THE BANK OF RAJASTHAN LIMITED

CUSTOMER IDENTITY FORM (FOR INDIVIDUALS ) (INF-10)

Branch_____________________

Customer ID (To be filled by Bank)

Applicant’s Details

Date ____________________

Title ( Tick √)  Mr.  Mrs.  Miss  Master  Baby  Dr.  Er.  Prof.

*Name in full

Surname

First name

Middle name

Father’s / Husband’s name

** Address: Plot /House Name / No.___________________________ Colony : _______________________________ Road_________________________________________ City:________________________ State:_________________ PIN:___________________ Country ________________ E-Mail ID_______________________________________ Telex No. ___________________________________ Fax No. ______________________________ Phone No. (with STD / ISD Code) ______________________ Mobile No.___________________________

Date of Birth

Date of attaining majority (In case of minor)

D

D

M

M

Y

Y

Y

Y

D

D

M

M

Y

Y

Y

Y

Gender ( Tick √) :  Male  Female  Others

Caste:  SC / ST  Others

Community ( Tick √) :  Hindu  Muslim  Sikh  Christian  Jain  Buddhist  Parsis  Others

Type (Tick √) :  Resident Indian  Non Resident Indian  Staff  Retired Staff  Staff Related

Status (to be filled by Bank)

If Staff, Emp. Code ________________________

If Staff Related

Name of staff ____________________________________________________________________________ Relationship ____________________ Emp. Code____________ Place of Posting _____________________

Occupation (Tick √):  Agriculture & Allied Activity  Transport Operator  Professional & Self Employed  Manufacturing  Antique Dealer Gun / Arms Dealer  Other Trade  Service  House Wife  Student  Unemployed  Other (specify) ________________________________

Details of Document in support of Identity

Details of Document in support of Address

Name & Identifying number of Document ____________ ____________________________________________

Name & Identifying number of Document ____________ ____________________________________________

Issuing Authority

Issuing Authority

Passport Details

Passport No.

Date of issue

Place of Issue

Date of expiry

PAN No. _____________________ (Form 60/61 be filled in by those who do not have PAN ). Are you a tax Assessee � Yes � No If yes, Details of Ward / Circle / Range where last return of income was filed: ________________________________________________________

Non–resident Details

Nationality_______________________ Date of becoming Non-resident___________________ Name of Country______________________________ Overseas Residential Address ______________________ _______________________________________________ _______________________________________________

Country Type (Tick √):  Bilateral /  External Date of Non-resident becoming Resident____________ Overseas Office Address __________________________ _______________________________________________ _______________________________________________

Relative’s Name (in India) _________________________ His / her Residential Address (in India) _______________ _______________________________________________ _______________________________________________

Relationship_______________________________ His / her Office Address (in India) ____________________ _______________________________________________ _______________________________________________

* Submit self attested true copy along with original @ of any one of the documents (from List A) to establish identity.

** Submit self attested true copy along with original @ of any one of the documents (from List B) to prove address.

@ Originals to be returned after verification.

Note: For opening accounts in the joint names of two or more individuals, separate personal ID of each individual is required to be created after applying KYC Norms, for which separate Customer ID forms be submitted.

Introduction Details
Name:________________________________________________________________________________________ Address:______________________________________________________________________________________ Customer Id.____________________________________ A/c No.________________ I know the applicant for the last ___________months / years. I confirm the identity and address of the applicant. Date____________________ (Signature of Introducer)
Photo of Customer	It is declared and confirmed that the information disclosed in this Identity Form is true and correct to the best of my knowledge and belief. Date ________________ (Signature of the Applicant.)