KYC Form

(For the purpose of Directive No.1 under Anti Money Laundering Act 2064, Regulation 2066 and Directive 2067 issued to Insurance Companies)

Customer Due Diligence Form

Customer Full Name (in Block)*
Photo*
Accepted file types: jpg, png.
Name of Father/Husband*
Occupation*
Employer's Name*
Designation*
Permanent Address*
State / Province / Region
Temporary Address*
State / Province / Region
Date of Birth*
Telephone No.*
Mobile No.*
Citizenship/Passport No.*
Issued Date
Place of Issued*
State / Province / Region
PAN No.
Signature
Accepted file types: jpg, png.