Name *

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PAN NO.

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Email*

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Address for correspondence

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Other Details

Gross Annual Income Details*Below Rs 1 Lac1-5 Lac5-10 Lac10-25 Lac25 Lacs-1 croreMore then 1 crore

Net-worth Amount*

Net-worth Date*

OccupationPrivate SectorPublic SectorGovernment ServiceBusinessProfessionalAgriculturistRetiredHousewifeOthers

Please Selects, if applicable, for any of your authorized signatories/ Promoters/ Partners/ Karta/ Trustees/ whole time directorsPolitically Exposed Person (PEP)Related to a Politically Exposed Person (PEP)

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