SK2132_010318930

Central Bank of India (APPLICATION FOR

* APPLICANTS INFORMATION (I-XI)

DATE : 01/03/2018 05:24 PM

I. Applicant Full Name
Jagarnath Kumar
II. Father Name
Janaklal Sah
III. Gender (M/F) : Male IV. Date of Birth : 01/01/2004 V. Age : 14 Years
VI. Occupation : Non personal Others
VII. Identity Type : UID (AADHAAR CARD) Identity No. : 313994886366
VIII. Address of the depositor:

Pincode: 852131 S/o-Janaklal Sah post-Dabhari

Taluka: Supaul Magurar, Supaul
State: BIHAR City: Supaul
Tel No.: Mob.No.: 9955295557

IX. Particulars of Nominees:

Name : Janaklal Sah Address : In case of Minor's A/c only:
Age 29 Years Magurar, Supaul Date of Birth :
Relation : Father Witness :

X. (a) Assets : House (b) Assets : Land Extent

Declaration: I hereby apply for opening of a Central Bank Biometrics Based Account and issue of a Biometrics Based Account to me.
I declare that the information provided by me in this application form is true and correct. I am aware that maximum balance in the account
at any point of time will not exceed Rs. 50,000/- and maximum daily deposits/withdrawal limits restricted to Rs……. Only. I accepted that
Central Bank is entitled at its discretion to accept or reject this application without assigning any reason whatsoever. I have read the
terms and conditions applicable to this account. I agree to the terms & conditions as may be in force from time to time.

Overdraft Amount Rs.:

Accordingly, the KYC procedure also provides for opening accounts for those persons who intend to keep balances not exceeding
Rupees Fifty Thousand (Rs. 50,000/-) in all their accounts taken together and the total credit in all the accounts taken together is not
expected to exceed Rupees One Lakh (Rs. 1,00,000/-) in a year.

*Introduction Details *SIGNATURE (SPECIMEN) / THUMB IMPRESSION

I Certify that I have known Mr./Mrs./Ms Jagarnath Kumar OF APPLICANT:
since past 5 months/years. I/ We confirm his/her
occupation, photo & address as stated in his/her application
*Submitted by Business Correspondent:
Name : 9900146157
Name :
A/c No :
Signature :
Address : Magurar, Supaul
A/c No :
Signature : Branch Name :

Approved By: Date: Seal:

Officer In charge Branch:

* FOR OFFICE USE ONLY

Customer ID : A/C No.
Card No.: Date of opening A/C:
I confirm that the card has been delivered to Name:. . . . . . . . . . . . . . . . . . . . . .
the A/c holder in my presence. Signature: . . . . . . . . . . . . . . . . . . .
Card Delivery Date:. . . . . . . . . . . .

पावती प

Application No. SK2132_010318930 Date : 01/03/2018 05:24:37 PM

Applicant Name Jagarnath Kumar

_________________

खाता खुलने के प ाताप, काड लेने हे तू, ये पावती प अपने साथ अव य लाय| (Authorised Signatory)