Corporate Office, 2nd Floor, Speed Post Center
Bhai Vir Singh Marg, Gole Market, New Delhi – 110001
Enhanced Due Diligence form for Individuals
Verified
by DOP EU or
Bank Staff
A. Personal Information
Customer ID Account No
Customer Name
Date of Birth
Pan
ID Proof (Obtain self-attested copy)
B. Address and Contact Details
Present Address*(Obtain self-attested Proof/Declaration)
Pin Code
Permanent Address
Pin Code
Mobile No (Own/Relatives/third party mobile no)
E Mail ID
C. Occupation and Income
If salaried – Obtain ITR/Salary slips, Organization
Name
If Self Employed – ITR/Income Declaration, Nature of
Business
If Agri and Allied- Income Declaration
If Professional – ITR/Income Declaration, Profession Name
Others – (Income Document/Income Declaration)
Gross Annual
Income
Source of funds: Pension/Funds from Family members/Salary/Rent/Business Income/Agri
Income/Others
Corporate Office, 2nd Floor, Speed Post Center
Bhai Vir Singh Marg, Gole Market, New Delhi – 110001
D. Expected Annual turnover in account
< 2 Lakhs 2 lakhs to 5 lakhs >5 lakhs
Undertaking by Customer
I confirm that the information provided by me is correct and the mobile number mentioned in the
form also belongs to me and used by me. All the transactions in the account are done myself. If in
future, any fraudulent transactions are found in the account, I shall be responsible for the same.
Customer’s Name:
Customer’s Signature:
Branch Recommendations:
Customer identification and address verification has been conducted by bank staff, by verifying given
information with original documents. Copy of records are attached with the application.
Basis the request given by the customer and due diligence conducted, I recommend/approve for
removal of freeze/lien/restrictions from the customer’s account
Branch in Charge Signature with office seal: End User Signature:
Name: EU Name:
Employee ID: EU Emp. ID.:
Date: Access Point Name:
Documents Collected
1. ID Proof
2. Address Proof
3. Income Proof/Declaration
4. Any other document
