Instructions / Checklist For Filling KYC Form

Instructions / checklist for filling KYC form
A. Important points
1. Self attested copy of PAN card is mandatory for all clients, including Promoters /Partners /Karta /Trustees and whole time directors and persons authorized to deal in securities
on behalf of company/firm/others.
2. Copies of all the documents submitted by the applicant should be self-attested and accompanied by originals for verification. In case the original of any document is not
produced for verification, then the copies should be properly attested by entities authorized for attesting the documents, as per the below mentioned list.
3. If any proof of identity or address is in a foreign language, then translation into English is required.
4. Name & address of the applicant mentioned on the KYC form, should match with the documentary proof submitted.
5. If correspondence & permanent address are different, then proofs for both have to be submitted.
6. Sole proprietor must make the application in his individual name & capacity.
7. For non-residents and foreign nationals, (allowed to trade subject to RBI and FEMA guidelines), copy of passport/PIO Card/OCI Card and overseas address proof is mandatory.
8. For foreign entities, CIN is optional; and in the absence of DIN no. for the directors, their passport copy should be given.
9. In case of Merchant Navy NRI's, Mariner's declaration or certified copy of CDC (Continuous Discharge Certificate) is to be submitted along with other statutory approvals
required for investment in commodities.
10. Politically Exposed Persons (PEP) are defined as individuals who are or have been entrusted with prominent public functions in a foreign country, e.g., Heads of States or of
Governments, senior politicians, senior Government/judicial/ military officers, senior executives of state owned corporations, important political party officials, etc.
B. Proof of Identity (POI)

List of documents admissible as Proof of Identity:
1. Unique Identification Number (UID) (Aadhaar)/ Passport/ Voter ID card/ Driving license.
2. PAN card with photograph.
3. Identity card / document with applicant's Photo, issued by any of the following: Central/State Government and its Departments, Statutory/ Regulatory Authorities, Public Sector
Undertakings, Scheduled Commercial Banks, Public Financial Institutions, Colleges affiliated to Universities, Professional Bodies such as ICAI, ICWAI, ICSI, Bar Council etc., to
their Members; and Credit cards/Debit cards issued by Banks.
C. Proof of Address (POA)

List of documents admissible as Proof of Address: (*Documents having an expiry date should be valid on the date of submission.)
1. Passport/ Voters Identity Card/ Ration Card/ Registered Lease or Sale Agreement of Residence/ Driving License/ Flat Maintenance bill/ Insurance Copy.
2. Utility bills like Telephone Bill (only land line), Electricity bill or Gas bill - Not more than 3 months old.
3. Bank Account Statement/Passbook - Not more than 3 months old.
4. Self-declaration by High Court and Supreme Court judges, giving the new address in respect of their own accounts.
5. Proof of address issued by any of the following: Bank Managers of Scheduled Commercial Banks / Scheduled Co-Operative Bank / Multinational Foreign Banks / Gazetted
Officer / Notary Public / Elected representatives to the Legislative Assembly/ Parliament / Documents issued by any Govt. or Statutory Authority.
6. Identity card/document with address, issued by any of the following: Central/State Government and its departments, Statutory / Regulatory Authorities, Public Sector
Undertakings, Scheduled Commercial Banks, Public Financial Institutions, Colleges affiliated to Universities and Professional Bodies such as ICAI, ICWAI, ICSI, Bar Council etc.,
to their Members.
7. The proof of address in the name of the spouse may be accepted.
D. Exemptions/clarifications to PAN (*Sufficient documentary evidence in support of such claims to be collected.)

1. In case of transactions undertaken on behalf of Central Government and /or State Government and by officials appointed by Courts e.g. Official liquidator, Court receiver etc.
2. Investors residing in the state of Sikkim (subject to the continued exemption granted by the Government).
E. List of people authorized to attest the documents

1. Notary Public, Gazetted Officer, Manager of a Scheduled Commercial / Co-operative Bank or Multinational Foreign Banks (Name, Designation & Seal should be affixed on the
copy).
2. In case of NRIs, authorized officials of overseas branches of Scheduled Commercial Banks registered in India, Notary Public, Court Magistrate, Judge, Indian Embassy
/Consulate General in the country where the client resides are permitted to attest the documents.
F. In case of non-individuals, additional documents are to be collected from the non-individual entity, over and above the POI and POA, as mentioned below.
Type of entity Documents required
Corporate Copy of balance sheets for the last 2 financial years (to be submitted every year) | Copy of latest share holding pattern, including list of
all those holding control, either directly or indirectly, in the company in terms of SEBI takeover regulations, duly certified by the company
secretary/whole time director/MD (to be submitted every year) | Photograph, POI, POA, PAN and DIN numbers of whole time directors/
two directors in charge of day to day operations | Photograph, POI, POA & PAN of individual promoters holding control either directly or
indirectly | Copies of Memorandum and Articles of Association and Certificate of Incorporation | Copy of Board Resolution for the
investment in commodity market | Copy of Board Resolution or declaration (on letterhead) naming the persons authorised to deal in the
commodity derivatives on behalf of the company.
Partnership firm Copy of balance sheets for the last 2 financial years (to be submitted every year) | Copy of registration/partnership deed. | Authorised
signatories list with specimen signatures | Photograph and copies of POI, POA & PAN of the partners.
Trust Copy of balance sheets for the last 2 financial years (to be submitted every year) | Copy of registration/trust deed. | List of trustees
certified by managing trustees/CA| Photograph and copies of POI, POA & PAN of the trustees.
HUF PAN of HUF | Deed of declaration of HUF & list of copartners | Bank statement/pass-book of HUF | Photograph, POI, POA & PAN of Karta
Government bodies Self certification on letterhead | Authorised signatories list with specimen signatures
Registered society Copy of Registration Certificate under Societies Registration Act | List of Managing Committee Members | Committee resolution for
persons authorised to act as authorised signatories with specimen signatures | True copy of society rules and bye laws certified by the
Chairman/Secretary
G. Copy of cancelled cheque leaf/ pass book/bank statement specifying name of the constituent, MICR Code or/ and IFSC Code of the bank should be submitted.
H. Proof of income: A recent month salary slip/6-month bank statement/demat holding statement
I. Demat master or recent holding statement issued by DP bearing name of the client.
For Individuals:
a. Stock broker has an option of doing 'in-person' verification through web camera at the branch office of the stock broker/sub-broker's office.
For non-individuals:
a. Form need to be initialized by all the authorized signatories.
b. Copy of Board Resolution or declaration (on the letterhead) naming the persons authorized to deal in securities on behalf of company/others & their specimen signatures.
1 Sign wherever you see

S. No. Name of the Document Brief Significance of the Document Page No.
MANDATORY DOCUMENTS AS PRESCRIBED BY SEBI & EXCHANGES
A. KYC form - Document captures the basic information about

1 Account Opening Form 3
the constituent and an instruction/checklist.
2 Tariff Sheet Document detailing the rate/amount of brokerage and other charges 7
levied on the client for trading on the commodity exchange(s).
Rights and Obligations of Document stating the Rights & Obligations of stock broker /trading
3 Members, Authorized member and client for trading on exchanges (including additional rights Annexure
Persons and Clients & obligations in case of internet/wireless technology based trading).
Uniform Risk Disclosure Document detailing risks associated with dealing in the commodity
4 Document (RDD) Annexure
market.
Do’s and Don’ts for the Document detailing do’s and dont’s for trading on exchange for
5 Annexure
Investors education of investors
6 Policies and Procedures Document describing significant policies and procedures of the Broker. Annexure
VOLUNTARY AND OPTIONAL DOCUMENTS AS PROVIDED BY THE STOCK BROKER
7 Annexure - N Disclosure information 8
8 Annexure - O Receipt of KYC, RDD, Rights & Obligations and Do’s and Don’t’s 8
9 Annexure - Q Letter of authority 9
10 Appendix - A Electronic Contract Note (ECN) declaration 10
11 Annexure - P Additional Rights & Obligations Annexure
Annexure
12 Nomination Details Collects details of any nomination made for the account 1A
Membership Details
Name of the Trading Member : Zerodha Commodities Private Limited
Exchange registration number : MCX - 46025 | NCDEX - 1138
SEBI Registration number : INZ000038238
Registered Office
153/154, 4th Cross, Dollars Colony, 4th Phase, JP Nagar, Opp. Clarence Public School, Bangalore - 560078.
Ph : 080-40402020
Correspondence Address: Same as above
Compliance Officer : Venu Madhav, Phone No. & Email ID: 080-40402020, compliance@zerodha.com
CEO : Nithin Kamath, Phone No. & Email ID: 080-40402020, ceo@zerodha.com
For any grievance please contact Zerodha at the above address or email complaints@zerodha.com &
Phone no. 91-8040402020.
For any grievance/dispute please contact Zerodha at the above address, email ID or phone number.
In case not satisfied with the response, please contact the concerned exchange at:
1.MCX at grievance@mcxindia.com or Phone No.: 022-67318888
2.NCDEX at askus@ncdex.com or Phone No.: 022-66406084.

Know Your Client (KYC) Application Form - for Individuals
Please fill this form in English and BLOCK Letters
(Please tick the box on the left margin of the appropriate row where CHANGE/CORRECTION is required and provide the details in the corresponding window)
For office use only (To be filled by the financial institution)

Application Type* New Update KYC Number
Account Type* Normal Simplified (for low risk customers) Small
A. Identity details
Photograph
VENKATA AJAY KUMAR MATTUPALLI
1. Name (Same as ID Proof) Please affix your
recent passport size
1a. Maiden Name (If any) ---- photograph and
2. Father's/Spouse's Name Mattupalli srinivasa rao sign across it
2a. Mother's Name mattupalli kumari
F1
3a. Gender * Male Female Transgender 3b. Marital Status * Single Married Other 3c. DOB 1990-05-26
4a. Citizenship * Indian Other ___________________(ISO 3166 Country Code )
4b. Residential Status * Resident Individual Non Resident Indian Person of Indian Origin Foreign National
Tick if applicable Residence for tax purposes in jurisdiction(s) outside India

ISO 3166 Country Code of Jurisdiction of residence Place of birth_____________________________________
Tax Identification Number or Equivalent ISO3166 Country Code of Birth
5a. PAN BGAPM1777K

5b. Unique Identification Number (UID) / AADHAR, if any 9b52f46afab988bdf002adc7ec29eeb3d6be62bb036c75299ab74295bf4c
6. Proof of Identity Submitted * Pan Card Other (Please Specify) ____________________________________
B. Contact Details
Telephone (Office) Mobile No 9618350549
Telephone (Residence) Email ID kumarvlsi449@gmail.com
C. Address details Address Type: * Residential Business Unspecified
2. Residence/Correspondence Address
Address 2-46 ramamandhiram bazar
.
City/Town Naguluppala Padu District Prakasam Pin Code 523183
State/U.T Code Andhra Pradesh Country/ISO Code India
Specify the Proof of Address Submitted for Residence / Correspondence Address
D. DECLARATION
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. In case any of the above information is found to be
false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.
I hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered F2 Client Signature
number/email address
Place : Naguluppala Padu Date : 2018-12-12
FOR OFFICE USE ONLY

In Person Verification (IPV) Details:
SUNDER
Name of the Person who has done the IPV: __________________________________________________
Account Opening
Designation: ____________________________________ Employee ID: Z1527
__________________________
Name of the Organization: Zerodha Commodities Pvt. Ltd.
Date of the IPV: 2018-12-12 Signature of the Person who has done the IPV Seal/Stamp of the Intermediary
Originals Verified and Self-Attested Document Copies Received
Date Signature of the Authorized Signatory

3. Permanent Address
Address 2-46 ramamandhiram bazar
.
City/Town Naguluppala Padu District Prakasam Pin Code 523183
State/U.T Code Andhra Pradesh Country/ISO Code India
4. Address in the jurisdiction details where applicant is resident outside India for tax purpose (if applicable)
Address
City/Town District Pin Code

State/U.T Code Country/ISO Code
E. Details of related person (In case of additional related persons, please fill below details)
Addition of Related Person Deletion of Related Person
KYC Number of Related Person (if available)
Related Person Type Guardian of Minor Assignee Authorized Representative
Name
(If KYC number & name are provided, below details are optional)
Proof Of Identity Of Related Person
Identity Proof Submitted Number
Expiry Date :
Others (any document notified by the central govt.) Identification No
Simplified Measures Account-Document Type Code Identification No
F. Bank account details

Account Type: Savings * Current Other
Bank Name CITI BANK
Branch Address NO 5
CITI BANK
Account Number 5464997817
MICR Number 560037002 IFSC Code CITI0000004
G. Other details
Gross Annual Income Details (please specify): Income Range per annum
Below Rs 1 Lakh 1-5 Lakh * 5-10 Lakh 10-25 Lakh >25 Lacs
Or Net-worth as on ________________date___________________ (Net worth should not be older than 1year)
Occupation
Private Sector Public Sector Government Service Business Professional * Agriculturist Retired
Housewife Student Self Employed Others (please specify) ____________________________________
Please tick, as applicable: Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP)
Not a Politically Exposed Person * Not related to a Politically Exposed Person
Mode in which you wish to receive the RDD, Rights & Obligations, and Guidance Note: Physical Electronic *
H. Past actions
Details of any action/proceedings initiated/pending/ taken by FMC/SEBI/stock exchange(s)/commodity exchange(s)/any other
authority against the applicant/constituent or its partners, promoters/whole time directors/authorized persons in charge of
dealing in securities during the last 3 years________________________________________________________________

I. Depository account(s) details
Depository Name: NSDL CDSL
Depository Participant Name
Beneficiary Name
Depository ID Beneficiary ID
Note : Provide a copy of demat master report or a recent holding statement issued by DP bearing name of the client.
J. Dealings through other members

Whether dealing with any other stock broker/sub-broker (in case dealing with multiple members, provide details of all in a
separate sheet containing all the information as mentioned below)
Name of Member/AP Exchange(s)
Website Exchange registration number
Client code Exchange registration number
Registered office address
Name of Member with whom AP is registered
Details of disputes/dues pending from/to such stock broker
K. Introducer details (optional)

Name of the Introducer
Status of the Introducer - Sub-broker/Remisier/Authorized Person/Existing Client
Address of the Introducer
Phone Number Signature (optional)
L. Trading preferences / experience

No Prior Experience
Years in Commodities 0 Years in other Investment Related Field
Please sign in the relevant boxes where you wish to trade. The segment not chosen should be struck off by the client.
Name of Exchange Date of consent Signature
MCX Client Signature F3 (a)
If, in future, the client wants to trade on any new segment, a separate authorization/letter should be taken from the client by
the broker.
M. Additional details
(I) Whether you wish to receive communication from member in electronic form on your email ID Yes * No
If yes then please fill in Appendix - A
N. Sales tax registration details (As applicable)

Name of state Registration number Expiry date
State
Registration number
Central
Expiry date
O. VAT details (As applicable)
Name of state Registration number Expiry date
P. Nomination details (Please tick the appropriate options)

I / We do wish to nominate (Fill the Annexure 1A)
* I / We do not wish to nominate

Declaration
1. I/We hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I/we
undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or
misleading or misrepresenting, I am/we are aware that I/we may be held liable for it.
2. I/We confirm having read/been explained and understood the contents of the tariff sheet and all voluntary/non-mandatory
documents.
3. I/We further confirm having read and understood the contents of the 'Rights and Obligations' document(s), 'Risk Disclosure
Document' and 'Dos and Don’ts'. I/We do hereby agree to be bound by such provisions as outlined in these documents. I/We have
also been informed that the standard set of documents has been displayed for Information on Member's designated website,if any.
Date 2018-12-12
Place : Naguluppala Padu F4 Client Signature
For office use only
JG6962
UCC Code allotted to the Client _________________________________________________________________________
Documents verified with Originals Client Interviewed By In-Person Verification done by

Name of the Employee SUNDER SUNDER
Employee Code Z1527 Z1527
Designation of employee Account Opening Account Opening

Date 2018-12-12 2018-12-12
Signature
I / We undertake that we have made the client aware of 'Policy and Procedures', tariff sheet and all the non-mandatory documents.
I/We have also made the client aware of 'Rights and Obligations' document (s), RDD and Guidance Note. I/We have given/sent him a
copy of all the KYC documents. I/We undertake that any change in the 'Policy and Procedures', tariff sheet and all the non-mandatory
documents would be duly intimated to the clients. I/We also undertake that any change in the 'Rights and Obligations' and RDD
would be made available on my/our website, if any, for the information of the clients.
Signature of the Authorised Signatory
Date : 2018-12-12 Seal/Stamp of the stock broker

Tariff sheet
To
Zerodha Commodities Private Limited
153/154, 4th Cross, 4th Phase, JP Nagar, Dollars Colony, Opp. Clarence School, Bangalore - 560078
Charges for Zerodha trading services
I/ We agree to pay the charges as per following charges structure for our trading account with Zerodha effective from the time
of account opening.
Client ID: JG6962
_______________________
Charge Head Brokerage/Charges
Commodity futures 0.01% of turnover or Rs. 20 per executed order, whichever is lower
Commodity options 0.01% of turnover or Rs. 20 per executed order, whichever is lower
Call & Trade Services Rs. 20 per order placed through a Dealer at Zerodha
Clients who opt to receive physical contract notes will be charged Rs. 20 per contract note plus courier charges at actual.
In addition to the brokerage charge the following charges will also be levied.
Schedule of Charges
Charge Head Charges
Turnover Charges Non-Agri: 0.0036% | Agri: 0.00275%
Commodity Transaction Tax 0.01% on sell side (Non-Agri)
GST 18% on (brokerage + transaction charges)
SEBI Turnover Fees INR 20/crore
Stamp Duty State-wise stamp duty as applicable will be levied
Note : Brokerage will not exceed the rates specified by SEBI and the Exchanges. All Statutory and Regulatory charges will be
levied at actuals. Brokerage is also charged on expired, exercised, and assigned Options contracts.
Turnover for Options is calculated as (Strike + Premium)*Lot Size
Detailed explanation of the Schedule of Charges is available online at :
https://zerodha.com/charge-list
Date D 2018-12-12
D M M Y Y Y Y F5 Client Signature

Disclosure Information Annexure - N
Dear Sir/Madam,
This is to inform you as per Rules, Regulations and Bye-laws of Multi Commodity Exchange of India Ltd. (MCX) that we
do client based trading and Pro-account trading and we are not indulged in portfolio management services.
Regards,
I/We acknowledge receipt of information given above by Zerodha Commodities Private Limited that they do client
base trading and Pro-account trading and they are not indulged in portfolio management services.
F6 Client Signature
To Annexure - O
153/154, 4th Cross, Dollars Colony, 4th Phase, JP Nagar, Opp. Clarence Public School, Bangalore - 560078.
Sub: Acknowledgement
This is to acknowledge the receipt of following documents. I further state and confirm that I have read and understood
all the clauses of aforesaid documents.
Sl. No Document
1 Duly Executed Copy of KYC
2 Rights and Obligations
3 Risk Disclosure Document (RDD)
4 Guidance Note - Do's and Dont's for trading on the Exchange(s) for investors
5 Policies and Procedures
6 Additional Rights & Obligations
I also confirm that I have received the relevant clarifications, if any, wherever required from the officials of Zerodha Commodities
Pvt. Ltd.
F7 Client Signature

Letter of Authority (Voluntary) Annexure - Q

#153/154, 4th Cross Dollars Colony, Opp. Clarence Public School,
J.P Nagar 4th Phase, Bangalore - 560078
Dear Sir,
I am/We are dealing in commodities with you and in order to facilitate ease of operations, I/we authorize you as under:
1. Authorization for Payment of Depository Participant Charges: I am having depository account with Zerodha Commodities
Pvt Ltd. I request you to debit my trading Account against the demand raised by the depository division of Zerodha
Commodities Pvt Ltd. towards my Depository Charges. I also agree to maintain the adequate balance in my trading account /
pay adequate advance fee for the said reason.
2. Authorization to Retain Credit Balance: I / We request you to retain credit balance in any of my / our account and to use the
idle funds towards our margin/future obligations at the Exchanges unless I/ we instruct you otherwise.
3. Authorization for Communication of Financial Products: I/We have opened an account with you and am/are interested in
knowing about other financial products. I/We authorize you, your group companies and associates to keep me/us informed
with any financial product which Zerodha Commodities Private Limited, its group companies and associates presently issue,
deal in, or distribute or may, from time to time, launch, issue, deal in or distribute; through E-mail, SMS,telephone, print
media or otherwise. This is without legal obligation on you, your group companies and associates to so inform and you or
they may, in their discretion, discontinue sending such information.
4. Running Account Authorization: I/We am /are desirous of regularly dealing in commodity market on Commodity Exchanges
and request you to maintain a running account for funds and commodities on/our behalf without settling the account on
settlement of each transaction on my/our behalf. I/We further request you to retain all amounts payable and commodities
receivable by me/us until specifically requested by me/us in writing to be settled or to be dealt with in any other manner. I/We
understand and agree that no interest will be payable to me/us on the amounts or commodities so retained with you pending
periodical settlement.This running account authorization would continue until it is revoked by me.
I/We request you to settle my fund and securities account (Choose one Option)
Once in a calendar Month
* Once in every calendar Quarter
except the funds given towards collaterals/margin in form of Bank Guarantee and/or Fixed Deposit Receipt
All accounts with credit balances of Rs. 50000/- or lesser may be automatically retained and transfer of funds to the bank
account may not be made as per SEBI circular MIRSD/SE/Cir-19/2009 & Exchange Circular Nos.MCX/INSP/325/2016 &
NCDEX/COMPLIANCE-015/2016/238. I/We confirm you that I will bring to your notice any dispute arising from the statement
of account or settlement so made in writing within 7 working days from the date of receipt of funds/securities or statement of
account or statement related to it, as the case may be at your registered office.
5. I understand that in case my account is in debit balance @0.05% and/or if I have insufficient funds to manage my trading
positions, I will be charged interest as delayed payment charges. I confirm having read the rules & regulation pertaining to
the levy of such interest under the policies & procedures page on Zerodha's website.
6. Authorization for not Providing Confirmation Slips: I/We authorize you not to provide me/us Order Confirmation
/Modification/Cancellation Slips and Trade Confirmation Slips to avoid unnecessary paper work. I/We shall get the required
details from contract notes issued by you.
7. Authorization for Providing Financial Ledger in Digital Form: I/we hereby authorize you to send me/us the financial ledger in
the digital form in the prescribed formed at my/our E-mail ID/Address.
Date 2018-12-12
Place : Naguluppala Padu

F8 Client Signature

Page 1 of 11
CITIBANK N.A
MATTUPALLI V AJAY KUMAR NO. 5 MG ROAD,
Place of Supply : 29-KARNATAKA
BENGALURU - 560001
LOS: 29-KARNATAKA
TEL: 08067739333
IFSC CODE : CITI0000004
MICR CODE : 560037002
GSTIN : 29AAACC0462F1Z0
Citibank Account Number: 54XX9XXX17

Statement Period: July 01,2018 to December 12,2018
Summary of Transactions on Savings Account Number 54XX9XXX17 in INR

For the period 01-07-2018 to 12-12-2018
Opening Balance: 9041.22 -
Date Transaction Details Withdrawals Deposits Balance

02/07/2018 IMPS OUTWARD ORG IMPSTO 142215514609 CTB REF 2300.00 6741.22
NO:-818316333169 GIFT
02/07/2018 IMPS OUTWARD REV IMPSTO 142215514609 CTB REF NO:- 2300.00 9041.22
818316333169 is reversed
NO:-818316334057 food
NO:-818317337584
NO:-818317344072 family
04/07/2018 IMPS OUTWARD ORG IMPSTO 31376776268 CTB REF NO:- 2000.00 7041.22
818513049543
04/07/2018 ATM WITHDRAWAL SUBJECT: NFSATM 04JUL1101Card no.: 5000.00 2041.22
5497XXX0XXXX7616 Ref: 818516004902 +PRESTIGE
TECHNOLOGY PABANGALORE KAIN Ref No :- 04JUL1101
10/07/2018 PURCHASE SUBJECT: MCUPOS 07JUL2220Card no.: 499.00 1542.22
5497XXX0XXXX7616 07JUL HOTEL KRITUNGA \HOTEL
K Ref: 001172272997 Ref No :- 07JUL2220
Page 2 of 11

5497XXX0XXXX7616 13JUL QUIKR INDIA PVT. LTD.\Building
Ref: 071311658525 Ref No :- 13JUL1640
820614238935
25/07/2018 PURCHASE REVERSAL SUBJECT: MCUPOS 193.00 200.22
23JUL1919Card no.: 5497XXX0XXXX7616 23JUL QUIKR
INDIA PVT. LTD.\Building Ref: 071311658525 Ref No :-
23JUL1919
NO:-820712798250
31/07/2018 SALARY CREDIT : UTR 1830971060000042 TRF FROM 29776.00 29776.22
ARICENT TECHNGS(HLDNGS)L -SALARY AC 00052264 Run
Ref No :- 1895619468
31/07/2018 IMPS OUTWARD ORG UPI To 5000.00 24776.22
anandsuresh.cheedella1@oksbi,REF NO - 821210607893,
Rent
NO:-821210088326
31/07/2018 IMPS OUTWARD ORG UPI To samim.akram4@okaxis,REF 4000.00 11776.22
NO - 821211689270, Repayment
vishnu.akshay007@okhdfcbank,REF NO - 821211705381, UPI
31/07/2018 IMPS INWARD ORG UPI From mohaneswar5111@okaxis,REF 70.00 10846.22
NO - 821213621083, UPI
31/07/2018 IMPS OUTWARD ORG UPI To kurravijay3677@oksbi,REF NO 150.00 10696.22
- 821218231384, Courier
01/08/2018 IMPS OUTWARD ORG UPI To vijayasgb@okhdfcbank,REF 5000.00 5696.22
NO - 821312923971, Repayment
5497XXX0XXXX7616 31JUL SAHITI RESTAURANT\DOOR
NO 15 O Ref: 821208043917 Ref No :- 31JUL1344
03/08/2018 PURCHASE SUBJECT: MCUPOS 01AUG1843Card no.: 458.83 5097.39
5497XXX0XXXX7616 01AUG MORE\SURVEY NO 88
OUTERRING RO Ref: 080100005722 Ref No :- 01AUG1843
Page 3 of 11

04/08/2018 IMPS INWARD ORG UPI From bakshu63@okhdfcbank,REF 130.00 5227.39
NO - 821600618205, UPI
04/08/2018 ATM WITHDRAWAL SUBJECT: NFSATM 04AUG1314Card 4400.00 827.39
no.: 5497XXX0XXXX7616 Ref: 821618008124 +CKB LAYOUT
BANGALORE KAIN Ref No :- 04AUG1314
5497XXX0XXXX7616 04AUG ONE97 COM LTD -PAYTM
Ref: 821600990864 Ref No :- 04AUG0000
5497XXX0XXXX7616 02AUG SAHITI RESTAURANT\DOOR
NO 15 O Ref: 821408045247 Ref No :- 02AUG1344
31/08/2018 IMPS OUTWARD ORG IMPS TO 142215514609 - KARUR 10.00 29791.99
VYSYA BANK REF NO:-824310327217
31/08/2018 IMPS OUTWARD REV IMPSTO REF NO:-824310327217 on 10.00 29801.99
31AUG
01/09/2018 ATM WITHDRAWAL SUBJECT: NFSATM 01SEP0435Card 6000.00 23801.99
No.: 5497XXX0XXXX7616 of M V AJAY KUMAR
01SEP18 Ref: 824410007742 +CKB LAYOUTBANGALORE
KAIN
01/09/2018 IMPS OUTWARD ORG IMPS TO 1422155000014609 - 10.00 23791.99
KARUR VYSYA BANK REF NO:-824410635696
MrSRINIVASA RAO M
KARUR VYSYA BANK REF NO:-824410639597 PERSONAL
MrSRINIVASA RAO M
03/09/2018 ATM WITHDRAWAL SUBJECT: EURONT 01SEP2254Card 1000.00 7791.99
01SEP18 Ref: 5702 +VIVEKANANDA LAYOUT
OFFBANGALORE KAIN
03/09/2018 IMPS OUTWARD ORG UPI To munafpandu143@okicici,REF 3000.00 4791.99
NO - 824513439277, Urgnet bro
02SEP18 Ref: 824514008176 APSRTCLobby ChittoorChittoor
APIN
03/09/2018 IMPS INWARD ORG UPI From arjun.amara1@okaxis,REF NO 500.00 4791.99
- 824620653664, Due Cleared
5497XXX0XXXX7616 31AUG18 140743 SAHITI
RESTAURANT\DOOR NO 15 O Ref: 824308117180
Page 4 of 11

05/09/2018 PURCHASE SUBJECT: MCUPOS 02SEP0835Card no.: 349.00 4142.99
5497XXX0XXXX7616 02SEP18 083543 RELIANCE JIO
INFOCOMM \E 510 C Ref: 090237224921
05/09/2018 IMPS OUTWARD ORG IMPS TO 31376776268 - STATE 1000.00 3142.99
BANK OF INDIA REF NO:-824815963938 Mr MATTUPALLI
VENK
05/09/2018 ATM CASH WITHDRAWAL Card No.: 5497XXX0XXXX7616 of 1000.00 2142.99
M V AJAY KUMAR 05SEP18 Ref: 824808993167 MORE
MEGA STOREBANGALORE KAIN
5497XXX0XXXX7616 05SEP18 135727 SAHITI
10/09/2018 IMPS OUTWARD ORG UPI To abhibus@axisbank,REF NO - 949.40 983.59
825218130959, UPI
10/09/2018 IMPS INWARD ORG UPI From 500.00 1483.59
venkatrams171@okhdfcbank,REF NO - 825218135883, UPI
5497XXX0XXXX7616 09SEP18 180441 ONE97 COM LTD -
PAYTM Ref: 825200464997
5497XXX0XXXX7616 09SEP18 185834 Citrusp*Abhibus
\Floor 1 Ref: 825213018870
14/09/2018 IMPS INWARD ORG UPI From munafpandu143@okicici,REF 700.00 770.78
NO - 825720590042, Sry for the late
15SEP18 Ref: 825819005108 UBI KURNOOL
ROADPRAKASAM APIN
NO - 826213581493, UPI
19/09/2018 IMPS INWARD ORG UPI From tulasiram3137@okaxis,REF 70.00 410.78
NO - 826217129077, Meals
Page 5 of 11

21SEP18 Ref: 2379 V.R.LAYOUTBANGALORE KAIN
26/09/2018 IMPS INWARD ORG UPI From sivaponnadi@oksbi,REF NO - 300.00 310.78
826912091825, Hi
PAYTM Ref: 826900536280
29/09/2018 SALARY CREDIT UTR 1839670050000677 TRF FROM 29776.00 29786.78
msr.sivaramakrishna.ml@okaxis,REF NO - 827211303159,
Repayments
venkatrams171@okhdfcbank,REF NO - 827211315130,
Repayment
MrSRINIVASA RAO M
KARUR VYSYA BANK REF NO:-827211038087 -MrAJAY
KUMAR MATTUPA
BANK OF INDIA REF NO:-827211038518 -Mr MATTUPALLI
VENK
29/09/2018 IMPS INWARD ORG UPI From subbu0203@okaxis,REF NO - 10000.00 24276.78
827223035467, UPI
29/09/2018 Payment for Credit Card No. 4617XXX1XXXX6816 10000.00 14276.78
AVULA,SUBBA
29/09/2018 INTEREST EARNED Period: 01JUL2018 - 30SEP2018 for 17.00 14293.78
Savings account
01/10/2018 IMPS INWARD ORG UPI From vsunreddy@oksbi,REF NO - 500.00 14793.78
827318988058, UPI
30SEP18 Ref: 0408 +OPP TO ST.MARTHA S
CHUBANGALORE KAIN
Page 6 of 11

5497XXX0XXXX7616 29SEP18 131502 AVENUES IND PVT
LT Ref: 827219159625
PAYTM Ref: 827300031269
chowdarychlp4201@okicici,REF NO - 827721886987, UPI
05/10/2018 IMPS OUTWARD ORG UPI To redbus@axisbank,REF NO - 1290.00 11384.78
827800019587, redBus booking
05/10/2018 ATM WITHDRAWAL SUBJECT: NFSATM 05OCT0617Card 500.00 10884.78
05OCT18 Ref: 827811002427 +PRESTIGE
TECHNOLOGYPABANGALORE KAIN
06/10/2018 PURCHASE SUBJECT: MCUPOS 01OCT2025Card no.: 1805.00 9079.78
5497XXX0XXXX7616 01OCT18 202502 MD A AND A
ENTERPRISES\416 LOW Ref: 827414272345
5497XXX0XXXX7616 02OCT18 201300 BRAND
FACTORY\#92/4, VANSHEE T Ref: 827514234203
5497XXX0XXXX7616 04OCT18 131444 MSW*REFECTORY
FOOD AND\MSW*REF Ref: 000672892794
08/10/2018 IMPS OUTWARD ORG UPI To srikanthpulivarthi@okicici,REF 470.00 3049.60
NO - 828016685107, Food
5497XXX0XXXX7616 06OCT18 223758 ONE97 COM LTD -
PAYTM Ref: 827900902949
5497XXX0XXXX7616 05OCT18 184030 MORE\SURVEY NO
88 OUTERRING RO Ref: 100500009031
5497XXX0XXXX7616 05OCT18 113037 FZ CONCETRIX
LUNCH 3\AFRESHZON Ref: 827806001479
ANDHRA BANK REF NO:-828217810452 -RAVI SANKAR
CHUPPALA
Page 7 of 11

16OCT18 Ref: 828920002021 +NO 53 AND 54 CKB
LAYOUBENGALURU KAIN
5497XXX0XXXX7624 15OCT18 133343 REFECTORY FOOD
AND BEV\REFECTO Ref: 001336227773
5497XXX0XXXX7624 16OCT18 134824 SAHITI
KUMAR MATTUPA
VENK
KARUR VYSYA BANK REF NO:-830411696608 -
MrSRINIVASA RAO M
31OCT
KARUR VYSYA BANK REF NO:-830411696935 UTILITY
PAYMENTS -MrSRINIVASA RAO M
ANDHRA BANK REF NO:-830500802476 -MATTUPALLI V
AJAY KU
03/11/2018 ATM WITHDRAWAL SUBJECT: NFSATM 03NOV0535Card 8500.00 13190.60
03NOV18 Ref: 830711002630 +MUNNEKOLALABANGALORE
KAIN
5497XXX0XXXX7624 31OCT18 134837 NELLORE ANDHRA
MESS\7 71 1 DOD Ref: 103100000642
KAIN
Page 8 of 11

12/11/2018 PURCHASE SUBJECT: MCUPOS 09NOV0000Card no.: 200.00 12410.60
5497XXX0XXXX7624 09NOV18 203206 ONE97 COM LTD -
PAYTM Ref: 831300631066
5497XXX0XXXX7624 08NOV18 133320 FZ CONCETRIX
5497XXX0XXXX7624 08NOV18 095415 REFECTORY FOOD
- 831721648980, Return pay
MATTUPALLI V AJAY KUMAR
5497XXX0XXXX7624 12NOV18 134529 NELLORE ANDHRA
MESS\7 71 1 DOD Ref: 111200000897
14NOV18 Ref: 831820001936 +NO 53 AND 54 CKB
LAYOUBENGALURU KAIN
MESS\7 71 1 DOD Ref: 111400000968
adithya.thorikonda61@okhdfcbank,REF NO - 832019612651,
UPI
MESS\7 71 1 DOD Ref: 111500001018
21/11/2018 IMPS OUTWARD ORG UPI To rgn126@okhdfcbank,REF NO - 60.00 536.85
832513719242, UPI
22/11/2018 IMPS INWARD ORG UPI From vinodgundra777@okaxis,REF 600.00 1136.85
NO - 832609323082, UPI
22/11/2018 IMPS OUTWARD ORG UPI To gangasgb69@okhdfcbank,REF 400.00 736.85
NO - 832613176713, UPI
22NOV18 Ref: 832616006145 +PRESTIGE
Page 9 of 11

KUMAR MATTUPA
30/11/2018 IMPS OUTWARD ORG UPI To sivaponnadi -1@okicici,REF 490.00 29322.85
NO - 833422913285, Bill
30/11/2018 IMPS INWARD ORG UPI From goog -payment@okaxis,REF 13.00 29335.85
NO - 833422023364, UPI
NO - 833422922061, Tulasi
PAYTM Ref: 833400061884
01DEC
01DEC
01/12/2018 IMPS INWARD ORG UPI From gangineni4u@okicici,REF NO - 1500.00 30245.85
833513030900, UPI
NO - 833513784952, UPI
01/12/2018 IMPS OUTWARD ORG UPI To gangineni4u@okhdfcbank,REF 1500.00 28758.85
NO - 833513842939, Repayment
bharatpe09898162611@yesbankltd,REF NO - 833515041229,
Verified Merchant
MrSRINIVASA RAO M
02DEC
03/12/2018 IMPS OUTWARD ORG UPI To shalibariya786@oksbi,REF NO 30.00 13648.85
- 833609063752, UPI
Page 10 of 11

03/12/2018 ATM WITHDRAWAL SUBJECT: EURONT 02DEC1352Card 1200.00 12448.85
02DEC18 Ref: 4763 +VIVEKANANDA LAYOUT
OFFBANGALORE KAIN
chaitanya.gv963@okhdfcbank,REF NO - 833708450350, UPI
linga.varadaraja83@okhdfcbank,REF NO - 833721030270,
Shopping
05/12/2018 IMPS OUTWARD ORG UPI To q55733714@ybl,REF NO - 7.00 13931.85
833908243110, UPI
06/12/2018 ATM WITHDRAWAL SUBJECT: NFSATM 06DEC0302Card 6500.00 7431.85
06DEC18 Ref: 834008009460 +NO 53 AND 54 CKB
LAYOUBENGALURU KAIN
06/12/2018 ATM WDL REVERSAL Card No.: 5497XXX0XXXX7624 of M V 6500.00 13931.85
AJAY KUMAR 06DEC18 Ref: 834008009460 +NO 53
AND 54 CKB LAYOUBENGALURU KAIN
OFFBANGALORE KAIN
BANK OF INDIA REF NO:-834017922054 -Mrs SRIHARI
BABU C
07/12/2018 PURCHASE SUBJECT: MCUPOS 05DEC1910Card no.: 228.00 6203.85
5497XXX0XXXX7624 05DEC18 191051 MORE\SURVEY NO
Please send you by nag
10/12/2018 IMPS OUTWARD ORG UPI To arjun.amara1@okaxis,REF NO 95.00 6203.85
- 834322410668, Venki mama
10/12/2018 IMPS INWARD ORG UPI From srikanthpulivarthi@okicici,REF 5300.00 11503.85
NO - 834421498708, M V Ajay Kumar
5497XXX0XXXX7624 10DEC18 205737 RBL BANK LTD -
BILLDESK Ref: 834419980184
5497XXX0XXXX7624 07DEC18 134747 NELLORE ANDHRA
MESS\7 71 1 DOD Ref: 120700001802
Page 11 of 11

- 834612254535, UPI
NO - 834612782382, UPI
Final Tally 207128.37 209630.00 11542.85
-
Closing Balance: 11542.85
Page 1 of 11
CITIBANK N.A
MATTUPALLI V AJAY KUMAR NO. 5 MG ROAD,
Place of Supply : 29-KARNATAKA
BENGALURU - 560001
LOS: 29-KARNATAKA
TEL: 08067739333
IFSC CODE : CITI0000004
MICR CODE : 560037002
GSTIN : 29AAACC0462F1Z0
Citibank Account Number: 54XX9XXX17

Statement Period: July 01,2018 to December 12,2018
Summary of Transactions on Savings Account Number 54XX9XXX17 in INR

For the period 01-07-2018 to 12-12-2018
Opening Balance: 9041.22 -

NO:-818316333169 GIFT
NO:-818316334057 food
NO:-818317337584
NO:-818317344072 family
818513049543
5497XXX0XXXX7616 07JUL HOTEL KRITUNGA \HOTEL
K Ref: 001172272997 Ref No :- 07JUL2220
Page 2 of 11

5497XXX0XXXX7616 13JUL QUIKR INDIA PVT. LTD.\Building
Ref: 071311658525 Ref No :- 13JUL1640
820614238935
25/07/2018 PURCHASE REVERSAL SUBJECT: MCUPOS 193.00 200.22
23JUL1919Card no.: 5497XXX0XXXX7616 23JUL QUIKR
INDIA PVT. LTD.\Building Ref: 071311658525 Ref No :-
23JUL1919
NO:-820712798250
Ref No :- 1895619468
anandsuresh.cheedella1@oksbi,REF NO - 821210607893,
Rent
NO:-821210088326
31/07/2018 IMPS OUTWARD ORG UPI To samim.akram4@okaxis,REF 4000.00 11776.22
NO - 821211689270, Repayment
vishnu.akshay007@okhdfcbank,REF NO - 821211705381, UPI
NO - 821213621083, UPI
31/07/2018 IMPS OUTWARD ORG UPI To kurravijay3677@oksbi,REF NO 150.00 10696.22
- 821218231384, Courier
01/08/2018 IMPS OUTWARD ORG UPI To vijayasgb@okhdfcbank,REF 5000.00 5696.22
NO - 821312923971, Repayment
5497XXX0XXXX7616 31JUL SAHITI RESTAURANT\DOOR
NO 15 O Ref: 821208043917 Ref No :- 31JUL1344
5497XXX0XXXX7616 01AUG MORE\SURVEY NO 88
OUTERRING RO Ref: 080100005722 Ref No :- 01AUG1843
Page 3 of 11

04/08/2018 IMPS INWARD ORG UPI From bakshu63@okhdfcbank,REF 130.00 5227.39
NO - 821600618205, UPI
04/08/2018 ATM WITHDRAWAL SUBJECT: NFSATM 04AUG1314Card 4400.00 827.39
no.: 5497XXX0XXXX7616 Ref: 821618008124 +CKB LAYOUT
BANGALORE KAIN Ref No :- 04AUG1314
5497XXX0XXXX7616 04AUG ONE97 COM LTD -PAYTM
Ref: 821600990864 Ref No :- 04AUG0000
5497XXX0XXXX7616 02AUG SAHITI RESTAURANT\DOOR
NO 15 O Ref: 821408045247 Ref No :- 02AUG1344
31AUG
01SEP18 Ref: 824410007742 +CKB LAYOUTBANGALORE
KAIN
MrSRINIVASA RAO M
KARUR VYSYA BANK REF NO:-824410639597 PERSONAL
MrSRINIVASA RAO M
01SEP18 Ref: 5702 +VIVEKANANDA LAYOUT
OFFBANGALORE KAIN
03/09/2018 IMPS OUTWARD ORG UPI To munafpandu143@okicici,REF 3000.00 4791.99
NO - 824513439277, Urgnet bro
02SEP18 Ref: 824514008176 APSRTCLobby ChittoorChittoor
APIN
- 824620653664, Due Cleared
5497XXX0XXXX7616 31AUG18 140743 SAHITI
Page 4 of 11

5497XXX0XXXX7616 02SEP18 083543 RELIANCE JIO
INFOCOMM \E 510 C Ref: 090237224921
BANK OF INDIA REF NO:-824815963938 Mr MATTUPALLI
VENK
05/09/2018 ATM CASH WITHDRAWAL Card No.: 5497XXX0XXXX7616 of 1000.00 2142.99
M V AJAY KUMAR 05SEP18 Ref: 824808993167 MORE
MEGA STOREBANGALORE KAIN
10/09/2018 IMPS OUTWARD ORG UPI To abhibus@axisbank,REF NO - 949.40 983.59
825218130959, UPI
PAYTM Ref: 825200464997
5497XXX0XXXX7616 09SEP18 185834 Citrusp*Abhibus
\Floor 1 Ref: 825213018870
14/09/2018 IMPS INWARD ORG UPI From munafpandu143@okicici,REF 700.00 770.78
NO - 825720590042, Sry for the late
15SEP18 Ref: 825819005108 UBI KURNOOL
ROADPRAKASAM APIN
NO - 826213581493, UPI
19/09/2018 IMPS INWARD ORG UPI From tulasiram3137@okaxis,REF 70.00 410.78
NO - 826217129077, Meals
Page 5 of 11

21SEP18 Ref: 2379 V.R.LAYOUTBANGALORE KAIN
26/09/2018 IMPS INWARD ORG UPI From sivaponnadi@oksbi,REF NO - 300.00 310.78
826912091825, Hi
PAYTM Ref: 826900536280
msr.sivaramakrishna.ml@okaxis,REF NO - 827211303159,
Repayments
venkatrams171@okhdfcbank,REF NO - 827211315130,
Repayment
MrSRINIVASA RAO M
KUMAR MATTUPA
VENK
29/09/2018 IMPS INWARD ORG UPI From subbu0203@okaxis,REF NO - 10000.00 24276.78
827223035467, UPI
AVULA,SUBBA
29/09/2018 INTEREST EARNED Period: 01JUL2018 - 30SEP2018 for 17.00 14293.78
Savings account
01/10/2018 IMPS INWARD ORG UPI From vsunreddy@oksbi,REF NO - 500.00 14793.78
827318988058, UPI
30SEP18 Ref: 0408 +OPP TO ST.MARTHA S
CHUBANGALORE KAIN
Page 6 of 11

5497XXX0XXXX7616 29SEP18 131502 AVENUES IND PVT
LT Ref: 827219159625
PAYTM Ref: 827300031269
chowdarychlp4201@okicici,REF NO - 827721886987, UPI
05/10/2018 IMPS OUTWARD ORG UPI To redbus@axisbank,REF NO - 1290.00 11384.78
827800019587, redBus booking
05OCT18 Ref: 827811002427 +PRESTIGE
5497XXX0XXXX7616 01OCT18 202502 MD A AND A
ENTERPRISES\416 LOW Ref: 827414272345
5497XXX0XXXX7616 02OCT18 201300 BRAND
FACTORY\#92/4, VANSHEE T Ref: 827514234203
5497XXX0XXXX7616 04OCT18 131444 MSW*REFECTORY
FOOD AND\MSW*REF Ref: 000672892794
08/10/2018 IMPS OUTWARD ORG UPI To srikanthpulivarthi@okicici,REF 470.00 3049.60
NO - 828016685107, Food
5497XXX0XXXX7616 06OCT18 223758 ONE97 COM LTD -
PAYTM Ref: 827900902949
5497XXX0XXXX7616 05OCT18 184030 MORE\SURVEY NO
5497XXX0XXXX7616 05OCT18 113037 FZ CONCETRIX
ANDHRA BANK REF NO:-828217810452 -RAVI SANKAR
CHUPPALA
Page 7 of 11

16OCT18 Ref: 828920002021 +NO 53 AND 54 CKB
LAYOUBENGALURU KAIN
5497XXX0XXXX7624 15OCT18 133343 REFECTORY FOOD
5497XXX0XXXX7624 16OCT18 134824 SAHITI
KUMAR MATTUPA
VENK
KARUR VYSYA BANK REF NO:-830411696608 -
MrSRINIVASA RAO M
31OCT
KARUR VYSYA BANK REF NO:-830411696935 UTILITY
PAYMENTS -MrSRINIVASA RAO M
ANDHRA BANK REF NO:-830500802476 -MATTUPALLI V
AJAY KU
KAIN
5497XXX0XXXX7624 31OCT18 134837 NELLORE ANDHRA
MESS\7 71 1 DOD Ref: 103100000642
KAIN
Page 8 of 11

PAYTM Ref: 831300631066
5497XXX0XXXX7624 08NOV18 133320 FZ CONCETRIX
5497XXX0XXXX7624 08NOV18 095415 REFECTORY FOOD
- 831721648980, Return pay
MATTUPALLI V AJAY KUMAR
MESS\7 71 1 DOD Ref: 111200000897
14NOV18 Ref: 831820001936 +NO 53 AND 54 CKB
LAYOUBENGALURU KAIN
MESS\7 71 1 DOD Ref: 111400000968
adithya.thorikonda61@okhdfcbank,REF NO - 832019612651,
UPI
MESS\7 71 1 DOD Ref: 111500001018
21/11/2018 IMPS OUTWARD ORG UPI To rgn126@okhdfcbank,REF NO - 60.00 536.85
832513719242, UPI
22/11/2018 IMPS INWARD ORG UPI From vinodgundra777@okaxis,REF 600.00 1136.85
NO - 832609323082, UPI
22/11/2018 IMPS OUTWARD ORG UPI To gangasgb69@okhdfcbank,REF 400.00 736.85
NO - 832613176713, UPI
22NOV18 Ref: 832616006145 +PRESTIGE
Page 9 of 11

KUMAR MATTUPA
NO - 833422913285, Bill
NO - 833422023364, UPI
NO - 833422922061, Tulasi
PAYTM Ref: 833400061884
01DEC
01DEC
01/12/2018 IMPS INWARD ORG UPI From gangineni4u@okicici,REF NO - 1500.00 30245.85
833513030900, UPI
NO - 833513784952, UPI
01/12/2018 IMPS OUTWARD ORG UPI To gangineni4u@okhdfcbank,REF 1500.00 28758.85
NO - 833513842939, Repayment
bharatpe09898162611@yesbankltd,REF NO - 833515041229,
Verified Merchant
MrSRINIVASA RAO M
02DEC
03/12/2018 IMPS OUTWARD ORG UPI To shalibariya786@oksbi,REF NO 30.00 13648.85
- 833609063752, UPI
Page 10 of 11

OFFBANGALORE KAIN
chaitanya.gv963@okhdfcbank,REF NO - 833708450350, UPI
Shopping
05/12/2018 IMPS OUTWARD ORG UPI To q55733714@ybl,REF NO - 7.00 13931.85
833908243110, UPI
06/12/2018 ATM WITHDRAWAL SUBJECT: NFSATM 06DEC0302Card 6500.00 7431.85
06DEC18 Ref: 834008009460 +NO 53 AND 54 CKB
LAYOUBENGALURU KAIN
06/12/2018 ATM WDL REVERSAL Card No.: 5497XXX0XXXX7624 of M V 6500.00 13931.85
AJAY KUMAR 06DEC18 Ref: 834008009460 +NO 53
AND 54 CKB LAYOUBENGALURU KAIN
OFFBANGALORE KAIN
BANK OF INDIA REF NO:-834017922054 -Mrs SRIHARI
BABU C
5497XXX0XXXX7624 05DEC18 191051 MORE\SURVEY NO
Please send you by nag
10/12/2018 IMPS OUTWARD ORG UPI To arjun.amara1@okaxis,REF NO 95.00 6203.85
- 834322410668, Venki mama
10/12/2018 IMPS INWARD ORG UPI From srikanthpulivarthi@okicici,REF 5300.00 11503.85
NO - 834421498708, M V Ajay Kumar
5497XXX0XXXX7624 10DEC18 205737 RBL BANK LTD -
BILLDESK Ref: 834419980184
5497XXX0XXXX7624 07DEC18 134747 NELLORE ANDHRA
MESS\7 71 1 DOD Ref: 120700001802
Page 11 of 11

- 834612254535, UPI
NO - 834612782382, UPI
Final Tally 207128.37 209630.00 11542.85
-
Closing Balance: 11542.85

Instructions / Checklist For Filling KYC Form

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Instructions / Checklist For Filling KYC Form

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Instructions / checklist for filling KYC form

B. Proof of Identity (POI)

C. Proof of Address (POA)

D. Exemptions/clarifications to PAN (*Sufficient documentary evidence in support of such claims to be collected.)

E. List of people authorized to attest the documents

1 Sign wherever you see

A. KYC form - Document captures the basic information about

2 Sign wherever you see

For office use only (To be filled by the financial institution)

Tick if applicable Residence for tax purposes in jurisdiction(s) outside India

5a. PAN BGAPM1777K

FOR OFFICE USE ONLY

Originals Verified and Self-Attested Document Copies Received

Date Signature of the Authorized Signatory

3 Sign wherever you see

City/Town District Pin Code

F. Bank account details

4 Sign wherever you see

J. Dealings through other members

K. Introducer details (optional)

L. Trading preferences / experience

MCX Client Signature F3 (a)

N. Sales tax registration details (As applicable)

P. Nomination details (Please tick the appropriate options)

5 Sign wherever you see

Place : Naguluppala Padu F4 Client Signature

For office use only

Documents verified with Originals Client Interviewed By In-Person Verification done by

Employee Code Z1527 Z1527

Designation of employee Account Opening Account Opening

Signature of the Authorised Signatory

Date : 2018-12-12 Seal/Stamp of the stock broker

6 Sign wherever you see

7 Sign wherever you see

8 Sign wherever you see

Zerodha Commodities Private Limited

Place : Naguluppala Padu

9 Sign wherever you see

Citibank Account Number: 54XX9XXX17

Summary of Transactions on Savings Account Number 54XX9XXX17 in INR

Opening Balance: 9041.22 -

Date Transaction Details Withdrawals Deposits Balance

Date Transaction Details Withdrawals Deposits Balance

Date Transaction Details Withdrawals Deposits Balance

Date Transaction Details Withdrawals Deposits Balance

Date Transaction Details Withdrawals Deposits Balance

Date Transaction Details Withdrawals Deposits Balance

Date Transaction Details Withdrawals Deposits Balance

Date Transaction Details Withdrawals Deposits Balance

Date Transaction Details Withdrawals Deposits Balance

Date Transaction Details Withdrawals Deposits Balance

Date Transaction Details Withdrawals Deposits Balance

Citibank Account Number: 54XX9XXX17

Summary of Transactions on Savings Account Number 54XX9XXX17 in INR

Opening Balance: 9041.22 -

Date Transaction Details Withdrawals Deposits Balance

Date Transaction Details Withdrawals Deposits Balance

Date Transaction Details Withdrawals Deposits Balance

Date Transaction Details Withdrawals Deposits Balance

Date Transaction Details Withdrawals Deposits Balance

Date Transaction Details Withdrawals Deposits Balance

Date Transaction Details Withdrawals Deposits Balance

Date Transaction Details Withdrawals Deposits Balance