KYC Registration

Client Registration Application Form

Select City *  

Client Name*
Customer Account Code *

Full Name of Firm/HUF/ Corporate/Proprieorship/ Partnership/Individual *
Correspndence Address (with Landmark) *
Email *
PAN NO. *
City
Pincode
Ph. NO.*
State
Country
Is the premise Owned
Leased
Licensed
Office premises have been occupied by applicant since years. Years

Same As Correspndence Address
Office Address (with Landmark) *
PAN NO.
City
Pincode
Ph. NO.
State
Country
Is the premise Owned
Leased
Licensed
Office premises have been occupied by applicant since years. Years

Same As Correspndence Address
Registerd Address (with Landmark) *
PAN NO.
City
Pincode
Ph. NO.
State
Country
Is the premise Owned
Leased
Licensed
Office premises have been occupied by applicant since years. Years

Date of Formation
/Incorporation of Proprietors/HUF/
Partnership/Corporate 		CIN No

Same As Correspndence Address
Warehouse Address (with Landmark) *
PAN NO.
City
Pincode
Ph. NO.
State
Country
Telephone No Fax


Sales Tax Registration Details

GST Certifivate *
CST Certifivate *
GST Registration No* State* Validity*
CST Registration No* State* Validity*


Bank Account Details

Cancelled Cheque Leaf *
Bank Pass Book *
Bank Statement *
Bank Name *
Branch *
Bank Account Type *
Bank Account No Bank Account No*
Date of Opening Account*   MICR Code*
Net worth as per balance sheet as on *   Rs.(In Lacs)*
Trading experience*   Year*


Details of Introducer

Name
Gender:
Relation with Applicant
Permanent Address with Landmark
PAN No. City
Ph No. State
Country Pincode
Telephone No Fax
Mobile No Email Id
Signature ___________________________________

Details of Referencer - 1

Name*
Gender:*
Relation with Applicant *
Permanent Address with Landmark*
PAN No.* City*
Ph No.* State*
Country* Pincode*
Telephone No* Fax*
Mobile No* Email Id*
Signature ___________________________________

Details of Referencer - 2

Name
Gender:
Relation with Applicant
Permanent Address with Landmark
PAN No. City
Ph No. State
Country Pincode
Telephone No Fax
Mobile No Email Id
Signature ___________________________________


Details of Sole Proprietor / HUF

Name
Gender:
Permanent Address with Landmark
City Pincode
State Country
Date of Birth(Proprietor/Karta)
Mobile No
Email id
Pan No(Proprietor/Karta):
Passport Size Photo of Proprietor/Karta
Note:Passport Size Photo of Proprietor/Karta with signature across the photograth
Speciman Signature of Proprietor/Karta ___________________________________________


Details of Partners/Directors 1

Name of Partner / Director*
Gender:*    
Designation:*
Permanent Address with Landmark*
City* Pincode*
State* Country*
Date of Birth(Proprietor/Karta)*
Mobile No*
Specimen Signature
Email Id*
PAN DETAILS
PAN No.(Partner/Director)*
Passport Size Photo of Proprietor/Karta
Note:Passport Size Photo of Proprietor/Karta with signature across the photograth
Speciman Signature of Proprietor/Karta ________________________________________




AMRAPALI INDUSTRIES LTD. :TRADING CUM CLEARING MEMBER MCX MEMBER CODE: 10675 FMCUMC: MCX/TCM/CORP/0291, NCDEX MEMBER CODE: 00856 FMCUMC - NCDEX-CO-07-00856, ACE MEMBER CODE: 5011 FMCUMC - ACEL/TCM/CORP/137

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