OPTY ID / Service Request No:

Request for Linking/Seeding Aadhaar Number and Receiving DBT Benefits into Bank Account
Name
First Name Middle Name Last Name
Customer Relationship Number: Aadhaar Number:
DOB D D MM Y Y Y Y Gender: Male Female Transgender
Name of the Aadhaar Holder
as in Aadhaar Card
1. I submit my Aadhaar number _______________________________ & give my voluntary consent to -
• Use my Aadhaar Details to authenticate me from UIDAI
• Link the Aadhaar Number to all my existing/new/future accounts & customer profile (Customer Relationship Number - CRN)
with your Bank.

(Signature of Customer)
2. Option for receiving DBT Benefits (Tick only one from below )
c
I wish to seed my account No. ______________________________ with NPCI mapper to enable me to receive Direct
Benefit Transfer (DBT) including LPG Subsidy from Government of India in my above account. I understand that if
more than one Benefit transfer is due to me, I will receive all benefit transfers in this account.(Applicable to customer
who have not so far seeded account with NPCI)
c
I request you to change my NPCI mapping *(DBT Benefit Account) to my account no. ___________________ with
<Bank Name>
your Bank. I already have an account with ______________________________ having IIN Number**
______________________________ and seeded with NPCI mapper for receiving DBT from Government of India.
c
I do not want to change my NPCI mapping* (DBT Benefit Account) from the existing Bank. I already have
<Bank Name>
an account with another Bank ______________________________ having IIN Number** ______________________________
and seeded with NPCI mapper for receiving DBT from Government of India.
c
I do not wish to seed my accounts from your Bank with NPCI mapper (I will not be getting DBT).

Declaration:
• I have been explained about the nature of information that may be shared upon authentication. I have been given to understand that my information
submitted to the bank herewith shall not be used for any purpose other than mentioned above, or as per requirements of law.
? I hereby declare that all the above information voluntarily furnished by me is true, correct and complete.
? In case if my DOB/Gender as per bank records does not match with that of as per my Aadhaar, I hereby authorise bank to rectify my DOB/Gender in my bank
record as per the Aadhaar.
• I am aware that communication on my Linking / Seeding of Aadhaar number will be received on the mobile number registered in Bank records.

(Signature of Customer)
* NPCI Mapping – Mapping is a process of associating a Bank with Aadhaar Number which is facilitated by NPCI for Direct Benefit Transfer to the respective Bank who have linked the
Aadhaar Number to a specific Bank account for receiving Direct Benefits to which customer has given the consent.
** IIN Number(Issuer Identification Number) will be provided by Bank receiving the consent application.

For Branch Use Only FOR CPC USE ONLY

Branch Name / Code: Received Date:

KMBL/Jan-2018/V1.02

Applicant’s Signature verified: Y N Request Captured by:

Employee Name: Request Authorized by:

Sign: Execution Date:

Employee Code:

Date forwarded to RPC:

Acknowledgement
Date Time

Request for Linking of Aadhaar for Mr / Mrs

Seeded to Account Number for receipt of DBT credits

Service Request Number Bank official sign and Branch seal

Kotak Mahindra Bank Ltd. | CIN: L65110MH1985PLC038137.

Registered Office: 27 BKC, C 27, G Block, Bandra Kurla Complex, Bandra (E), Mumbai - 400 051. www.kotak.com