Annexure-® FINANCIAL INCLUSION ACCOUNT OPENING CUM OVERDRAFT APPLICATION FOR INDIVIDUALS. Date Name ofthe Branch vilage/ Town. Distret state First Applicant Sole Appi FULLNAME, In CAPITAL letters (Fis, Middle and Last Name: Mr/Mes,/MS. Fathers/Musband’s name in CAPTAL letters: Mr Date ofBith J _J____ Gender: W/E Cccupation: Agn/Service/Housenife/Business/Others: TelNo, Mobile No: Email ‘Second Apoicant/ Joint Aoolcan FULLINAME, In CAPITAL letters (Fist, Middle and Last Name: Mr Mrs /MS. Fathees/Husband’s name in CAPITAL laters: Mr Date of ith JJ. Gender: ME (Occupation: Agri/Service/Housewife/Business/Others TelNo, ‘Mobile No: Email iO Operating instructions Present Adress Permanent addres: Pw Other Facilites Required (Pease Tick mark inthe appropriate box) S.No. Particulars yes | no | sno. Pertculars Yes | Wo 1 | passbook 4 _| rupay card Debit card 2__| statement of A/c through Emai/Post 5_| internet Sanking Faciy 3__| cheque Book 6_| Motte Banking Fai 7 LUnking of Aadhar Now fff J J J oter ID No.ifavallable ff Jf J ff ‘Nomination: Deposit Nominee Nature of | Distinguishing] Additional Name of | Address of | Relationship with | Age | Ifnominee sa Deposit No, Detail Nominee | Nominee Depositor tino, hiher DOB Since the nominee isa minor on this date, we appoint Mr TMS Adress Ree we receive the amount of deposit on behalf ofthe nominee in the event of my/aur minors) death | We agree to abide by the terms and conditions af Saving Bork Account of Bank of Baroda, [Above Particulars Verified 4 2. ‘Signature (8) ofthe aplieants) "Name and signature ofthe Business Correspondent (8C) [APPLICATION FOR OVERDRAFT FACILITY | also request you to sanetion me an Overdraft Limit of Rs (,. for mesting my emergency farnly needs, shal abe by the terms and conditions stipulated by the Bank inthis regards, My Gross Annual Income i Rs, {rom all sources. My main source of income s (Signature ofthe appicant)‘On the Back side ofthe Single page Apllcation Form FOR OFFICE USE ONLY (Processing Cum Sanction Memo) Branch: Branch Alpha Scheme Code: $8124/150 Name /s ofthe A/c Holder(sj=_ ae No. CustomerID No, Annual Income from various sources as declared by the applicant(s) Rs Overdraf Limit Sanctioned Rs (Rs. Rate of int. Sb above Base Rate minimum _____¥ with monthly rests Period: 12 Months Documents: 1-D P Note; 2- Letter of continuing security tobe signed by the borrower Recommended Sanctioned In charge Chiet/ Senior/Branch Manager Saving Bank Deptt VC IDENTIFICATION DOCUMENTS/PAPERS TO BE SUBMITTED BY APPLICANT (S) (ny one document from each ofthe following two ists subject to Bank's satisfaction) st Tiek | 5. sta Tick (Latest /recent documents showing identity proof) | Mack | No | (Latest /recent documents showing identity | Mark S.No root) | Ding iene with photograph 1 | Driving cense with photograph 2__ | MNREGA ob Card 2 | Telephone Bil Electricity Bil, Ration Card Voters identity Card 3 | Bank account statement (with address) 3 IMNREGA job Card PAN Card, Government 10 Card @_| Any documentary evidence n support of residential adress ta the Bank ‘adhaar Card 6 | Aadhaar Card, voter Card “any other document as per RBI Guidelines 5 | Inease of married women address proof ofthe 5 room is acceptable Details of documents for identification submitted bythe a In case the KYC documents as mentioned above are not available then introduction from an existing account holder (atleast six months old satisfactorily conducted and KYC compliant account) needs to be obtained, Name: “ecoant Wa adress Date of Opening oF Ale Gasomer Ema Branch Name Mabie. “ype oF RE SOTERTECTO: Ie is cetfied that Me Mrs/.Ms is known to me/us personally since lst __manths/yers and confirm the occupation, photograph and address inthe application form for opening of account are correct to the best of my/our knowledge and belie (Signature of the introducer)