Customer Updaon Form for
ReKYC & Profile Update -
Resident Indian/ HUF
(All f ields are mandatory)
The Branch Head Axis Bank Ltd.
Branch Sol ID DateCKYC ID if available
RMA BAR CODE
*Is the Customer having links with any Polically Exposed Persons
*COMMUNICATION ADDRESS (Please leave space between two words)
Address
*Mobile Number
Email id
Landline # (R)
(O):
Or Form 60
*Permanent Account Number (PAN)
Name as per PAN Card
Note: Incase you would like to update your PAN in the Bank's records, please fill the below PAN details
Note: Details of demographics would be captured across all your relaonships. Incase you would like to update in specific relaonship, please select below.
1
(To be cked only when
Occupaon is Salaried)
Pvt Ltd Public Ltd Proprietorship
Partnership f irm
Public Sector Government Mulnaonal
Trust/Associaon/
Society/Club
If Salaried
____________________________________________
(Only Alphabecal characters allowed)
Salary
Business Income Investment Income
Agriculture
Others
*Source of Funds
(To be cked only when
Occupaon is Self Employed)
Informaon
Technology
If Self Employed
Trader
Real Estate
Stock Broker
Bullion/
Gold Jewellery
Agriculture
Professional Service provider
Money Lender
Salaried
Self Employed
Rered
Student
Housewife Unemployed
Polician
* Occupaon Code
(To be filled by branch Official)
*Occupaon
*Customer Name
Middle Name Last NameFirst Name
Middle Name Last NameFirst Name
*Name as per
ID Proof
Applicant Details
Contact Details
+ 9 1
Addional Details
Y Y Y
Y
*Date of Birth/Date of Incorporaon
Naonality : Indian
No of years in Business
(If Self Employed)
D D M M
Y Y Y
Y
D D M M
DOB as per PAN Card
Y Y Y
Y
D D M M
*Gender
Male Female Transgender
*Customer Id
*A/C No.
*Annual Income
(Only Absolute & numeric
Values to be entered)
Same as communicaon address
*PERMANENT ADDRESS (Please leave space between two words)
Address
Maiden Name (If any*)
Middle Name Last NameFirst Name
Middle Name Last NameFirst Name
Father’s Name*
Or
Middle Name Last NameFirst Name
Mother’s Name*
Or
Middle Name Last NameFirst Name
Spouse’s Name
Middle Name Last NameFirst Name
Credit CardsLoan A/csCurrent A/csSavings & FD
Landmark
City
Pin code State
Country
I N D I A
I N D I A
Landmark
City
Pin code State
Country
2
*HUF Declaraon & Mandate
The joint family/firm is carrying business under the name and style of M/s. _______________________________________________________,
which is our joint family trade
We, the undersigned, hereby authorize (Karta/Manager)____________________________________ to operate upon the Bank account severally, jointly and all transacons entered into
and obligaons incurred or to be hereaer incurred by them will be binding on all of us. Any acts done/to be done to comply with Bank's rules which are in force or as amended from
me to me in the maer of maintaining and conduct of such accounts will be binding on us.
Please treat this as a mandate from us to:
We hereby undertake to indemnify the Bank in case of any loss/claims/damages/penalty/charges etc suffered by the Bank, on account of our aforesaid instrucon/mandate.
Place: Date: Name :
Signature :_____________________________
Signature :_____________________________
Signature :_____________________________
Signature :_____________________________
*Here state the name of the children of each of
the family
members stang their parentage and state also the name of guardians by whom they are represented.
Form 60
Form of declaraon to be f iled by a person who does not have a PAN and who enters into any transacon specified in rule 114B
If PAN not applied, fill esmated total income (including income of spouse, minor child etc. as per
secon 64 of Income-tax Act, 1961) for the financial year in which the above transacon is held
a Agricultural income (`)
b Other than Agricultural income (`)
Verificaon
I am a tax resident of India and not resident of any other country
I am a tax resident of the country/ies menoned in the table below:
Please indicate the country/ies in which the enty is a resident for tax purposes and the associated Tax ID Number below:
City of Birth* Country of Birth*
Country#
Tax Idenficaon
Number%
Idenficaon Type
(TIN or Other, please specify)%
Address For Tax Purpose*
Communicaon Address Permanant Address Please note the address below
Landmark
Pin
S
ta
te
Country
_____________________________
(Applicable for Current Account only)
# To also include USA, where the individual is a cizen/ green card holder of USA % incase Tax Idenficaon Number is not available, kindly provide funconal equivalent FATCA
- CRS Cerficaon. I have understood the informaon requirements of this Form (read along with the FATCA/CRS Instrucons and Terms & Condions) and hereby Confirm that
informaon provided by me/us on this Form is true, correct, and complete and hereby accept the same.
Terms & Condions
• In case of Joint A/c., separate form is required.
• All informaon provided by me of any nature (including personal & sensive informaon) can be shared with agencies/service providers who have an agreement business
purpose and on need to know basis.
• Axis Bank shall always strive to comply with the rules and regulaons as applicable from me to me on this context in accordance with the bank's Privacy policy my consent
to the sharing of the data, the products/services available to me, pursuant to the consent provided earlier, shall no longer be available to me, and iniate closure of such
products/ services.
• All the terms and condions, processes and alternaves have been explained to me in local language as well.
We, the undersigned, for ourselves and _______________________________________________________________________________as Manager/Karta and Ejaman of the family, also guardian of
*____________________________________________________________ request you to take noce that we are members of Hindu Undivided Family/firm.
If applied for PAN and it is not yet generated enter date of applicaon and acknowledgement number
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 esmated total income (including income of spouse, minor child etc. as per secon 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 transacon is held will be less than maximum amount not chargeable to tax. Verified
today, the _____________________________________ day of___________________________20____
Date Place __
The Hindu Undivided Family is engaged in_______________________________________________ acvity/occupaon not in the nature of the business or trade.
Collect/ Credit Cheques/ remiances/ Warrants/ Refund orders/ ECS/ RTGS/ NEFT/ instruments issued in favour of ________________________________________, being the karta in the
account in the HUF A/c No______________________________________of ____________________________________ HUF
Declaraons (Tick as Applicable)
*FATCA- CRS DECLARATION Please ck the applicable tax resident declaraon (Any one)*
D D M M Y Y Y Y
Date of Birth
D D M M Y Y Y Y
D D M M Y Y Y Y
Place: Date: Name :
D D M M Y Y Y Y
D D M M Y Y Y Y
D D M M Y Y Y Y
D D M M Y Y Y Y
Place: Date: Name :
Place: Date: Name :
Signature
_____________________________
Signature
*Constuon code
• I hereby declare that the details furnished above 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 informaon is found to be false or untrue or misleading or misrepresenng, I/We am/are aware that I/we may be held
liable for it.
• My personal / KYC details may be shared with Central KYC Registry
• I hereby consent to receiving informaon from Central KYC Registry through SMS/Email on the above registered number/email address
• I agree to indemnify and keep indemnified the Bank at all mes from and against all costs, charges, damages, penales (including aorney fees)
suffered and/or incurred by for any act done or omied to be done on account of the above declaraon.
Customer Declaraon
KYC VERIFICATION CARRIED OUT BY
*Identy Verificaon
Done Place: *Date
*Emp. Name :
*Emp. Designaon : *Emp. Branch:
Acknowledgement Copy
Customer Name
Date of Request Received
Service Request No.
Name of Branch Official
Employee Number of Branch Official
Signature & Branch Stamp
Signature & Branch Stamp
3
*
*Documents Received
Cerfied Copies E-KYC data received from UIDAI Data received from Offline verificaon Digital KYC Process Equivalent e-document
*Designaon
OH BH *S.S No
Cerfied that this Form is complete in all respect & all relevant documents are obtained & verified with Mode of operaon and
signatures of the A/c. The request may please be processed.
•
Customer DOB Mismatch Declaraon: I cerfy that the customer has personally met and idenfied the customer. Kindly process the request.
•
Signature Mismatch Declaraon: I cerfy that the customer has personally met by me and I have idenfied the customer and he/she has signed in my presence.
Kindly process the request.
•
Customer Photo Mismatch Declaraon: I confirm that the photo of the applicant affixed on CRF and that on OVD is of one and the same person.
•
Negave Declaraon:
I have conducted necessary due diligence and confirm that the name of the customer for Rekyc updaon is not part of negave database.
Branch Declaraon
Branch Declaraon - For Bank Use Only
Customer Acknowledgement
•
E-Aadhaar Declaraon: E-Aadhaar downloaded in presence of me - wherever applicable.
• Name Mismatch Declaraon: I cerfy that the customer has personally met and has signed in my presence. Kindly process the request.
S.S No
E-Aadhaar Declaraon
Name Mismatch Declaraon
There is no change in the Aadhaar Detail aer the date of download of e-Aadhaar submied to the Bank.
I want to update Rekyc for Current/Savings/FD/OD/Loan Account with your Branch. I am subming the following documents which carry variaons in my name
Name as per NSDL:
Name as per OVD:
With reference to my request for Rekyc/Profile updaon, I hereby affirm that my signature has changed from the one featured in my____________________________________(document)
over passage of me. My present signature is as under and I hereby confirm that all acons and transacons authorized/executed by me using the below signature shall be legally
binding on me.
Previous Signature Present Signature
With reference to my request for Rekyc/Profile updaon, I hereby affirm that date of birth as declared by me in the form is correct and request you to
kindly consider the same and make the necessary update in the Bank records.
Signature of Applicant
AFFIX
RECENT
PHOTO
&
Customer Signature
Across Photo and
Branch stamp and signature
Customer DOB Mismatch Declaraon
Signature Mismatch Declaraon
Profile Update Declaraon
Inoperave Account Acvaon
Y Y Y
Y
D D M M
Employee Signature & Branch Stamp
Y Y Y
Y
D D M M
Middle Name Last NameFirst Name
Resident Individual
HUF
Name:
D D M M Y Y Y Y
Name is correct as per the OVD and both the names are one and the same. I request you to update Rekyc as per the OVD.
Name differs with NSDL site; kindly aach PAN copy
I Would Like To Acvate My Inoperave Account
I agree to update my profile details to be linked with my account. I have read and agreed to the terms & condions associated with the below menoned scheme code.
Scheme code:
*Reason for not operang the account
Not in state / country Using alternate account Others _________________________________________________
Middle Name Last NameFirst Name
Middle Name Last NameFirst Name
Middle Name Last NameFirst Name
Middle Name Last NameFirst Name
*Emp. Code:
Please f ill as many ReKYC forms as the number of account holders when raising a Profile Update request in Saksham.