INDIAN BANK

YOUR OWN BANK

ACCOUNT OPENING FORM

Branch and CBS CODE:

ONLINE APPLICATION REFERENCE

NUMBER:IBSB7882

CIF(Customer Information
File)/Account Opening Form for
Personal CIF ( Full KYC )

I request the bank to open General Savings Account without Cheque Book and provide
services opted by me .The required individual details are given below.
Title

Mr

First Name:

VENGADAGANESH

Middle Name:
Last Name:

Date

Affix your
recent photo

PALANI

Maiden Name
Father Name:

PALANI K

Spouse Name:
Mother`s Name
Address (Resi)

81/163, PONMANAGAR NEW COLONY

Line2

MOOLACHI PANCHAYAT,

Line3

SOUTH KALLIDAIKURICHI,

Signature of
Applicant

Nationality

INDIAN

Country

INDIA

City/ state/Pin code

TIRUNELVELI

TAMILNADU

627416

Address (Temp)
Line2
Line3
City/ State/Pin code
Name of Employer,

Emp. No.

Employer Address

.
Alternate Channels

SMS

*ATM

*Netbanking

*MobileBanking

*Nomin
ation

DOB

Gender

Occupation

Marital Status

22-07-1994

Others

Religion

Community

Occupancy

Income/Turnover

.Hindu

BC

Others

Phone No(Resi):

Phone No(Office):

Mobile

Email ID

9715802752

vengadaganesh60@gmail.com

Occupancy

Home Owner/Family
Home/Tenant/Others

If others ,

Nominees Father/
Mother/Spouse name

Nominee's Name

If minor guardian name

Nominee CIF, if
available

.
PAN

Form 60/61 Date:

Aadhar No

Particulars for Identification

ID type 1

Date of Issue

Aadhaar No .

13-07-2016

ID type 2

Date of Issue

Voter ID .

07-01-2014

Mode of operation

self

Place of Issue

ID no
466645327727

Place of Issue

ID no
NEW1045889

E or S

F or S

A or S

Joint

Introducer Name(if any)

A/c type

SB/CA/ODCC

Account No:

Signature of Introducer

Branch Use
Religion/Caste

Physically Challenged?

Politically
Exposed

Income Catagory

Risk Catagory

BPL/Above BPL

Low/Medium/High

Details

Special Catagory?

Y/N

Details

Y/N

Customer type

General

Alternate Channels

SMS

Location of Customer

ATM

HNI

Y/N

Mob Banking

Net
Banking

Threshhold limit

Any Other Particulars

Signature of the Introducer and all the particulars including KYC particulars provided in this
application by the applicant are verified by me and CIF/Account for
this customer may be opened/ OR This Application is for linking the customer as joint account
holder/beneficial owner/nominee to the account opened with Main Application Number
Branch & CBS
CODE

Signature with Name and SR No of

the verifying officer

*Separate Forms to be obtained from the customer

CIF No

A/c No

Date

Declaration by the Customer

I/we understand that a booklet on the Banking Codes & Standards Board of India Code (BCSBI) posted on
your website shall be provided to me on demand
Terms & Conditions:

I/we confirm having received, read and understood (a) the accounts rules and hereby agree to be bound by
the terms and conditions outlined in these rules which govern the account(s) which I/we am/are opening/will
open and (b) amendments to the
rules made from time to time and those relating to various services availed by me/us and those relating to
various services offered by the Bank
and other facilities listed in this form . The usage of these facilities is governed by the terms and conditions
stipulated by the Bank from time to time.
Date
Place
Signature/Thumb Impression of first/sole Applicant

Signature/Thumb Impression of second Applicant

B. Introduction from an existing account holder of the branch

Name of the Introducer

Type of account and A/c No

I
hereby introduce the above named applicant(s) and certify that I know Mr./Ms
VENGADAGANESH PALANI for the past
months/years and confirm his/her occupation and
address as stated in this application. I also attest his/her signature(s).
Address of the Introducer:
PINCODE:
Phone No:
Account held since:
Signature of the Introducer
For Bank Use Only
Name & Code of the Branch

Cust. ID

A/C No.

1.
Account has been opened on
2.
I have explained the rules / regulations to the
applicant
3.
I have verified the introduction / the documents
of identity proof / residence proof.
4.
ATM No.
has been issued and
password has also been issued.
Date

Officer (SRNO)
Particulars of Identification

Photo Proof

Address Proof

Driving License

Driving License

Permanent Account Number(PAN)

Permanent Account Number(PAN)

Voters Identity Card Issued by Election Commission Voters Identity Card Issued by Election Commission
Job Card Issued by NREGA duly signed by an
Officer of State Government

Job Card Issued by NREGA duly signed by an

Officer of State Government

The Letter issued by UIDAI containing Name,

Address and Aadhaar number

The Letter issued by UIDAI containing Name,

Address and Aadhaar number

For Low Risk Customers : Identity card with

applicants photograph issued by
Central/State Government Departments, Statutory /
Regulatory Authorities,

For Low Risk Customers : Identity card with

applicants photograph issued by
Central/State Government Departments, Statutory /
Regulatory Authorities, Public Sector

Public Sector Undertakings, Scheduled Commercial

Banks, and Public Financial Institutions

Undertakings, Scheduled Commercial Banks, and

Public Financial Institutions

Letter issued by a gazetted officer, with a duly

attested photograph of the person.

Letter issued by a gazetted officer, with a duly

attested photograph of the person.

Note: The information containing personal details like

name, address, age,
Utility bill which is not more than two months old of
gender etc and photographs made available from
any service provider (electricity, telephone,
UIDAI as a result of e-KYC
postpaid mobile phone, piped gas & water bill)
process will also be treated as an officially valid
document
Property or Municipal Tax Receipt
Bank account or Post Office savings bank account
statement
Pension or family pension payment orders (PPOs)
issued to retired employees by Government
Departments or Public Sector Undertakings, if they
contain the address
Letter of allotment of accommodation from employer
issued by State or Central Government departments,
Statutory or Regulatory bodies,
Public Sector Undertakings, Scheduled Commercial
Banks, Financial Institutions and Listed companies.
Similarly Leave and License agreements with such
employers allotting official accommodation
Documents issued by Government departments of
foreign jurisdictions and letter issued by
Foreign Embassy or Mission in India
Single document for proof of identity and proof of address.

If the officially valid document submitted for opening a bank accounthas both, identity and address of the
person,there is no need for submitting any other document for address proof
Counter foil to the customer
Branch& CBS Code
We confirm having received the Application form from
VENGADAGANESH
PALANI
on
For opening of Savings Account OR for linking the
customer as Nominee / Other Account Holder / Beneficial owner to the account
to be opened with main Application Number
Please bring this portion to get your Passbook/ other details without
Fail
Signature of the Officer