Southern Star Chits Pvt. Ltd.
Recent
Regd. Off. C-1, DDA Market (LSC), 1st Floor, MOR Land, Photo with
New Rajender Nagar, New Delhi-60 Signature across
Photo
Mob. : 9999536638-39 E-mail : chits.southern@yahoo.com
KYC INFORMATION FORM
Mem. No.
D D M M Y Y Y Y
Date of Birth
Name
Resi. Address: ........................................................... Office Address: ..................................................................
................................................................................... ..........................................................................................
................................................................................... ..........................................................................................
................................................................................... ..........................................................................................
Pin Pin
Tel. Nos.
Mob. Nos.
E-Mails
PAN No.
UID No.
Assets Owned
House Car Two Wheeler Others....................................................
Family Information Name Date of Birth Age
Father D D M M Y Y Y Y
Mother D D M M Y Y Y Y
Spouse D D M M Y Y Y Y
Child 1 D D M M Y Y Y Y
Child 2 D D M M Y Y Y Y
Child 3 D D M M Y Y Y Y
Occupation Monthly Income
Govt. Pvt. Business Doctor Lawyer < 20,000 20,001-50,000 50,001-1,00000
Teacher Engineer Others.............................. > 1,00001
Please attach photocopy of ID proof and address proof of residence from the following documents.
A). Passport E). Aadhar Card (UIDA)
B). Voter’s Identity Card F). Bank Passbook
C). Driving License G). Electricity Bill (Latest)
D). PAN Card H). Telephone Bill (Latest)
Date : ......................................... Signature : .......................................
(TO BE FILLED-UP IN CAPITAL LETTERS ONLY)
NB: ALL DOCUMENTS TO BE SELF ATTESTED BY THE MEMBER. Signature of Authorized officer
ORIGINAL DOCUMENTS TO BE SHOWN DURING SUBMISSION Name:
