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Nomination Form

This document is a nomination form for bank deposits. It allows a customer to nominate another person to receive the funds in their bank deposit accounts in the event of the customer's death. The form provides fields to enter the customer's name and address, details of the bank deposit accounts, nominee's name, age, relationship and address. If the nominee is a minor, the customer can appoint a guardian to receive the funds on the minor's behalf. The customer signs the form in the presence of witnesses to complete the nomination. The form ensures the bank has all necessary details to transfer the deposit funds to the nominated person upon the customer's death.

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LakshyaRamani
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242 views1 page

Nomination Form

This document is a nomination form for bank deposits. It allows a customer to nominate another person to receive the funds in their bank deposit accounts in the event of the customer's death. The form provides fields to enter the customer's name and address, details of the bank deposit accounts, nominee's name, age, relationship and address. If the nominee is a minor, the customer can appoint a guardian to receive the funds on the minor's behalf. The customer signs the form in the presence of witnesses to complete the nomination. The form ensures the bank has all necessary details to transfer the deposit funds to the nominated person upon the customer's death.

Uploaded by

LakshyaRamani
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

NOMINATION FORM

FORM DA1

Date :

DDMMYYYY

CUSTOMER DECLARATION
Nomination under Section 45ZA of the Banking Regulation Act, 1949 and Rule 2(1) of the Banking Companies (Nomination) Rules 1985 in
respect of the bank deposits.
I/We [Name(s)]
[Address(es)]

nominate the following person to whom in the event of my / our / minor's death the amount of the deposit, particulars whereof are
given below, may be returned by Citibank, N.A. [Branch Name and Address] __________________________________________________________________

DEPOSIT DETAILS
Nature of deposit

Distinguishing No./ Account No.

Additional details, if any

Version 1.3

NOMINEE DETAILS
Name

Relationship with
If nominee is a minor,
Age
Depositor, if any
his/her date of birth

Address

*As the nominee is a minor on this date, I/we appoint


Shri/Smt./Kum. [Name]

[Age]

[Address]

The form should be signed only after all details


are completely filled

to receive the amount of the deposit on behalf of the nominee in the event of my / our / minor's death during the minority of the nominee.

SIGNATURE(S)
**Signature(s)/Thumb impression(s)

**Signature(s)/Thumb impression(s)

**Signature(s)/Thumb impression(s)

of Depositor(s)

of Depositor(s)

of Depositor(s)

WITNESS(ES)#
Name:

1. _____________________________________________________

2. _____________________________________________________

Address:

_______________________________________________________

_______________________________________________________

_______________________________________________________

_______________________________________________________

Signatures: _______________________________________________________

_______________________________________________________

Place ____________________________Date_________________

Place ____________________________Date_________________

* Strike out if nominee is not a minor.


** Where deposit is made / account is held in the name of a minor, the nomination should be signed by a person lawfully entitled
to act on behalf of the minor.
#
Thumb impression(s) shall be attested by two witnesses

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