{"id":1910,"title":"CENTRAL KYC REGISTRY | Know your Customer (KYC) Application Form | Individual","purpose":"service","insurer":{"slug":"star-union-dai-ichi-life-insurance","name":"Star Union Dai-Ichi Life Insurance Company Limited"},"source_pdf":"https://dxwkpt4djlxwl.cloudfront.net/CKYC_Form_d52291b1a1_f966fb4099.pdf","sha256":"76edff158d20134fd1b61edb1014abd74f1c38ad7ff53386921adae3de78452e","pages":6,"collected":"2026-10-20","instructions":{"about":"This form is used to apply for or update an individual's KYC (Know Your Customer) details with the Central KYC Registry. It is filled by the individual applicant and optionally by related persons.","notes":["Fields marked with ‘*’ are mandatory.","Fill the form in English and in BLOCK letters.","Fill all dates in DD-MM-YYYY format.","Use two-digit state codes as per Indian Motor Vehicle Act, 1988 and two-character ISO 3166 country codes as per list at the end.","KYC number is mandatory for update applications.","For particular section update, tick the box before the section number and strike off sections not required to be updated.","Self-certification of documents is mandatory.","If driving licence or passport is used as PoI, expiry date must be provided.","For Simplified Measures Accounts, specific document codes apply.","Provide certified copies of PoI and PoA documents.","Do not add '0' before mobile number; include country code.","In case of multiple correspondence/local addresses or related persons, use Annexure A1 or Annexure B1 respectively."],"title":"CENTRAL KYC REGISTRY | Know your Customer (KYC) Application Form | Individual","submit":{"to":"","how":"","address":""},"purpose":"service","sections":[{"title":"Application Details (For office use only)","fields":[{"help":"Select the type of KYC application","type":"choice","label":"Application Type*","options":["New","Normal","Simplified (for low risk customers)","Small","Update"],"required":true,"pdf_field":""},{"help":"Application number if applicable","type":"text","label":"Application No.:","options":[],"required":false,"pdf_field":""},{"help":"Mandatory for update application","type":"text","label":"KYC Number","options":[],"required":false,"pdf_field":""},{"help":"Select the account type","type":"choice","label":"Account Type*","options":["Professional","Self Employed","Retired","Housewife","Student","Private Sector","Public Sector","Government Sector","Not Categorised"],"required":true,"pdf_field":""}],"filled_by":"financial institution"},{"title":"1. Personal Details","fields":[{"help":"Enter full name with prefix as per ID proof","type":"text","label":"Name* (Same as ID proof)","options":[],"required":true,"pdf_field":""},{"help":"Enter maiden name if applicable","type":"text","label":"Maiden Name (If any*)","options":[],"required":true,"pdf_field":""},{"help":"Enter either father's or spouse's name","type":"text","label":"Father / Spouse Name*","options":[],"required":true,"pdf_field":""},{"help":"Enter mother's name","type":"text","label":"Mother Name*","options":[],"required":true,"pdf_field":""},{"help":"Enter date in DD-MM-YYYY format","type":"date","label":"Date of Birth*","options":[],"required":true,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender*","options":["M- Male","F- Female","T- Transgender"],"required":true,"pdf_field":""},{"help":"Select marital status","type":"choice","label":"Marital Status*","options":["Married","Unmarried"],"required":true,"pdf_field":""},{"help":"Select citizenship status","type":"choice","label":"Citizenship*","options":["Resident Individual","Foreign National","Non Resident Indian","Person of Indian Origin"],"required":true,"pdf_field":""},{"help":"Select country code from list at end","type":"choice","label":"ISO 3166 Country Code of Birth*","options":[],"required":true,"pdf_field":""},{"help":"Enter place or city of birth","type":"text","label":"Place / City of Birth*","options":[],"required":true,"pdf_field":""},{"help":"Select occupation type","type":"choice","label":"Occupation Type*","options":["S-Service","O-Others","B-Business"],"required":true,"pdf_field":""},{"help":"Select residential status","type":"choice","label":"Residential Status*","options":["X- Not Categorised"],"required":true,"pdf_field":""}],"filled_by":"applicant"},{"title":"2. Residence for Tax Purposes Outside India","fields":[{"help":"Tick if residence for tax purposes outside India","type":"checkbox","label":"Tick if applicable","options":[],"required":false,"pdf_field":""}],"filled_by":"applicant"},{"title":"3. Proof of Identity (PoI)*","fields":[{"help":"Select one and provide certified copy","type":"choice","label":"Proof of Identity*","options":["A- Passport Number","B- Voter ID Card","C- PAN Card","D- Driving Licence","F- NREGA Job Card","S- Simplified Measures Account - Document Type code","Z- Others (any document notified by the central government)"],"required":true,"pdf_field":""},{"help":"Mandatory if passport is used as PoI","type":"date","label":"Passport Expiry Date","options":[],"required":false,"pdf_field":""},{"help":"Mandatory if driving licence is used as PoI","type":"date","label":"Driving Licence Expiry Date","options":[],"required":false,"pdf_field":""},{"help":"Provide number for document selected","type":"text","label":"Identification Number","options":[],"required":false,"pdf_field":""}],"filled_by":"applicant"},{"title":"4. Proof of Address (PoA)*","fields":[{"help":"Select one and provide certified copy","type":"choice","label":"Proof of Address*","options":["Passport","Driving Licence","Voter Identity Card","NREGA Job Card","Others","Unspecified"],"required":true,"pdf_field":""},{"help":"Select address type","type":"choice","label":"Address Type*","options":["Residential","Business","Registered Office"],"required":true,"pdf_field":""},{"help":"Enter address line 1","type":"text","label":"Line 1*","options":[],"required":true,"pdf_field":""},{"help":"Enter address line 2","type":"text","label":"Line 2","options":[],"required":false,"pdf_field":""},{"help":"Enter address line 3","type":"text","label":"Line 3","options":[],"required":false,"pdf_field":""},{"help":"Enter city, town or village","type":"text","label":"City / Town / Village*","options":[],"required":true,"pdf_field":""},{"help":"Enter district","type":"text","label":"District*","options":[],"required":true,"pdf_field":""},{"help":"Select state code from list at end","type":"choice","label":"State / U.T Code*","options":[],"required":true,"pdf_field":""},{"help":"Enter postal code","type":"number","label":"Pin / Post Code*","options":[],"required":true,"pdf_field":""},{"help":"Select country code from list at end","type":"choice","label":"ISO 3166 Country Code*","options":[],"required":true,"pdf_field":""}],"filled_by":"applicant"},{"title":"4.1 Current / Permanent / Overseas Address Details","fields":[{"help":"Tick if same as above address","type":"checkbox","label":"Same as Current / Permanent / Overseas Address details","options":[],"required":false,"pdf_field":""}],"filled_by":"applicant"},{"title":"4.2 Correspondence / Local Address Details","fields":[{"help":"Tick if same as above address","type":"checkbox","label":"Same as Current / Permanent / Overseas Address details","options":[],"required":false,"pdf_field":""},{"help":"Enter address line 1","type":"text","label":"Line 1*","options":[],"required":true,"pdf_field":""},{"help":"Enter address line 2","type":"text","label":"Line 2","options":[],"required":false,"pdf_field":""},{"help":"Enter address line 3","type":"text","label":"Line 3","options":[],"required":false,"pdf_field":""},{"help":"Enter city, town or village","type":"text","label":"City / Town / Village*","options":[],"required":true,"pdf_field":""},{"help":"Enter district","type":"text","label":"District*","options":[],"required":true,"pdf_field":""},{"help":"Select state code from list at end","type":"choice","label":"State / U.T Code*","options":[],"required":true,"pdf_field":""},{"help":"Enter postal code","type":"number","label":"Pin / Post Code*","options":[],"required":true,"pdf_field":""},{"help":"Select country code from list at end","type":"choice","label":"ISO 3166 Country Code*","options":[],"required":true,"pdf_field":""}],"filled_by":"applicant"},{"title":"5. Contact Details","fields":[{"help":"Enter office telephone number","type":"phone","label":"Tel. (Off)","options":[],"required":false,"pdf_field":""},{"help":"Enter fax number","type":"phone","label":"FAX","options":[],"required":false,"pdf_field":""},{"help":"Enter residential telephone number","type":"phone","label":"Tel. (Res)","options":[],"required":false,"pdf_field":""},{"help":"Enter email address","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Enter mobile number with country code, no leading zero","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""}],"filled_by":"applicant"},{"title":"6. Details of Related Person","fields":[{"help":"Provide if known","type":"text","label":"KYC Number of Related Person (if available*)","options":[],"required":false,"pdf_field":""},{"help":"Select type","type":"choice","label":"Related Person Type*","options":["Guardian of Minor","Assignee","Authorized Representative"],"required":true,"pdf_field":""},{"help":"Enter full name","type":"text","label":"Name*","options":[],"required":true,"pdf_field":""},{"help":"Select one and provide certified copy","type":"choice","label":"Proof of Identity [PoI] of Related Person*","options":["A- Passport Number","B- Voter ID Card","C- PAN Card","D- Driving Licence","F- NREGA Job Card","S- Simplified Measures Account - Document Type code","Z- Others (any document notified by the central government)"],"required":true,"pdf_field":""},{"help":"Mandatory if passport is used as PoI","type":"date","label":"Passport Expiry Date","options":[],"required":false,"pdf_field":""},{"help":"Mandatory if driving licence is used as PoI","type":"date","label":"Driving Licence Expiry Date","options":[],"required":false,"pdf_field":""},{"help":"Provide number for document selected","type":"text","label":"Identification Number","options":[],"required":false,"pdf_field":""}],"filled_by":"applicant"},{"title":"7. Remarks","fields":[{"help":"Optional remarks","type":"text","label":"Remarks (If any)","options":[],"required":false,"pdf_field":""}],"filled_by":"applicant"},{"title":"8. Applicant Declaration","fields":[{"help":"Sign or provide thumb impression","type":"signature","label":"Signature / Thumb Impression of Applicant","options":[],"required":true,"pdf_field":""},{"help":"Enter date in DD-MM-YYYY format","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"applicant"}],"deadlines":[],"applies_to":"Individual KYC application and update for financial institutions","attachments":["Certified copy of any one of the following Proof of Identity (PoI)","Certified copy of any one of the following Proof of Address (PoA)"],"declarations":["I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein immediately.","I am aware that if any information is found to be false, untrue, misleading or misrepresenting, I may be held liable for it.","I hereby consent to receiving information from Central KYC Registry through SMS/Email on the registered number/email address."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/star-union-dai-ichi-life-insurance/1910-central-kyc-registry-know-your-customer-kyc-application-form-individual"}