Passport Address and Present Address Mismatch Declaration — Declaration Format

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Date:

Transaction Reference No.:

Customer Name:

Passport No.:

Address appearing in Passport

Present Residential Address

Declaration

I declare that the address mentioned in my passport differs from my present residential address because:

I have shifted my residence.The passport contains my permanent / parental address.I am staying in rented accommodation.I have relocated due to employment / business / education.I have recently changed my address and the passport has not been updated.Other:

I confirm that:

Both addresses relate to me.
My current residential address stated above is complete and correct.
I authorise the company to verify the present address through the documents submitted by me.
I undertake to produce additional evidence if required.
I shall inform the company if my address changes before completion of the transaction.

Present Address Proof Submitted

Aadhaar CardDriving LicenceVoter IDBank StatementUtility BillRegistered Rent AgreementEmployer LetterOther:

Customer Signature

For Office Use

Original address proof verified:YesNo

Verified by:

Authorised Signatory: