16 KYC details* [To be filled in by Foreign Institutional Investor or a Qualified Foreign Investor, as prescribed under the regulations issued by
the Securities and Exchange Board of India (SEBI)]
[ "Control" as defined under SEBI (Substantial Acquisition of Shares and Takeovers) Regulations,1997
" Beneficial owner" as defined in the para 5.1 of SEBI circular on Anti Money Laundering.]
(a) In case of Individuals
Please select
as applicable
Marital Status
Single
Married
Divorced
Widow/Widower
Citizenship Status
I Foreigner
P Person of Indian origin
O Overseas citizen of India
In case of foreigner, country of citizenship
Occupation details
Private sector service
Public sector/Govt. service
Business
Professional
Agriculturist
Retired
Housewife
Student
Others
(b) In case of non individuals
Please select
as applicable
R Private Company
U Public Company
D Body Corporate
S Financial Institution
N Non Government Organization
C Charitable Organization
( c) Gross Annual Income - INR
Netwoth (Assets less liabilities) in INR
(d) In case of a Public Company, whether listed on a stock exchange
Yes
No
Please select
as applicable
If yes, then indicate name of the stock exchange
(e) In case of Non-individuals
Does it have few persons or persons of the same family holding beneficial ownership and control.
Yes
No
Please select
as applicable
["Control" :Control shall include the right to appoint majority of the directors or to control the management or policy decisons exercisable
by a person or persons acting individually or in concert, directly or indirectly, including by virtue of their shareholding or management
rigths or shareholders agreements or voting agreements or in any other manner
"Beneficial owner" means the natural person who ultimately owns or controls the
applicant and/or the person on whose behalf a transaction
is being conducted, and
includes a person who exercises ultimate effective control over a juridical person]
(f) Is the entity involved / providing any of the following services
Please select
as applicable
Foreign exchange, Money Changer Services
Yes
No
Gaming/Gambling/Lottery services (Casinos and Betting Syndicates)
Yes
No
Money Lending, Pawning
Yes
No
(g) Whether the applicant or the applicant's authorised signatories/trustees/office bearers is
(i)
a politically exposed person
Yes
No
(ii)
related to a politically exposed person
Yes
No
[For definition of politically exposed person refer to guidelines issued under the Prevention of Money Laundering Act (PMLA)]
(h) Taxpayer identification Number in the country of residence
17
I/We
, the applicant, in the capacity of
do hereby declare that what is stated above is
true to the best of my/our information and belief.
Place
D
D
M M Y
Y
Y
Y
Signature / Left Thumb Impression of
Date
Applicant (inside the box)