UCC Registration Form

SubBroker

Title *

First Name *

Middle Name

Last Name

Tax Status *

Gender *

Date of Birth *

Occupation *

Holding Nature *

PAN Number *

Father Name

Mother Name

TaxSlab *

Net Worth

Country Of Tax *

KRA Validated Status*

CKYC Number*

Politically exposed person Yes No

Second Holder Details

Second Holder First Name

Second Holder Middle Name

Second Holder Last Name

Second Holder DOB

Second Holder Email

Second Holder Mobile

Second Holder Email Declaration

Second Holder Mobile Declaration

PAN Number *

TaxSlab *

Country Of Tax *

KRA Validated Status*

Second Holder CKYC Number*

Politically exposed person Yes No

Third Holder Details

Third Holder First Name

Third Holder Middle Name

Third Holder Last Name

Third Holder DOB

Third Holder Email

Third Holder Mobile

Third Holder Email Declaration

Third Holder Mobile Declaration

PAN Number *

TaxSlab *

Country Of Tax *

KRA Validated Status*

Third Holder CKYC Number*

Politically exposed person Yes No

Guardian Details

Guardian First Name

Guardian Middle Name

Guardian Last Name

Guardian DOB

Guardian Relationship

KRA Validated Status*

Guardian CKYC Number*

PAN Number *

Bank Account 1

Account Type *

Account Number *

MICR No

IFSC Code *

Default Bank Flag Yes

Bank Account 2

Account Type

Account Number

MICR No

IFSC Code

Default Bank Flag Yes

Bank Account 3

Account Type

Account Number

MICR No

IFSC Code

Default Bank Flag Yes

Cheque Name

Dividend Pay Mode *

Nomination Option *

Nomination Authentication Mode *

Nominee 1

Nominee Name

Relationship

Applicable Percentage

Identity Type

ID Number

Mobile

Minor Flag

Date of Birth

Guardian Name

Guardian PAN

Same as Primary Holder Address

Address 1

Address 2

Address 3

Pincode

Country

City

Nominee 2

Nominee Name

Relationship

Applicable Percentage

Identity Type

ID Number

Mobile

Minor Flag

Date of Birth

Guardian Name

Guardian PAN

Same as Primary Holder Address

Address 1

Address 2

Address 3

Pincode

Country

City

Nominee 3

Nominee Name

Relationship

Applicable Percentage

Identity Type

ID Number

Minor Flag

Mobile

Date of Birth

Guardian Name

Guardian PAN

Same as Primary Holder Address

Address 1

Address 2

Address 3

Pincode

Country

City

Address 1 *

Address 2

Address 3

Pincode *

Country *

State *

City *

Residential Phone

Residential Fax

Office Phone

Office Fax

Communication Mode *

Email *

Email Declaration*

Indian Mobile No *

Mobile Declaration*

Place*

Address 1 *

Address 2

Address 3

Pincode *

Country *

State *

City *

Residential Phone

Residential Fax

Office Phone

Office Fax

PAN	Name	Status	Remarks	Freeze Status

UCC Registration Form

Second Holder Details

Third Holder Details

Guardian Details

Bank Account 1

Bank Account 2

Bank Account 3

Bank Account 4

Bank Account 5

Nominee 1

Nominee 2

Nominee 3

Voluntary Freezing / Blocking of Trading Accounts:

UCC Registration Form

Second Holder Details

Third Holder Details

Guardian Details

Bank Account 1

Bank Account 2

Bank Account 3

Bank Account 4

Bank Account 5

Nominee 1

Nominee 2

Nominee 3