KYC
CENTRAL KYC REGISTRY | Know Your Customer (KYC) Application Form | Individual
Important Instructions:
  • A) Fields marked with '*' are mandatory fields.
  • B) Please fill the form in English and in BLOCK letters.
  • C) Please fill the date in DD-MM-YYYY format.
  • D) Please read section wise detailed guidelines / instructions at the end
  • E) List of State / U.T code as per Indian Motor Vehicle Act. 1988 is available at the end.
  • F) List of two character ISO 3166 country codes is available at the end.
  • G) KYC number of applicant is mandatory for update application.
  • H) For particular section update, please tick (ü) in the box available before the section number and strike of the sections not required to be updated.
 
For office use only Application Type* New        Update
(To be filled by financial institution) KYC Number (Mandatory for KYC update request)
Account Type* Normal    Simplified (for low risk customers)    Small
  1. PERSONAL DETAILS (Please refer instuction A at the end)
 
 
Prefix   First Name   Middle Names   Last Name
Name* (Same as ID proof)
     
Maiden Name (if any*)
     
Father / Spouse Name*
     
Mother Name*
     
Date of Birth*
— —
Gender* M- Male F- Female T- Transgender
Marital Status* Married Unmarried Others
Citizenship* IN- Indian
Others (ISO 3166 Country Code )
Residential Status* Resident Individual Non Resident Indian
Foreign National Person of Indian Origin
Occupation Type* S-Servics Sector(
Private Public Sector Government Sector)
O-Others (
Professional Self Employed Retired
Housewife Student  
B-Business
X- Not Categorised
PHOTO
 
Signature / Thumb Impression
  2. TICK IF APPLICABLE RESIDENCE FOR TAX PURPOSES IN JURISDICTION(S) OUTSIDE INDIA (Please refer instuction B at the end)
ADDITIONAL DETAILS REQUIRED* (Mandatry only if section 2 is ticked)
ISO 3166 Country Code of Jurisdiction of Residence*
Tax Identification Number of equivalent (if issued by jurisdiction)*
Place / City of Birth*   ISO 3166 Country Code of Birth*
 
  3. PROOF OF IDENTITY(Pol)* (Please refer instuction C at the end)
(Certified copy of any one of the following Proof of ldentity [Pol] needs to be submitted)
A- Passport Number   Passport Expiry Date
B- Voter ID Card      
C- PAN Card      
D- Driving Licence   Driving Licence Expiry Date
E- UID (Aadhaar)      
F- NREGA Job Card      
Z- Others (any document notified by
      the central government)		   Identification Number
S- Simplified Measures Account -
      Document Type code 		  Identification Number
       4. PROOF OF ADDRESS (PoA)*
   4.1 CURRENT / PERMANENT / OVERSEAS 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* Residential / Business Residential Business Registered Office Unspecified
Proof of Address* Passport Driving Licence UID (Aadhaar)    
  Voter Identity Card NREGA Job Card Others
 
Simplified Measures Account - Document Type code
Address
Line 1*
Line 2*
Line 3*
City / Town / Village*
District*
  Pin / Post Code*   State / U.T Code*   ISO 3166 Country Code*
 
4.2 CORRESPONDENCE / LOCALADDRESS DETAILS* (Please see instuction E at the end)
Same as Current / Permanent / Overseas Address details (In case of multiple correspondence / local addresses, please fill 'Annexure A1')
Line 1*
Line 2*
Line 3*
City / Town / Village*
District*
  Pin / Post Code*   State / U.T Code*   ISO 3166 Country Code*
4.3 ADDRESS IN THE JURISDICTION DETAILS WHERE APPLICANT IS RESIDENT OUTSIDE INDIA FOR TAX PURPOSES* (Applicable if section 2 is ticked)
Same as Current / Permanent / Overseas Address details Same as Correspondence / Local Address details
Line 1*
Line 2*
Line 3*
City / Town / Village*
State*
  ZIP / Post Code*     ISO 3166 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)   Tel. (Res)   Mobile
FAX   Email ID
   6. 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 Deketion of Related Person KYC Number of Related Person (if available*)
Related Person Type* Guardian of Minor Assignee Authorized Representative
 
 
Prefix   First Name   Middle Names   Last Name
Name*
     
 
(If KYC number and name are provided, below details of section 6 are optinal)
  PROOF OF IDENTITY [PoI] OF RELATED PERSON* (Please see instruction (H) at the end)
A- Passport Number   Passport Expiry Date
B- Voter ID Card      
C- PAN Card      
D- Driving Licence   Driving Licence Expiry Date
E- UID (Aadhaar)      
F- NREGA Job Card      
Z- Others (any document notified by
      the central government)		   Identification Number
S- Simplified Measures Account -
      Document Type code 		  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 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 am aware that I may be held liable for it.
  • I hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/email address
Date:   Place:    
   9. ATTESTATION / FOR OFFICE USE ONLY
Documents Received Certified Copies
KYC VERIFICATION CARRIED OUT BY
Date :
Emp. Name
Emp. Code
Emp. Designation
Emp. Branch
 
INSTITUTION DETAILS
Name
Code
 
 
     
 
     
 
   CENTRAL KYC REGISTRY | Instructions / Check list / Guidelines for filling individual KYC Application Form
 

General Instructions:
  1. Fields marked with are mandatory fields.
  2. Tick '✓' wherever applicable.
  3. Self-Certification of documents is mandatory.
  4. Please fill the form in English and in BLOCK Letters.
  5. Please fill all dates in DD-MM-YYYYformat.
  6. Wherever state code and country code is to be furnished, the same should be the two-digit code as per Indian Motor Vehicle, 1988 and ISO 3166 country code respectively list of which is available at the end.
  7. KYC number of applicant is mandatory for updation of KYC details.
  8. For particular section update, please tick (✓) in the box available before the section number and strike off the sections not required to be updated.
  9. In case of 'Small Account type' only personal details at section number 1 and 2, photograph, signature and self-certification required.
A

Clarification / Guidelines on filling 'Personal Details’section
  1. Name: Please state the name with Prefix (Mr/Mrs/Ms/Dr/etc.). The name should match the name as mentioned in the Proof of Identity submitted failing which the application is liable to be rejected.
  2. Either father's name or spouse's name is to be mandatorily furnished. In case PAN is not available father's name is mandatory.
B

Clarification / Guidelines on filling details if applicant residence for tax purposes in jurisdiction(s) outside India
  1. Tax identification Number (TIN): TIN need not be reported if it has not been issued by the jurisdiction. However, if the said jurisdiction has issued a high integrity number with an equivalent level of identification (a "Functional equivalent"), the same may be reported. Examples of that type of number for individual include, a social security/insurance number, citizen/personal identification/services code/number, and resident registration number)
C

Clarification / Guidelines on filling 'Proof of Identity [Pol]' section
  1. If driving license number or passport is provided as proof of identity then expiry date is to be mandatorily furnished.
  2. Mentio identification / reference number if 'Z- Others (any document notified by the central government)' is ticked.
  3. In case of Simplified Measures Accounts for verifying the identity of the applicant, any one of the following documents can also be submitted and undernoted relevant code may be mentioned in point 3 (S).
  Document Code   Description
01   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.
02   Letter issued by a gazetted officer, with a duly attested photograph of the person.
D

Clarification / Guidelines on filling 'Proof of Address (PoA) - Current / Permanent / Overseas Address details' section
  1. PoA to be submitted only if the submitted Pol does not have an address or address as per Pol is invalid or not in force.
  2. State / U.T Code and Pin / Post Code will not be mandatory for Overseas addresses.
  3. In case of Simplified Measures Accounts for verifying the address of the applicant, any one of the following documents can also be submitted and undernoted relevant code may be mentioned in point 4.1.
  Document Code   Description
01   Utility bill which is not more than two months old of any service provider (electricity, telephone, post-paid mobile phone, piped gas, water bill).
02   Property or Municipal Tax receipt.
03   Bank account or Post Office savings bank account statement.
04   Pension or family pension payment orders (PPOs) issued to retired employees by Government Departments or Public Sector Undertakings, if they contain the address.
05   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.
06   Documents issued by Government departments of foreign jurisdictions and letter issued by Foreign Embassy or Mission in India.
E

Clarification / Guidelines on filling 'Proof of Address [PoA] - Correspondence / Local Address details' section
  1. To be filled only in case the PoA is not the local address or address where the customer is currently residing. No separate PoA is required to be submitted.
  2. In case of multiple correspondence / local addresses. Please fill 'Annexure Al’
F

Clarification / Guidelines on filling 'Contact details' section
  1. Please mention two- digit country code and 10 digit mobile number (e.g. for Indian mobile number mention 91-9999999999).
  2. Do not add '0' in the beginning of Mobile number.
G

Clarification / Guidelines on filling 'Related Person details' section
  1. Provide KYC number of related person if available.
H

Clarification / Guidelines on filling 'Related Person details - Proof of Identity [Pol] of Related Person' section
  1. Mention identification / reference number if Z- Others (any document notified by the central government)' is ticked.
 
 
     
 
     
 
List of two - digit state / U.T codes as per Indian Motor Vehicle Act, 1988
 
  State / U.T Code
  Andaman & Nicobar AN
  Andhra Pradesh AP
  Arunachal Pradesh AR
  Assam AS
  Bihar BR
  Chandigarh CH
  Chattisgarh CG
  Dadra and Nagar Haveli DN
  Daman & Diu DD
  Delhi DL
  Goa GA
  Gujarati GJ
  Haryana HR
 
  State / U.T Code
  Himachal Pradesh HP
  Jammu & Kashmir JK
  Jharkhand JH
  Karnataka KA
  Kerala KL
  Lakshadweep LD
  Madhya Pradesh MP
  Maharashtra MH
  Manipur MN
  Meghalaya ML
  Meghalaya MZ
  Nagaland NL
  Orissa OR
 
  State / U.T Code
  Pondicherry PY
  Punjab PB
  Rajasthan RJ
  Sikkim SK
  Tamil Nadu TN
  Telangana TS
  Tripura TP
  Uttar Pradesh UP
  Uttarakhand UA
  West Bengal WB
  Other XX
 
List of ISO 3166 two- digit Country Code
 
  Country Country Code
  Afghanistan AF
  Aland Islands AX
  Albania Al
  Algeria DZ
  American Samoa AS
  Andorra AD
  Angola AO
  Anguilla AL
  AntarcticaAntarctica AQ
  Antigua and Barbuda AG
  Argentina AR
  Armenia AM
  Aruba AQ
  Australia AU
  Austria AT
  Azerbaijan AZ
  Bahamas BS
  Bahrain BH
  Bangladesh BD
  Barbados BB
  Belarus BY
  Belgium BE
  Belize BE
  Benin BJ
  Bermuda BM
  Bhutan BT
  Bolivia, Plurinational State of BO
  Bonaire, Sint Eustatius and Saba BQ
  Bosnia and Herzegovina BA
  Botswana BW
  Bouvet Island BV
  Brazil BR
  British Indian Ocean Territory IO
  Brunei Darussalam BN
  Bulgaria BG
  Burkina Faso BF
  Burundi BI
  Cabo Verde CV
  Cambodia KH
  Cameroon CM
  Canada CA
  Cayman Islands KY
  Central African Republic CF
  Chad TO
  Chile CL
  China CN
  Christmas Island CX
  Cocos (Keeling) Islands CC
  Colombia CO
  Comoros KM
  Congo CG
  Congo, the Democratic Republic of the CD
  Cook Islands CK
  Costa Rica CR
  Cote d'Ivoire ICfite d'Ivoire CI
  Croatia HR
  Cuba CU
  Curacao ICurafao CW
  Cyprus CY
  Czech Republic CZ
  Denmark DK
  Djibouti DJ
  Dominica DM
 
  Country Country Code
  Dominican Republic DO
  Ecuador EC
  Egypt EG
  El Salvador SV
  Equatorial Guinea GQ
  Eritrea ER
  Estonia EE
  Ethiopia ET
  Falkland Islands (Malvinas) FK
  Faroe Islands FO
  Fiji FJ
  Finland FI
  France FR
  French Guiana GF
  French Polynesia PF
  French Southern Territories TF
  Gabon GA
  Gambia GM
  Georgia GE
  Germany DE
  Ghana GH
  Gibraltar GI
  Greece GR
  Greenland GL
  Grenada GD
  Guadeloupe GP
  Guam GU
  Guatemala GT
  Guermsey GG
  Guinea GN
  Guinea-Bissau GW
  Guyana GY
  Halti GT
  Heard Island and McDonald Islands HM
  Holy See (Vatican City State) VA
  Honduras HN
  Hong Kong HK
  Hungary HU
  Iceland IS
  India IN
  Indonesia ID
  Iran, Islamic Republic of IR
  Iraq IQ
  Ireland IE
  Isle of Man IM
  Israel IL
  Italy IT
  Jamaica JM
  Japan JP
  Jersy JE
  Jordan JO
  Kazakhstan KZ
  Kenya KE
  kiribati KI
  Korea, Democratic People's Republic of KP
  Korea, Republic of KR
  Kuwait KW
  Kyrgyzstan KG
  Lao People's Democratic Republic LA
  Latvia LV
  Lebanon LB
  Lesotho LS
  Liberia LR
 
  Country Country Code
  Libya LY
  Liechtenstein LI
  Lithuania LT
  Luxembourg LU
  Macao MO
  Macedonia, the former Yugoslav Republic of MK
  Madagascar MG
  Malawi MW
  Malaysia MY
  Maldives MV
  Mali ML
  Malta MT
  Marshall Islands MH
  Martinique MQ
  Mauritania MR
  Mauritius MU
  Mayotte YT
  Mexico MX
  Micronesia, Federated States of FM
  Moldova, Republic of MD
  Monaco MC
  Mongolia MN
  Montenegro ME
  Montserrat MS
  Morocco MA
  Mozambique MZ
  Myanmar MM
  Namibia NA
  Nauru NR
  Nepal NP
  Netheriands NL
  New Claedonia NC
  New Zealand NZ
  Nicaragua NI
  Niger NE
  Nigeria NG
  Niue NU
  Norfolk Island NF
  Northern Mariana Islands MP
  Norway NO
  Oman OM
  Pakistan PK
  Palau PW
  Palestine, State of PS
  Panama PA
  Papua New Guinea PG
  Paraguay PY
  Peru PE
  Philippines PH
  Pitcairn PN
  Poland PL
  Portugal PT
  Puerto Rica PR
  Qatar QA
  Reunioun IReuioun RE
  Romania RO
  Russian Federation RU
  Rwanda RW
  Saint Barthelemy ISaint Barthelemy BL
  Saint Helena, Ascension and Tristan da Cunha SH
  Saint Kitts and Nevls KN
  Saint Lucia LC
  Sain Martin (French part) MF
 
  Country Country Code
  Saint Plerre and Miquelon PM
  Saint vincent and the Grenadines VC
  Samoa WS
  San Marino SM
  Sao Tome and Principe ST
  Saudi Arabia SA
  Senegal SN
  Serbia RS
  Seychelles SC
  Slerra Leone SL
  Singapore SG
  Sint Maarten (Dutch part) SX
  Slovakia SK
  Slovenia SI
  Solomon Islands SB
  Somalia SO
  South Africa ZA
  Southe Georgia and the South Sandwich Islands GS
  South Sudan SS
  Spain ES
  Sri Lanka LK
  Sudan SD
  Suriname SR
  Svalbard and Jan Mayen SJ
  Swaziland SZ
  Swedan SE
  Switzerland CH
  Syrian Arab Republic SY
  Taiiwan, Province of China TW
  Tajikistan TJ
  Tanzania, United Republic of TZ
  Tahiland TH
  Timor -Leste TL
  Togo TG
  Tokelau TK
  Tonga TO
  Trinidad and Tobago TT
  Tunisia TN
  Turkey TR
  Turkmenistan TM
  Turks and Caicos islands TC
  Tuvalu TV
  Uganda UG
  Ukraine UA
  United Arab Emirates AE
  United Kingdom GB
  United States US
  United States Minor Outlying Islands UM
  Uruguay UY
  Uzbekistan UZ
  Vanuatu VU
  Venezuela, Bolivarian Republic of VE
  Viet Nam VN
  Virgin Islands, British VG
  Virgin Islands, U.S. VI
  Walls and Futana WF
  Western Sahara EH
  Yemen YE
  Zambia ZM
  Zimbabwe ZW
 
     
 
     
 
Annexure A1
CENTRAL KYC REGISTRY | Know Your Customer (KYC) Application Form | Individual | Correspondence / Local Address
Important Instructions:
  • A) Fields marked with '*' are mandatory fields.
  • B) Please fill the form in English and in BLOCK letters.
  • C) Please fill the date in DD-MM-YYYY format.
  • D) Please read section wise detailed guidelines / instructions at the end
  • E) List of State / U.T code as per Indian Motor Vehicle Act. 1988 is available at the end.
  • F) List of two character ISO 3166 country codes is available at the end.
  • G) KYC number of applicant is mandatory for update application.
  • H) For particular section update, please tick (ü) in the box available before the section number and strike of the sections not required to be updated.
 
For office use only Application Type* New    Update
(To be filled by financial institution) KYC Number (Mandatory for KYC update request)
   1. CORRESPONDENCE / LOCALADDRESS DETAILS (Please see instuction E at the end)
   Same as Current / Permanent / Overseas Address details
Line 1*
Line 2*
Line 3*
City / Town / Village*
District*
  Pin / Post Code*   State / U.T Code*   ISO 3166 Country Code*
   2. CONTACT DETAILS (All communications will be sent on provided Mobile no./Email.ID) (Please refer instruction F at the end)
Tel. (Off)   Tel. (Res)   Mobile
FAX   Email ID
        3. APPLICANT DECLARATION
 
  • I hereby declare that the details furnished above are true and correct to the best of my 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 am aware that I may be held liable for it.
Date:   Place:
 
 
 
     
 
     
 
Annexure B1
CENTRAL KYC REGISTRY | Know Your Customer (KYC) Application Form | Individual | Related Person
Important Instructions:
  • A) Fields marked with '*' are mandatory fields.
  • B) Please fill the form in English and in BLOCK letters.
  • C) Please fill the date in DD-MM-YYYY format.
  • D) Please read section wise detailed guidelines / instructions at the end
  • E) List of State / U.T code as per Indian Motor Vehicle Act. 1988 is available at the end.
  • F) List of two character ISO 3166 country codes is available at the end.
  • G) KYC number of applicant is mandatory for update application.
  • H) For particular section update, please tick (ü) in the box available before the section number and strike of the sections not required to be updated.
 
For office use only Application Type* New    Update
(To be filled by financial institution) KYC Number (Mandatory for KYC update request)
   1. 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 Assignee Authorized Representative
 
 
Prefix   First Name   Middle Names   Last Name
Name*
     
 
(If KYC number and name are provided, below details of section 6 are optinal)
PROOF OF IDENTITY (POI) OF RELATED PERSON* (Please see instruction (H) at the end)
A- Passport Number   Passport Expiry Date
B- Voter ID Card      
C- PAN Card      
D- Driving Licence   Driving Licence Expiry Date
E- UID (Aadhaar)      
F- NREGA Job Card      
Z- Others (any document notified by
      the central government)		   Identification Number
S- Simplified Measures Account -
      Document Type code 		  Identification Number
   2. APPLICANT DECLARATION
 
  • I hereby declare that the details furnished above are true and correct to the best of my 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 am aware that I may be held liable for it.
Date:   Place:
[Signature / Thumb Impression]
Signature / Thumb Impression of Applicant
     3. ATTESTATION / FOR OFFICE USE ONLY
Documents Received Certified Copies
KYC VERIFICATION CARRIED OUT BY
Date :
Emp. Name
Emp. Code
Emp. Designation
Emp. Branch
 
INSTITUTION DETAILS
Name
Code
 
     

HDFC ERGO General Insurance Company Limited. (Formerly HDFC General Insurance Limited from Sept 14, 2016 and L&TGeneral Insurance Company Limited upto Sept 13, 2016). CIN: U66030MH2007PLC177117. Registered & Corporate Office: st1Floor, HDFC House, 165 - 166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Customer Service Address: D-301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078. For more details on the risk factors, terms and conditions, please read the sales brochure before concluding the sale. Trade Logo displayed above belongs to HDFC Bank Ltd and ERGO International AG and used by the Company under license. Toll-free: 1800 2 700 700 | Fax: 91 22 66383699 | care@hdfcergo.com | www.hdfcergo.com.UIN:HDFHLIP10002V010910. IRDAI Reg No. 146.