Proactive Professional Services Pvt. Ltd.

Know Your Customer (KYC) Form

A. Identity Details

Name of Department

Name

Date of Birth

Photo Passport size
(affixed by company)

Contact No. Not verified

Alternate No. Not verified

Aadhaar Card Number

PAN Card Number

Marital Status

Gender

Father's Name

Mother's Name

Father's Contact Number Not verified

Mother's Contact Number Not verified

Father's Occupation

Mother's Occupation

Blood Group

Emergency Contact No. Not verified

May match a family member's number, but must differ from your own Contact No.

Email id Not verified

B. Address Details

Permanent Address Details

Address 1

Address 2

City

State

Pin Code

Present Address Details Same as permanent address

Address 1

Address 2

City

State

Pin Code

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 will be held liable for it.

Employee Signature (type full name)

Date

To be filled by Company

This section is completed by the company. It is read-only on the employee form.

Required Documents (Copy)

Aadhaar Card PAN Card Address Proof Passport Size Photograph Cheque (Bank)

Verified By

Authorized Signature