_pëQ>ñQ>oQ> a{O. Z§. 267 Multi-state R. No.

267

Account Opening Form / ZdrZ ImVo CKS>Ê`mMm AO©

BRANCH : DATE : / /
emIm : {XZm§H$ :

Customer No. A/c. No.

J«mhH$ H«$. : ImVo H«$. :

I / We request you to open my / our saving account in your Society

‘r/Amåhr Aer {dZ§Vr H$aVmo H$s Vw‘À¶m g§ñWo_Ü`o ‘mPo / Am‘Mo ~MV ImVo CKS>mdo.
ImË`mMm àH$ma: ~MV R>od ImVo Mmcy R>od ImVo _wXV R>od _m{gH$ R>od
Type of A/c. Saving A/c. Current A/c. Fixed Deposit Monthly A/c.

Surname Name Father's / Husband's Name

AmS>Zmd Zmd d{S>bm§Mo / nVrMo Zmd
1

2
(Photo)
N>m¶m{MÌ
3

Specimen Signature (Please don't sign in Black Ink) / Z‘wZm ñdmjar (H$mù¶m emB©Zo H$ê$ Z`o)
(1) (2)
(Photo)
N>m¶m{MÌ

(3) (4)
2

(Photo)
N>m¶m{MÌ

(Photo)
N>m¶m{MÌ

1. Either or survivor 2. Jointly or survivor 3. Former or survivor 4. Any one of us or any one of the survivor or the last survivor
5. Other (Please Specify)
1. EH$ qH$dm Or{dV. 2. gd© {‘iyZ qH$dm Or{dV. 3. n{hbm qH$dm Or{dV. 4. Am‘À¶mn¡H$s EH$ AWdm Or{dVmn¡H$s EH$ qH$dm eodQ>Mm Or{dV
5. Aݶ (H¥$n¶m ‘m{hVr Úm)
 Personal Details / d¡¶{³VH$ ‘m{hVr
( To be filled by Joint A/c. holders separately) / (à˶oH$ ImVoXmamZo doJir ^amdr)
( Attach documentary evidence for minor /senior citizen (above 60 yrs.) / (AkmZ qH$dm Á¶oð> ZmJ[aH$m§gmR>r (60 dfmªdarb) H$mJXmonÌr nwamdm OmoS>mdm.)

Date of Birth DD MM YY
OÝ‘{XZm§H$ : {XZm§H$ ‘{hZm df©

Marital Status : Single / Married / Unmarried Children :

b¾{df¶H$ : EH$Q>m / {ddm{hV / A{ddm{hV ‘wbo :

Gender : Male / Female

qbJ : nwéf /ór

Occupation : Salaried / Business / Retired / Student / Housewife / Self Employed / Other

ì¶dgm¶ : nJmar / ì¶dgm¶ / {Zd¥Îm / {dÚmWu / J¥{hUr / ñdV:Mm ì¶dgm¶ / Aݶ

Employer / Business Name & Address

ZmoH$arMo / ì¶dgm¶mMo Zm§d d nÎmm :
Employee No. : Designation :
godH$ H«$. : nX :

Annual Income : PAN / GIR No.

dm{f©H$ CËnÝZ : n°Z / Or. Am¶. Ama. H«$.

Passport No. : Expiry Date of Passport :

nmanÌ H«$. : nmanÌ ‘wXV g§nʶmMm {XZm§H$

Previous Banker : A/c. No. :

AmYrMr ~±H$ : ImVo H«$. :

Membership if any : Membership No.

g^mgXÎd Agë¶mg : g^mgX H«$.

Residence : Owned / Rental

{Zdmg ñWmZ : ñdV:Mo / ^mS>çmMo

Flat No. and Name of the Society

gX{ZH$m H«$. Am{U gmogm¶Q>rMo Zmd :

Road No. / Name : Area / Locality

añVm H«$. / Zmd : ñWi / {d^mJ :

City : Pin :
eha : {nZ :

Tel. No. : (R) (O) :

XyaÜdZr H«$. : (KaMm) (H$m¶m©b¶rZ) :

E-mail ID. : Mobile No.

B© ‘ob Am¶S>r : Xya^mf ^«‘UÜdZr H«$. :
 Proof of Identity / AmoiI{df¶H$ nwamdm
(Attach copies & provide original for verification)
Passport / Letter From Existing Bank / PAN or provide at least one each from List A & List B (Please tick)
(‘yi nÌmÀ¶m àVr OmoS>m d ‘yinÌ nS>VmiUrgmR>r AmUm.)
nmgnmoQ>©, gܶmÀ¶m ~±Ho$H$Sy>Z nÌ, n°Z qH$dm Imbrbn¡H$s {bñQ> E d {bñQ> ~r n¡H$s {H$‘mZ EH$ (~amo~aMr IyU H$am.)
List A (Proof of Identity) / {bñQ> E (AmoiI{df¶H$ nwamdm) List B (Proof of Present Address) / {bñQ> ~r (AmoiI{df¶H$ nwamdm)
Voter's ID Card / ‘VXma AmoiInÌ Latest Electricity Bill / Telephone Bill / Mmby drO {~b/’$moZ {~b/
LIC Premium Receipt EbAm¶gr hß˶mMr nmdVr
Driving Licence / dmhZ Mmb{dʶmMm nadmZm Letter From Employer/Educational Institute ì¶mdgm{¶H$/e¡ j{UH$ g§ñWoH$Sy>Z nÌ
ID Card of reputed employer / ì¶mdgm{¶H$ / e¡j{UH$ giving present residential address Á¶mV gܶmÀ¶m nζmMm CëboI Amho
Educational Institute g§ñWoMo AmoiInÌ Photo copy of Agreement of amh˶m KamÀ¶m H$amaZmå¶mMr N>m¶m§{H$V
Govt. / Defence ID card / gaH$mar/{S>’o$Ýg AmoiInÌ residential flat/maintenance receipt àV/XoI^mb nmdVr
Any Other / Aݶ Income / Wealth Tax Assessment Order Am¶H$a/g§nÎmrH$a AmH$maUrMo {ddaU nÌ

Documents Required / Amdí¶H$ H$mJXnÌo

( Provide Original For Verification )
Individuals : 1) Photograph 2) Photo Copy of PAN Card/Form 60 3) Proof of Identity
Club/Trust/Society : 1) Photograph of all authorized signatories
2) Certified copy of Trust Deed
3) Certified Copy of Bye laws
4) Resolution to open the account and Authorized Signatories
5) Certified copy of Registration Certificate.
1) Photographs of the Karta and all Co-parceners
HUF :
2) HUF letter signed by Karta & all major co-parceners.

(nS>VmiUrgmR>r ‘yi àV AmUm)

d¡¶{º$H$ : 1) N>m¶m{MÌ 2) n°Z H$mS>©Mr N>m¶m§{H$V àV/’$m°‘© 60 3) AmoiI{df¶H$ nwamdm
³b~/Q´>ñQ>/gmogm¶Q>r : 1) gd© O~m~Xma ì¶{º$¨Mr N>m¶m{MÌo 2) {dœñV g§ñWoÀ¶m Cn{dYrMr à‘m{UV àV
3) Cn{dYrMr à‘m{UV àV 4) ZdrZ ImVo CKS>ʶmgmR>r R>amd
5) Zm|XUr à‘mUnÌmMr à‘m{UV àV
qhXÿ A{d^º$ Hw$Qw>§~ : 1) H$˶m©Mo Am{U gd© gm‘m{¶H$ dmagm§Mr N>m¶m{MÌo
2) qhXÿ A{d^º$ Hw$Qw>§~mMo nÌ (H$˶m©Zo ñdmjar Ho$bobo) Am{U gd© gkmZ gm‘m{¶H$ dmagm§Mo g§‘VrnÌ

Declaration / OmhraZm‘m
I / We declare, confirm, agree :-
a) that all the particulars and information given in the Application form are true, correct, complete, up-to-date in all respects
and I/We have not withheld any information,
b) that the rules of Savings Bank Account of the Bank have been read by ME / US and that I / WE accept them as binding upon me/us.

‘r / Amåhr Ago Omhra H$aVmo :-

1) ¶m AOm©Vrb Vnerb d ‘m{hVr hr g˶, ~amo~a Amho Am{U gd© ~m~t‘ܶo nyU© Amho Am{U ‘r/Amåhr H$moUVrhr ‘m{hVr bn{dbr qH$dm amIyZ R>odbobr Zmhr.
2) ¶m ~±Ho$À¶m ~MV Im˶mMo gd© {Z¶‘ d AQ>r ‘r/Amåhr dmMë¶m AmhoV Am{U ˶m ‘bm/Amåhmbm ‘mݶ AmhoV Am{U ˶m ‘mPoda/Am‘Moda ~§YZH$maH$ AmhoV.

* Note : If the depositor is illiterate, thumb impression should be attested by two witnesses.
* gyMZm : Oa ImVoXma A{e{jV Agob Va A§JR>çmMm R>gm XmoZ gmjrXmam§Zr à‘m{UV H$amdm.
Signature of Witness
Your's Faithfully, Name & Address of Witness
Amnbm/Amnbo [dídmgy gmjrXmamMm Zmd d nÎmm gmjrXmamMr ñdmjar

1 1

2 2
 Introduction by an existing Account Holder / g§ñWoÀ¶m ImVoXmamZo AmoiI {Xbr Agë¶mg
Mr. I Ms.
lr./lr‘Vr
Surname Name Father's / Husband's Name
AmS>Zmd Zmd d{S>bm§Mo/nVrMo Zmd
SB/CD/CC/OD/Loan A/c. No. : Branch. : Tele. No. :
~.Im./Mm.Im./grgr/AmoS>r/H$O© ImVo H«$. emIm : XÿaÜdZr H«$ :

I Know the customer for a prerlod of months / years and confirm his / her address.
‘r gXa J«mhH$mg ‘{hZo/df© ¶m H$mbmdYrnmgyZ AmoiIVmo Am{U {VZo/˶mZo {Xbobm nÎmm ~amo~a Amho.

Date Signature Of Introducer :

{XZm§H$ AmoiI H$ê$Z KoUmè¶mMr ñdmjar :

Signature Verified by / ñdmjar nS>VmiUr

Name : Employee Code :
Zmd : H$‘©Mmar g§Ho$V H«$.:
Designation : Signature :
hþÔm : ñdmjar :

Nomination (For Individual / Sole Proprietorship Accounts only)

Zm‘{ZX}eZ (ì¶{³VJV Im˶m§gmR>r / EH$Q>çmÀ¶m ‘mbH$sMr g§ñWm Agob Va)
Nomination Form / Zm‘{ZX}eZ nÌ
Nomination : Required Not Required
Zm‘{ZX}eZ : hdo ZH$mo
I / We nominate following named person as my / our nominee after my / our death who will be entitled legally to receive the money.
‘r/Amåhr Imbrb ì`{º$Moo Zmd gyM{dV AmhmoV. ‘m¶m / Am‘À¶m ‘¥Ë¶yZ§Va Imbrb 춺$s H$m¶Xoera[a˶m n¡go {‘iʶmg nmÌ amhVrb.

(Only one person can be nominated per account)

(EH$m Im˶mgmR>r ’$º$ EH$m ì¶{º$Mo Zm‘{ZX}eZ hmoD$ eH$Vo.)
Name & Address / Zmd d nÎmm Age / d¶ Date of Blrth Relation with Depositor
OÝ‘ {XZm§H$ ImVoXmamer ZmVo

As the nominee is minor on this date I / we appoint Shri./Smt./Miss

AmOÀ¶m KS>rbm Zm‘{ZX}{eV Ho$bobr 춺$s AkmZ Amho. åhUyZ ‘m¶m/Am‘À¶m ‘¥Ë¶yÀ¶m doir ‘r / Amåhr lr / lr‘Vr / Hw$‘ma
Address
nÎmm

to receive the amount of the deposit on behalf of the nominee in the event of my/our death during the minority of the nominee.
¶m 춺$sMr AkmZ ì`{º$Mo (dmbr åhUyZ) Zo‘UyH$ H$aVmo. _mÂ`m / Am_À`m _¥Ë`wÀ`m doir Zm_{ZX}{eV ì`º$s AkmZ Agë`mg øm 춺$sbm a¸$‘ {‘imdr.
* Note : If the depositor is illiterate, thumb impression should be attested by two witnesses.
gyMZm : Oa ImVoXma A{e{jV Agob Va A§JR>çmMm R>gm XmoZ gmjrXmam§Zr àm‘m{UV H$amdm.

Signature(s) of Depositor(s) / ImVoXmamÀ¶m ñdmjar Signature(s) of Witness(es) / gmjrXmam§À¶m ñdmjar

1. 1.
2.
3. 2.
4.

FOR SOCIETY'S USE ONLY / g§ñWoZo ^amd¶mMm Vnerb

A/c. Opened on : Signature of Clerk :
/ /
ImVo CKS>ʶmMm {XZm§H$ : boI{ZH$mMr ñdmjar :

Signature of Sr. Clerk / Officer : Manager

d[að> {b{nH$ / A{YH$mar ñdmjar : ì¶dñWmnH$