KNOW YOUR CUSTOMER FORM
1. Name of Company SUJIT NAGENDRA NADKARNI
If Partnership firm (name of all partners)
□ 28/06/2017
2 Year of Establishment
□ Individual/Proprietary firm
3 Nature of Company Ownership
□ Company
□ Trusts/Foundations
□ Partnership firm
4 Name of Promoters / Directors Contact Details
5 Contact Persons Designation Mobile No. E-mail Identities Signatory to
Bank A/c. (Y/N)
SUJIT NAGENDRA Partner/M.D. 8850018974 [email protected]
NADKARNI
6 Nature of Business
7 Permanent or Registered address A-36, MIDC CHAKAN INDUSTRIAL
AREA PHASE -1 NEAR SUZLON PUNE
Telephone
410501
Fax number
0253-2374352
Mobile Number
E-mail address
Website
8 Branch address (if any)
Telephone
Fax number
E-mail address
9 In case of CHA / NVOCC / Consolidator
(a) License No. (Copy)
(b) Member of BCHAA
10 PAN No. (Mandatory) ADEPN0912D
11 TAN No.
12 GST NO. 27ADEPN0912D1Z1
12 TIN No. 27340835028V
14 IEC No. (Not mandatory for individuals)
15 Bank Name TJSB SAHAKARI BANK LTD.
16 Accounts Number 045130100000060
17 Branch
18 IFSC CODE
I/We hereby declare that the particulars given herein above are true, correct and complete to the
best of my/our knowledge and belief, the documents submitted in support of this Form KYC are
genuine and obtained legally from the respective issuing authority. In case of any change in any of
the aforementioned particulars, I/we undertake to notify you in writing failing which the above
particulars may be relied upon including all shipments/documents executed and tendered by the
individual so authorized and mentioned in above. I/we hereby authorize you to submit the above
particulars to the customs and other regulatory authorities on my/our behalf as may be required in
order to transport and customs clear my/our shipments.
Place: MUMBAI Signature
Date: 12/06/2019 Name:
Official Seal (for all other than individuals)