MobiKwik Wallet Kyc User Form · 2020-07-14 · MobiKwik Wallet KYC FormMobiKwik Wallet KYC Form...
Transcript of MobiKwik Wallet Kyc User Form · 2020-07-14 · MobiKwik Wallet KYC FormMobiKwik Wallet KYC Form...
MobiKwik Wallet KYC FormMobiKwik Wallet KYC Form
Wallet Details
Phone number linked with Wallet
1
Identity Details (as per ID Proof)2
Address Details (as per Address Proof)3
Declaration4
Seal/Stamp of Verifying Agency
Documents verified against originals
Self-attest verifiedPhotos Collected
Please a�x recent passport sized photo
graph.
Cross sign the photograph
For O�ce Use Only5
(Bank Statement/Utility Bills should not be more than 2 months old)
Flat No. / Plot No. / House No. / Building / Area
Address Proof Submitted
Aadhar Card
Utility Bills
Bank Statement
Pension Payment
Driving License
NREGA Job Card
Voter ID
Municipal Tax Receipt
Passport
City/District
State PIN Code
Email ID linked with Wallet
I hereby declare that the above furnished details are true to the best of my knowledge. 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.
SignaturePlace Date
Agency Name
Agent Name
Gender Male Female
ID Proof Submitted
PAN Card Aadhar Card Driving License Passport
Voter ID NREGA Job Card Government Issued ID Proof
D D M M Y Y Y Y
Please fill in BLOCK letters. One Mobikwik Systems Private Limited
(recommended)
(should have photograph)
Name
Date of Birth