Document 6602523

Client Information Sheet
(Loan Request for Loan against Securities)
(Please fill in Capital letters – Fields marked with are Compulsory Fields)
KFSL Relationship Manager Details:
RM Name:
Branch
Mobile:
Email ID:
Client Personal Details:
Name
First Name
Middle Name
Surname
Father’s Name
First Name
Middle Name
Surname
Spouse’s Name
First Name
Middle Name
Surname
PAN
Date of Birth/
Incorporation
Voter ID
Passport
Telephone
Mobile
DD / MM / YYYY Gender M/F
Email ID:
Current Address:



State/UT
Pincode
Email ID 
Name of the Company/Firm:
Office Address:



State/UT
Pincode
Contact Person Name:
Mobile
Email ID:
Client Financial Details:
Networth:
as on date:_____________
nd
Annual Income: ______________ (Last Year) _____________(2 Last Year)
Portfolio Value
as on date:_____________
List of 5 major scrips in Portfolio (Please also attached list of Scrips with Value)
Scrip Name
Qty
Rate
Total of 5 scrip values
Average Daily Trading Value (In case of LAPS Clients) (Rs)
Scrip Holding Value
Existing Association with KSBL:
KSBL Branch Name:
Sourcing (Tick one)
Client Trading Code:
Broking/Distribution/Wealth/Fortune
No. of Years of Association
Lead Sourced by (Name of Employee)
Employee Code
Dealer Mail Id 
Contact No 
Loan Proposal:
Loan Amount Required
Product
LAPS / LAS
Purpose:
Tenure: ________ Months
Margin (Specific Requirement %)
Funding Against Specific Scrip
Interest (Specific Requirement %)
Scrip Name
Value (Rs)
Specific Requirement if any:
Remarks of RM:
Trading History:
Conduct of applicant in trading as well as overall trading history:

Regular intraday trader – working more on rumors + quality of scrips usually dealt in approved or unapproved,

Regular trader but holds particular scrips for short duration (may or may not follow some pattern) – frequent
churning of portfolio quality of scrips usually dealt in approved or unapproved.

Regular trader but holding stock over longer periods – signifying solid investment intentions + quality of scrips
usually dealt in approved or unapproved.

Infrequent trader – hold stock for longer periods – in anticipation of long term capital gains + quality of scrips
usually dealt in approved or unapproved.
Documents Require along with CIS – (For LAS/PF Facility ):
1) Latest Financial, ITR , Annual returns for last 2 Years
2) Latest Bank Statement of Account from Principal Banker for Last 3 Months
3) Latest CA Certify Net worth Certificate
Declaration from the Client:
I certify that KFSL may by itself or through authorised persons, lawyers, agencies, bureau etc verify any/all information
given, check credit references, employment details and obtain credit reports to determine my credit worthiness in
connection with this Loan request or in case KFSL requires to conduct additional/further checks in order to assess my
eligibility for further loans in the future.
I hereby agree and give my consent to the company to disclose and furnish all/any information and/or data relating to
any credit facility availed of/or to be availed by me to the affiliates of the Company, Credit Bureau, Credit Rating
agencies, Banks, Financial Institutions, Non Banking Financial Institutions, Data Bank or any governmental or regulatory
authorities/ bodies/departments for the purpose of complying with legal and/or regulatory requirements.
Date: 
Place:
Signature of Client
Signature of Relationship Manager
Karvy Financial Services Ltd
Corporate Office:
Office No.762, Building No.7, 6th Floor, Solitaire Park,Andheri (E),Mumbai - 400093.
Phone: +91-22-67875300, Email:customercare.kfsl@karvy.com