaziland
SE - Sweden
CH - Switzerland
SY - Syrian Arab Republic
TW - Taiwan, Province of China
TJ - Tajikistan
TZ - Tanzania, United Republic of
TH - Thailand
TL - Timor-Leste
TG - Togo
TK - Tokelau
TO - Tonga
TT - Trinidad and Tobago
TN - Tunisia
TR - Turkey
TM - Turkmenistan
TC - Turks and Caicos Islands
TV - Tuvalu
UG - Uganda
UA - Ukraine
AE - United Arab Emirates
GB - United Kingdom
US - United States
UM - United States Minor Outlying Islands
UY - Uruguay
UZ - Uzbekistan
VU - Vanuatu
VE - Venezuela, Bolivarian Republic of
VN - Viet Nam
VG - Virgin Islands, British
VI - Virgin Islands, U.S.
WF - Wallis and Futuna
EH - Western Sahara
YE - Yemen
ZM - Zambia
ZW - Zimbabwe
4.2 Correspondence / Local Address Details
*
Same as Current / Permanent / Overseas Address Details
Line 1
*
Line 2
Line 3
City/Town/Village
*
District
*
Pin/Post Code
*
State / UT Code
*
AN - Andaman & Nicobar
AP - Andhra Pradesh
AR - Arunachal Pradesh
AS - Assam
BR - Bihar
CH - Chandigarh
CG - Chattisgarh
DN - Dadra and Nagar Haveli
DD - Daman & Diu
DL - Delhi
GA - Goa
GJ - Gujarat
HR - Haryana
HP - Himachal Pradesh
JK - Jammu & Kashmir
JH - Jharkhand
KA - Karnataka
KL - Kerala
LD - Lakshadweep
MP - Madhya Pradesh
MH - Maharashtra
MN - Manipur
ML - Meghalaya
MZ - Mizoram
NL - Nagaland
OR - Orissa
PY - Pondicherry
PB - Punjab
RJ - Rajasthan
SK - Sikkim
TN - Tamil Nadu
TS - Telangana
TR - Tripura
UP - Uttar Pradesh
UA - Uttarakhand
WB - West Bengal
XX - OTHER
ISO 3166 Country Code
*
AF - Afghanistan
AX - Aland Island
AL - Albania
DZ - Algeria
AS - American Samoa
AD - Andorra
AO - Angola
AI - Anguilla
AQ - Antarctica
AG - Antigua and Barbuda
AR - Argentina
AM - Armenia
AW - Aruba
AU - Australia
AT - Austria
AZ - Azerbaijan
BS - Bahamas
BH - Bahrain
BD - Bangladesh
BB - Barbados
BY - Belarus
BE - Belgium
BZ - Belize
BJ - Benin
BM - Bermuda
BT - Bhutan
BO - Bolivia, Plurinational State of
BQ - Bonaire, Sint Eustatius and Saba
BA - Bosnia and Herzegovina
BW - Botswana
BV - Bouvet Island
BR - Brazil
IO - British Indian Ocean Territory
BN - Brunei Darussalam
BG - Bulgaria
BF - Burkina Faso
BI - Burundi
CV - Cabo Verde
KH - Cambodia
CM - Cameroon
CA - Canada
KY - Cayman Islands
CF - Central African Republic
TD - Chad
CL - Chile
CN - China
CX - Christmas Island
CC - Cocos (Keeling) Islands
CO - Colombia
KM - Comoros
CG - Congo
CD - Congo, the Democratic Republic of the
CK - Cook Islands
CR - Costa Rica
CI - Cote d'Ivoire !Côte d'Ivoire
HR - Croatia
CU - Cuba
CW - Curacao !Curaçao
CY - Cyprus
CZ - Czech Republic
DK - Denmark
DJ - Djibouti
DM - Dominica
DO - Dominican Republic
EC - Ecuador
EG - Egypt
SV - El Salvador
GQ - Equatorial Guinea
ER - Eritrea
EE - Estonia
ET - Ethiopia
FK - Falkland Islands (Malvinas)
FO - Faroe Islands
FJ - Fiji
FI - Finland
FR - France
GF - French Guiana
PF - French Polynesia
TF - French Southern Territories
GA - Gabon
GM - Gambia
GE - Georgia
DE - Germany
GH - Ghana
GI - Gibraltar
GR - Greece
GL - Greenland
GD - Grenada
GP - Guadeloupe
GU - Guam
GT - Guatemala
GG - Guernsey
GN - Guinea
GW - Guinea-Bissau
GY - Guyana
HT - Haiti
HM - Heard Island and McDonald Islands
VA - Holy See (Vatican City State)
HN - Honduras
HK - Hong Kong
HU - Hungary
IS - Iceland
IN - India
ID - Indonesia
IR - Iran, Islamic Republic of
IQ - Iraq
IE - Ireland
IM - Isle of Man
IL - Israel
IT - Italy
JM - Jamaica
JP - Japan
JE - Jersey
JQ - Jordan
KZ - Kazakhstan
KE - Kenya
KI - Kiribati
KP - Korea, Democratic People's Republic of
KR - Korea, Republic of
KW - Kuwait
KG - Kyrgyzstan
LA - Lao People's Democratic Republic
LV - Latvia
LB - Lebanon
LS - Lesotho
LR - Liberia
LY - Libya
LI - Liechtenstein
LT - Lithuania
LU - Luxembourg
MO - Macao
MK - Macedonia, the former Yugoslav Republic of
MG - Madagascar
MW - Malawi
MY - Malaysia
MV - Maldives
ML - Mali
MT - Malta
MH - Marshall Islands
MQ - Martinique
MR - Mauritania
MU - Mauritius
YT - Mayotte
MX - Mexico
FM - Micronesia, Federated States of
MD - Moldova, Republic of
MC - Monaco
MN - Mongolia
ME - Montenegro
MS - Montserrat
MA - Morocco
MZ - Mozambique
MM - Myanmar
NA - Namibia
NR - Nauru
NP - Nepal
NL - Netherlands
NC - New Caledonia
NZ - New Zealand
NI - Nicaragua
NE - Niger
NG - Nigeria
NU - Niue
NF - Norfolk Island
MP - Northern Mariana Islands
NO - Norway
OM - Oman
PK - Pakistan
PW - Palau
PS - Palestine, State of
PA - Panama
PG - Papua New Guinea
PY - Paraguay
PE - Peru
PH - Philippines
PN - Pitcairn
PL - Poland
PT - Portugal
PR - Puerto Rico
QA - Qatar
RE - Reunion !Réunion
RO - Romania
RU - Russian Federation
RW - Rwanda
BL - Saint Barthelemy !Saint Barthélemy
SH - Saint Helena, Ascension and Tristan da Cunha
KN - Saint Kitts and Nevis
LC - Saint Lucia
MF - Saint Martin (French part)
PM - Saint Pierre and Miquelon
VC - Saint Vincent and the Grenadines
WS - Samoa
SM - San Marino
ST - Sao Tome and Principe
SA - Saudi Arabia
SN - Senegal
RS - Serbia
SC - Seychelles
SL - Sierra Leone
SG - Singapore
SX - Sint Maarten (Dutch part)
SK - Slovakia
SI - Slovenia
SB - Solomon Islands
SO - Somalia
ZA - South Africa
GS - South Georgia and the South Sandwich Islands
SS - South Sudan
ES - Spain
LK - Sri Lanka
SD - Sudan
SR - Suriname
SJ - Svalbard and Jan Mayen
SZ - Swaziland
SE - Sweden
CH - Switzerland
SY - Syrian Arab Republic
TW - Taiwan, Province of China
TJ - Tajikistan
TZ - Tanzania, United Republic of
TH - Thailand
TL - Timor-Leste
TG - Togo
TK - Tokelau
TO - Tonga
TT - Trinidad and Tobago
TN - Tunisia
TR - Turkey
TM - Turkmenistan
TC - Turks and Caicos Islands
TV - Tuvalu
UG - Uganda
UA - Ukraine
AE - United Arab Emirates
GB - United Kingdom
US - United States
UM - United States Minor Outlying Islands
UY - Uruguay
UZ - Uzbekistan
VU - Vanuatu
VE - Venezuela, Bolivarian Republic of
VN - Viet Nam
VG - Virgin Islands, British
VI - Virgin Islands, U.S.
WF - Wallis and Futuna
EH - Western Sahara
YE - Yemen
ZM - Zambia
ZW - Zimbabwe
4.3 Address In The Jurisdiction Where Applicant is Resident Outside India for Tax Purposes
*
(Applicable only if section 2 is ticked)
Same as Current / Permanent / Overseas Address Details
Line 1
*
Line 2
Line 3
City/Town/Village
*
District
*
(if any)
ZIP/Post Code
*
State
*
ISO 3166 Country Code
*
Code - Country
AF - Afghanistan
AX - Aland Island
AL - Albania
DZ - Algeria
AS - American Samoa
AD - Andorra
AO - Angola
AI - Anguilla
AQ - Antarctica
AG - Antigua and Barbuda
AR - Argentina
AM - Armenia
AW - Aruba
AU - Australia
AT - Austria
AZ - Azerbaijan
BS - Bahamas
BH - Bahrain
BD - Bangladesh
BB - Barbados
BY - Belarus
BE - Belgium
BZ - Belize
BJ - Benin
BM - Bermuda
BT - Bhutan
BO - Bolivia, Plurinational State of
BQ - Bonaire, Sint Eustatius and Saba
BA - Bosnia and Herzegovina
BW - Botswana
BV - Bouvet Island
BR - Brazil
IO - British Indian Ocean Territory
BN - Brunei Darussalam
BG - Bulgaria
BF - Burkina Faso
BI - Burundi
CV - Cabo Verde
KH - Cambodia
CM - Cameroon
CA - Canada
KY - Cayman Islands
CF - Central African Republic
TD - Chad
CL - Chile
CN - China
CX - Christmas Island
CC - Cocos (Keeling) Islands
CO - Colombia
KM - Comoros
CG - Congo
CD - Congo, the Democratic Republic of the
CK - Cook Islands
CR - Costa Rica
CI - Cote d'Ivoire !Côte d'Ivoire
HR - Croatia
CU - Cuba
CW - Curacao !Curaçao
CY - Cyprus
CZ - Czech Republic
DK - Denmark
DJ - Djibouti
DM - Dominica
DO - Dominican Republic
EC - Ecuador
EG - Egypt
SV - El Salvador
GQ - Equatorial Guinea
ER - Eritrea
EE - Estonia
ET - Ethiopia
FK - Falkland Islands (Malvinas)
FO - Faroe Islands
FJ - Fiji
FI - Finland
FR - France
GF - French Guiana
PF - French Polynesia
TF - French Southern Territories
GA - Gabon
GM - Gambia
GE - Georgia
DE - Germany
GH - Ghana
GI - Gibraltar
GR - Greece
GL - Greenland
GD - Grenada
GP - Guadeloupe
GU - Guam
GT - Guatemala
GG - Guernsey
GN - Guinea
GW - Guinea-Bissau
GY - Guyana
HT - Haiti
HM - Heard Island and McDonald Islands
VA - Holy See (Vatican City State)
HN - Honduras
HK - Hong Kong
HU - Hungary
IS - Iceland
IN - India
ID - Indonesia
IR - Iran, Islamic Republic of
IQ - Iraq
IE - Ireland
IM - Isle of Man
IL - Israel
IT - Italy
JM - Jamaica
JP - Japan
JE - Jersey
JQ - Jordan
KZ - Kazakhstan
KE - Kenya
KI - Kiribati
KP - Korea, Democratic People's Republic of
KR - Korea, Republic of
KW - Kuwait
KG - Kyrgyzstan
LA - Lao People's Democratic Republic
LV - Latvia
LB - Lebanon
LS - Lesotho
LR - Liberia
LY - Libya
LI - Liechtenstein
LT - Lithuania
LU - Luxembourg
MO - Macao
MK - Macedonia, the former Yugoslav Republic of
MG - Madagascar
MW - Malawi
MY - Malaysia
MV - Maldives
ML - Mali
MT - Malta
MH - Marshall Islands
MQ - Martinique
MR - Mauritania
MU - Mauritius
YT - Mayotte
MX - Mexico
FM - Micronesia, Federated States of
MD - Moldova, Republic of
MC - Monaco
MN - Mongolia
ME - Montenegro
MS - Montserrat
MA - Morocco
MZ - Mozambique
MM - Myanmar
NA - Namibia
NR - Nauru
NP - Nepal
NL - Netherlands
NC - New Caledonia
NZ - New Zealand
NI - Nicaragua
NE - Niger
NG - Nigeria
NU - Niue
NF - Norfolk Island
MP - Northern Mariana Islands
NO - Norway
OM - Oman
PK - Pakistan
PW - Palau
PS - Palestine, State of
PA - Panama
PG - Papua New Guinea
PY - Paraguay
PE - Peru
PH - Philippines
PN - Pitcairn
PL - Poland
PT - Portugal
PR - Puerto Rico
QA - Qatar
RE - Reunion !Réunion
RO - Romania
RU - Russian Federation
RW - Rwanda
BL - Saint Barthelemy !Saint Barthélemy
SH - Saint Helena, Ascension and Tristan da Cunha
KN - Saint Kitts and Nevis
LC - Saint Lucia
MF - Saint Martin (French part)
PM - Saint Pierre and Miquelon
VC - Saint Vincent and the Grenadines
WS - Samoa
SM - San Marino
ST - Sao Tome and Principe
SA - Saudi Arabia
SN - Senegal
RS - Serbia
SC - Seychelles
SL - Sierra Leone
SG - Singapore
SX - Sint Maarten (Dutch part)
SK - Slovakia
SI - Slovenia
SB - Solomon Islands
SO - Somalia
ZA - South Africa
GS - South Georgia and the South Sandwich Islands
SS - South Sudan
ES - Spain
LK - Sri Lanka
SD - Sudan
SR - Suriname
SJ - Svalbard and Jan Mayen
SZ - Swaziland
SE - Sweden
CH - Switzerland
SY - Syrian Arab Republic
TW - Taiwan, Province of China
TJ - Tajikistan
TZ - Tanzania, United Republic of
TH - Thailand
TL - Timor-Leste
TG - Togo
TK - Tokelau
TO - Tonga
TT - Trinidad and Tobago
TN - Tunisia
TR - Turkey
TM - Turkmenistan
TC - Turks and Caicos Islands
TV - Tuvalu
UG - Uganda
UA - Ukraine
AE - United Arab Emirates
GB - United Kingdom
US - United States
UM - United States Minor Outlying Islands
UY - Uruguay
UZ - Uzbekistan
VU - Vanuatu
VE - Venezuela, Bolivarian Republic of
VN - Viet Nam
VG - Virgin Islands, British
VI - Virgin Islands, U.S.
WF - Wallis and Futuna
EH - Western Sahara
YE - Yemen
ZM - Zambia
ZW - Zimbabwe
5. Contact Details
*
(All communcations will be sent on the provided Mobile No. / Email-ID)
Tel. (Off)
-
Tel. (res):
-
Mobile:
*
-
Fax
-
Email
*
6. Details of Related Person
(if applicable)
Addition or Deletion
*
-
Addition of Related Person
Deletion of Related Person
KYC Number of Related Person
(if available)
Related Person Type
*
-
Guardian of Minor
Assignee
Authorized Representative
Prefix
First Name
*
Middle Name
Last Name
*
Name
* (Same as ID Proof)
-
Mr.
Mrs.
Ms.
6.1 Proof Of Identity (POI) of Related Person
* (Only if section 6 selected)
A - Passport Number
Passport Expiry Date
-
-
B - Voter ID Card
C - PAN Card
D - Driving Licence
Driving Licence Expiry Date
-
-
E - UID (Aadhar)
F - NREGA Job Card
Z - Others
(any document notified by the central government)
Identification Number
S - Simplified Measures Account
Document Type Code
-
01
02
Identification Number
7. Remarks (if any)
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