Scribd
Upload
84 views2 pages

Sbi Documents

The document is a KYC self-declaration form for Subrat Kumar Rout, confirming no changes in KYC information since the last update. It includes personal details such as account number, address, PAN, and contact information, along with a declaration of responsibility for any changes in the provided information. The form is intended for use by the State Bank of India for customer due diligence and record-keeping.

Uploaded by

anonymousanny369
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
84 views2 pages

Sbi Documents

The document is a KYC self-declaration form for Subrat Kumar Rout, confirming no changes in KYC information since the last update. It includes personal details such as account number, address, PAN, and contact information, along with a declaration of responsibility for any changes in the provided information. The form is intended for use by the State Bank of India for customer due diligence and record-keeping.

Uploaded by

anonymousanny369
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

Subrat Kumar Rout

.
KYC ANNEXURE ‘A’

laugaon
STATE BANK OF INDIA___________________ BRANCH

SELF DECLARATION FORM FOR KYC UPDATION


(INDIVIDUALS: NO CHANGE IN KYC INFORMATION)
Account Number* 33778429928
CKYCR No *
OVDs submitted to Bank ~YES NO Date of Expiry of OVD
are valid/not expired (as (If applicable) NA
on date) *
Name* SUBRAT KUMAR ROUT
.
PAN Number (If available) BOGPR7202L
Current Address* AT-SAREIKUL PO-SIKHER
Line 1: ________________________________________________________________
Naugaon
Line 2: ________________________________________________________________
City/Town/Village: _______________
Odisha
Sag at singh
pur
District: ____________________________
State: _____________________ 754113
PIN: _____________________________________
india
Country: _______________
Occupation*
Annual Income*
Sources of Income -
(Please tick all that are Salary Business Income Agriculture Investment Income Pension Others
applicable) *
Mobile Number 9776436453
Email ID S KRout 15 e gmail .
Com

CUSTOMER’S DECLARATION
I hereby declare that there is no change in existing status of my KYC Information which was provided at the time of opening the
account / last KYC updation. I undertake the responsibility to declare, disclose and provide immediately and in no case beyond 30
days from the date of change, any changes that may take place in the information provided herein/or otherwise, as well as in the
documentary evidence provided by me or if any certification becomes incorrect or undergoes a change. In case the above information
is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.

Subrat Kumar Rout


03-08 -
2024
Date:………………………. Signature/Thumb Impression of Customer
Sarreikul
Place:……………………… SUBRAT KUMAR ROUT.
Name ……………………………………………………..

For Office Use only


1. Certified that KYC Documents of the Customer available with the Bank are as per current Customer Due Diligence (CDD)
Standards.
2. CKYCR Number of the customer is available in Bank records.
3. PAN details (if available) have been verified from database issuing authority.
4. Information submitted by the customer verified & KYC updation date entered in CBS.

Maker……………………….. Checker……………………………
PF No.......................... (S.S. No______________)
(This form is to be sent to LCPC for digitisation and storage)

You might also like