Data Updation Form / Personal Information Sheet

Branch : Lajpat Nagar Date : 0D 6D 0M 6M 2Y 0Y 1Y Y

7

6 0 2 1 0 0 1 0 0 0 0 2 8 7 0
Account No. : Customer No. :
Name: Mr PARESHNATH RAVEENDRAN SUKUMARAN
Title First Name* Middle Name Last Name*
Latest Photo
Account Holder : Primary y Joint Signatory (i.e. Partner, Director etc)

Date of Birth* 1 5
D D 0
M 5M 1 Y
Y 9 Y8 Y
0

Residence Address :
(Please sign across the Photo)

House No.* D 495 Building/Block No. First Floor

Building Name Ramphal Chowk Street Name* Dwarka Sector 7

Landmark* Near HP Gas Agency Locality Dwarka

Suburb South West Delhi Town New Delhi City* New Delhi

Pincode* 1 1 0 0 7 5 State* New Delhi Country* INDIA

Residence* : Owned Company Provided Leased Others RENTED

Residing Since * : 0D D
1 M
0 M
1 Y 0Y Y
2 1 Y
6 Gender : Male Y Female

Religion : HINDU Caste : No Mention Status : Single Married Y

Contact STD
Information : Mobile* : 9 5 4 4 6 4 2 2 8 8 Code:
STD
Office No. : Code: Extn. :
Email Id : p a r e s h n a t h 2 2 8 8 @ g m a i l . c o m

Identification Documents :
PAN No.: E I Q P S 3 2 7 6 C Aadhar No.: 2 5 1 4 8 4 1 6 9 7 7 2

Driving License No. : Passport No. :

Education Qualification* : Professional

Occupation* : Salaried Y Self-Employed Business Retired Student

Housewife Professional Others, please specify_________________________

If Salaried : Name of the Employer* :

Designation* : Working Since : D D M M Y Y Y Y

If Professional : CA Engineer Doctor Lawyer Consultant Software

Y
*Mandatory fields COMMERCIAL PILOT
Others, please specify________________________________________
Office Address :
D 4 9 5 , F / F , R a m p h a l C h o w k D w a r k a S e c t o r -7

N e w D e l h i 1 1 0 0 7 5

Annual Income: Annual Turnover:

IDENTIFICATION DETAILS :
Please submit copy of any one document from each of the under listed two columns for Identity Proof and Address Proof.
(Original will have to be produced for verification)
PROOF OF IDENTITY*(Expiry date of documents) PROOF OF ADDRESS* (Expiry date of documents)
Passport Electricity Bill
Voter Id Card Telephone Bill
Y PAN Card Ration Card
Driving Licence
Y Aadhar Card
Y Aadhar Card Copy of registered Leave and
Letter from a Recognised Public Authority
Licence agreement/ Sale agreement
verifying the identity and residence of the applicant
Others if any, please specify :
Others if any, please specify :

(* Incase any of above document contains photo & address, then single document should be obtained).
I confirm that the information provided in this data updation form are latest and correct.
I authorize the Bank to verify the details given herein above through any means/person(s), as may be
deemed necessary by the Bank.

Pareshnath Raveendran Sukumaran

Name of the Account Holder

Date : D0 D6 0 M
M 6 Y2 Y0 Y1 Y7 Signature of the Account holder

Place : DWARKA SCTOR 7 , NEW DELHI

For Office use

Data updation form received &

updated in CBS by Maker Checker

Name : ________________________________ __________________________

Employee Code:__________________________ __________________________

Signature:_______________________________ __________________________

Date : __________________________________ __________________________