‘Account No. [_ Customer ID 1 HAA NEL ‘Account Opening Form for Non Resident Individual: FCNR (B)_NRE| NRO) Please Open my/ourljoint Account at: Branch to Leslee! (Prease fil the formin Block Letters only - ll Fields eked are MANDATORY) Cae eeel ‘A)* PERSONAL DETALS (THIS A MACHINE READABLE FORM AND WLL PASS THROUGHA SCANNER) =$§ O00) T yeu ar an existing custome pease move drety fo section’ Minor Account Spoume ate ft (__] saamiostld | [|| | li. Authentication of Depostors Signature by |_| bark [| Indan Embassy|_| High Conrission || Consulate |_| Notary Puc ] Dacor TT ILE [ ‘astro derdcaton proce (VG) Atach doce for IO Proof and ackies root 2 Driving Lcense|_|3Pareard |_| 4Bi||5.Othors (Spec.[BECLARATION ie age toate arto bo burly th nds be tk rcinfae acl tay be rade oti tore. 2M cari Mae NUP FEA 10 3) cele tt lth pars ael errors ghen inte Agate omar core, copa to ena pac ar Mee rc wh day Inert) uaa ttt sbove czars lb ceed to bass oh atari racy ms We itr age ty fee isang ikea (Grey rts osrgresson ary meer fat wl rer scour ll fortran are iar ain) We rare ct ering any ert ayes ny (err ry ter ance of rank are Mi undertone ing 25 soon a ary retail aay elma hr ark ry lhe rrch cfyartank UM ata efoyirg edt faiion vith cher bar bance) your bark ss deals ghenin Sw ondosedshuct 7)IMb apt th Barks tothe ‘Sos fo dow the aco regent tum of cher for vat fcr ary te rite et cbaoved. hae by earth sell rect irerapscant in fi preset ad ure reac of ary esripon. Iselin the Bark agit he aro emia for ary wide arsctons mado by minis er acourt Ne aoe hm airy etry a myer czar fr sav hayes ape erie tire EW ncn at tx wll hited he pring as per the Incdan loo Tax Ack Tt) IM Iereby undorake to InGrete you above myéour ratun to Ina for pamenent residence on aval. Shae NEFOR Jr oars teed eat obs Tet wom taco ried teNUPO pin sat ach om Por Arey he fxd a ke anno vert enascr iref ie fw NRIPO sates. | PreasePaste | reae Paste | Photo Photo: | tt applcaton hast appiction | Wotan ono tt ener d bow sched hrge Garey Bdarawllstatchrge dR pe qurerlr smrtswth ape qu Becerra Fe ether carga fr Net Barking ATH Branch sandcas 2s detente sche cf charges, ‘Plane sig intckikiede tm x roid aon Pant salt snd aces te alanis 2 Pes erat l many eds haw bile comecty ee ttefomisitetobe rece = (Woche anlar he adn unde tittle re ont mere Mba itty or aman ahn eyEak or _-and IW have signed in is her presence | Sqneitore me ckoors Skate tlle. rocco is odin cc, Dacrert ar verti fr rvs anc ackresen, Parco Open Acca KYC ns cbeoved. | sogetodtinmdtin tn Se | [/Jooatenng ek None! anes [Jel] lee kg eens ie) No Mo Bkrg2 ee ACCOUNT NUMBER OVERSEAS ADDRESS [CONTACT NUMBER E-MAIL ID FATCA / CRS DECLARATION FORM PART | - Please fill in the country for each of the following 1 [Country of; a) | Birth b) | citizenship c) | Residence for Tax purpose 2_[Us person (Yes/No) PART Il - Please note : a. If in all fields above, the country mentioned by you is India and if you do not have US. person status please proceed to Part Ill for signature. b. If for any of the above field, the country mentioned by you is not India and/or if you are US person status is Yes, please provide your Tax Identification Number (TIN) or functional equivalent as issued in the specific country in the below table : ) | tN Country of w [TN Country of Issue 7 Country of Issue a. In case any of the parameters in Part | indicates that you are a US person or as person resident outside India for tax purpose and you do not have Taxpayer Identification Number / functional equivalents. please complete and sign the Self - certification section given in Part - IV b. In case you are declaring US person status as ‘No’ but your country of birth is US, please provide documents evidencing relinquishment of citizenship. If not available please provide reasons for not having relinquishment certificate. Please also fill Part - IV of Self-CertificationPart Ill - Customer Declaration (Applicable for all customer) i) Under penalty of perjury, 1/We certify that 1. The applicant is (i) an applicant taxable as US person under the laws of United States of America (CU.S") or any state or political subdivision thereof or therein, including the district of Columbia or any other states of the U.S.,(j) an estate the income of which is subject to U.S federal income tax regardless to source thereof,(This clause is applicable only ifthe account holder Is identified as 8 US person) 2. The applicant is an applicant taxable as a tax resident under the laws of country outside India, (This clause is applicable only if the account holder is tax resident outside of India) (il) 1/We understand that the bank's relying on this information forthe purpose of determining the status ‘ofthe applicant named above in compliance with FATCA/CRS.The bank is not able to offer any tax ‘advice in CRS or FATCA or its impact on the applicant. I/We shall seek advice from profession tax ‘advisor for any tax questions. (il) 1/We agree to submit a new form within 30 days if any information or certification on this form becomes incorrect. (iv) 1/We agree as may be required by domestic regulators /tax authorities the bank may also required to report, reportable details to CBDT or close or suspend my account. (¥)_ I/We cerity that I/We provide the information on tis form and fo be the best or my/our knowledge ‘and belie that the certification is true, correct and complete including the taxpayer identfication number ofthis applicant. Signature : Name : Date (DD/MM/YYYY) Part IV - Self Certification : To be filed only if (a) Name of the country in part | is other than India and TIN or functional equivalent is not aveilable, or (b) US person mentioned as Yes in part |, and TIN is not availabe. | confirm that I am neither a US person nor a resident for Tax purpose in any country other than India, though nay one or more parameters suggest my relation with the country outside India. Therefore | am providing the following documents as proof of my citizenship ‘and residency in India. Signature Documents proofs to be submitted (please tick document being submitted) Passport Election Id card PAN Card Driving license IDA letter NREGA job card Gov.Issued Id card“FORM No.60 (See Second proviso to rule 114B) Form for declaration tobe fled by an individual or a person (not being a company or firm) who does not have a permanent account number and who enters into any transaction specified in rule 114B 1 [First Name 2 | Date of Birt Incorporation of declarant] Middle Name ‘Sumame 3 | First Name (in case of in Middle Name vidual ‘Sumame 4 [Flat Room No. 5] FloorNo 6 | Name of premises 7 | Block Name/ No. 8 | Road/ Street Lane 9 | Area Locality 10 | Town Gy Ti | District DB] sae 13 | Pin code TH] Telephone Number (with STD code) 15] Mobite Number = Ti cae of ransaotion in joint names 16 [Amount of transaction (RS) fe eet cee aap ae 17 [Date of transaction fransactio 19 | Mode of transaction =JCash, [JCheque, [1Card, [)DrafBanker's Cheque, C] Online transfer, (J Other 20 | Aadhaar Number issued by UIDAT (Gfavailable) 2 | lappled tor PAN andi sna yet generate eter dae of aplication and acknowledgement nunber 722 | iF PAN not applied il estimated total income (including income of spouse, minor child et. as per seton 64 ofIneome-tax Act, 1961) for the financial yer in which the above transaction is held @ [Agricultural income (Rs) 1 [Other than agricultural income (Rs) Details of document being produced in [Document] Document identification] Name and address ofthe authority isuing the 25] suppor ofdenty in Column (Refer Jeede | mumber document Instruction overleat ‘Details of document being produced in | Document] Document identification) Name and addres ofthe authority Issuing the 24| suppor of address in Columns 41013. feode {number Jdocument (Refer Instruction overleaf) ‘Verification L do hereby declare that what stated above is tre o thebestof my knowledge and Deli | further declare that Ido not have a Permanent Account Number and mylour estimate total income (including income of spouse, minor child ete as per section 64 of Income-tax Act, 1961) computed in accordance with the provisions of Income-tax Act, 1961 for the financial year in which the above transaction is held wil be less than maximum amount not chargeable to tax vetifed today, the day of. 20 Place (Signature of declarant) Note: [L"Befoe signing the declaration, the declarant should satisty himself that the information furnished inthis form sta, correct and complete in all rexpects. any person making file statement i the declaration shall be Fable o prosecution under section 277 ofthe incometax Act, 1961 and on convitio be punishable= (ina case where tax sought tobe evaded exceeds twenty-five lakh rupees, wih igorous imprisonment which shall not be less than six ‘months but which may extend to seven years and with fine; i) in any other cas, with rignorous imprisonment which shal ot be Tess than tree months but which may extend to two yeas and with fine 2. The person accepting the declaration shall nt accept the declaration where the amount of income ofthe nature referred 0 in item 226 ‘exceeds the maximum amount which is not chargeable to tax, unless PAN is applied for and column 21 is duly filledInstruction: (1) Documents wich can be proced in report of deity and adres (nt requ if epi for PAN sod item 20 Document | Proof of | Proof of sl. ‘Nature of Document neuen eet ae ‘A _| For Individuals and HUF 1. AADHAR card o Ye_[ Ye 2._| Bank/Post office passbook bearing photograph ofthe person 2 Yes | Yes 3._| Elector’ photo ldentity ard oe Yes | Yes 4 | Rato/Puble Distribution Syste card Dearing photograph of u Ye | Yes e person 5_| Driving License 0S Ye | Ye 6_| Passport 6 Yes_| Yes 7._| Pensioner Photo card 7 ves | Yes 8 | Nation! Rural Employment Gurante Scheme (NREGS job 08 Yes | Ye 9.__[ Caste or Domicile certificate bearing photo of the person o Ye_| Ye 10, | Cerificate of identity/address signed by a Member of Parliament 10 Yes | Yer ‘or Member of Legislative Assembly or Municipal Councillor or a Gazetted Officer as per annexure A prescribed in Form 49A TE | Geriateom employers per annexure B pestbed in Form 7 Ye | ve 12, | Kisan passbook bearing photo 2 Yex_[_No 13, | Arm's License B Yes_| No 14, | Central Government Health Scheme] Ex-servicemen ry Yes | No Contributory Health Scheme card 15, | Photo identity card issued by the government/ Public Sector 15 Yes [ No Undertaking 16, | Electricity bill (Not more than 3 months old) 16 No | Yes 17. | Landline Telephone bill (Not more than 3 months old) 7 No [Yes 18. | Water bill (Not more than 3 months old) 18 No | Ye. 19. | Consumer gas eard/book or piped gas bill (not more than 3 9 No | Ye: ‘months old) 20. | Bank Account Statement (Not more than 3 months old) 20 No | Ye 21. | Credit Card statement (Not more than 3 months old) 21 No | Yes 22. | Depository Account Statement (Not more than 3 months old) 2 No |_ Yes 23, | Property registration document 2 No |_ Yes 24, | Allotment letter of accommodation from Government 24 No_| Yes 25. | Passport of spouse beating name ofthe person 25 No | Yes 26. | Property tax payment receipt (Not more than one year old) 26 No |_Yes B_| For Association of persons (Trusts) ‘Copy of trust deed or copy of certcate of registration issued by a Ye ] ve Charity Commissioner T_| For Association of persons (other than Trusts) oF Body of Individuals or Local authority or Artificial Juridical Person) Copy of Agreement oF copy of certificate of registration issued by 8 Yes | ver Charity commissioner or Registar of Cooperative society or any ‘other competent authority or any other document originating from any Central oF State Government Department establishing identity and address of such person. {@) In case of transaction in the name of a Minor, any of the above mentioned documents @ proof of Identity and Add any of parents‘guardians of such minor shall be deemed to be the proof of identity and address for the minor declar the declaration shouldbe signed by the parent guard, (3) For HUF any document inthe name of Kara of HUF i require. (@) in case the transaction isin the name of more than one person the total number of persons should be mentioned in SLNo.18 and the total amount of transaction is to be filled in SILNo. 16. In case the estimated total income in column 22h exceeds the maximum amount not chargeable to tax the person should apply for PAN, fill out item 21 and furnish proof of submission of eppicatiFORM: 275 City UNION BANK (Regd. Office Kumbakonam - 612 001. ‘TECHNOLOGY SERVICE APPLICATION FORM FOR Personal Banking - Internet Banking / Mobile Banking / SMS Pull / ATM / VISA CARDS Individuals / Joint / Sole Proprietorship ‘Account (All fields marked with ®are mandatory tobe filled) To Date: The Branch Manager Customer I [Name of the Applicant Mr. / Ms. So, Do, Wio “Email ID Date of Birth ‘MOBILE! SMS BANKING ae Unique Mobile Number to be registered for the customerID [91 | wish to aval the SMS Barking Alt Fact. ily alert ef he roar is debited ree than P| the acca to the above Csr D. [] Jwshtoasa Mee Barn Fc rhe above ert Castor Dfrthe aoe Neti Nab” Noe: To aval Mobile Barking Fait customer shoud have GPRSUave enabled mobile phones. INTERNET BANKING Please tick one of the following : [1 Inichto apy for Ne Bark oity wiht Tester T]Wira Fur Trantor ‘VISA DEBIT CARD S MyAcoutNarberDesis [Sox T [coo] ToeCCCCCCEEEEEeee [News Relat cf Cat [7] Aiton Ga Declaration | caf at 1a te cle aczunt Rll or | have the eqdred mandate ed accu had) 0s eprate Be Aco | vl tap th SM ars ané my rele | prone my possessions a tines. | wil fom te Bark immedtly ease my meble oF SIM cad 6 fs. Ar | undesood ‘tat | eal be sly responsble fo athe tansacons tapered theugh my neble. {have rea and undesod the Tees and Caron (a copy o wich am a possession of eatirg fo opening ofan accourtant varus sevice In bt ret Ie o() Mle Barkirg ! SS Alt Sei ) Net Bang (cP ay acy (AT VISACarFaciy acaptandageetota bound esd Terns andContns. Vai, coner ard ucake a | har rad and Urecond te Terms Conan f usage of fe tenet Baring, svi of Cy Urn Bank ard an sare of Charges Alcala fore See, ss orn wamrlineib anc tht | ape on my oun bea. 25 he mands Rl on beh Of fe jot exc her, ae wl echere el the emscondtins of openeg/ aging /oalieg | malar ! ceri (es epplete fr uge of he lramet Baking Sern of Oly Union Bonk as may be in fore fom fe 1b time | hrber auboize Oty Union Bark to cet my Accom) towers any charges dere at af te paris and eration Gren tis application fom (an al documents relat or pote heewh) ae re, cect corpee and uptodate ina respects and |, and ower accu hades avert wild any orion. | unerand acorn paar gre by me ae reuted by Be cpersienl quienes goemeg Sening companies. | ayee ard untae fe govde any Aber bmaten to Oy Unen Bank | ace and desta thal Cty Union Bak reser te rift to ret any aplcaton ido proving any reason. | agee and ures that Cty Union Bank ‘asevetie it eiainteapeaien ers andthe doce ried are nctng ogg, an wet ten Resanetone. \"ogwe ard undesiand bat hve > ccete the alas for spectc lly paditeres fom Cty Urcn Bak as posited ton tine tone, and tat sch ft appar stl be repaid as an raga pat ofthis appli (nt ce vera, tht uss oerise doe uch fuer foms #8 pov. Be pars So iibmaten eet fo herein a¢ wl ge Somers rloved or provaeé herent ae hue, carec comple ‘2 upiodat in al respect | are and undsiand hat such Arb: apo wil eqreearpraon ofthe apa for mun, and sch deals 280 UnonBark moyprescibeotcitae da "aie tat the bart wt ot be held ete | response fray oso ably cred on account of beach of sy deni of sevice ee, becuse f ac ter echciogallae Orca my request Onine CUB acctsacertedary ry wr Disacaiedy Peart [Ay eked acroas (ncn any ne accoutstat may be opened wh my carer I subsequer the sue of Orne CUB accant User © and sao wl be coe unr te ndesgovenat under Orie CUE accut fon tne 1 me | hereby corm fa he above menkne aes mates iia assess prevaus gether. Cerne! wl grecarge ares rouato MarFor office use only ‘Therequestof Customer NAME) forthe services requested may be enabled, CUSTOMER ID (@P 10) IS 1) The mode of operations for al his declared accounts have been verified and found Corec. 2) Signatures of Joint holders have been verified and found Contec. 3) The Customer ID and the above signature have been verified and found comect andthe accounts inked wit the above Customer | are perained to this customer only. 4) Theabove address given by the customer matches with the record 5) The accountis nota minor account 6) For SMS Banking we have enabled the SMS Banking agin CBS, eee he customer Mbile Number corecy and amount Signature ofthe Oficer | Manager MANDATE FORM FOR JOINT ACCOUNT HOLDERS caster LT alee ea] From Maas. b City Union Bank Ld. Branch, Dear Si, ‘Savings Bank{CuentAccounlTerm Deposit Account No held inthe joint names of Mis Sa Ms, at eee We hereby authorise Mis, {Name othe applicant forthe series) o aval the OnineCUB / SMS Alert Mobile Barking Senicesin respect ofthe above CusomerD and te acounis inked tothe Customer I. UWe have ead and understood the res, ers and condos for avaling the Onine CUB / SMS Alert / Mobile Banking Services, We undertake to ratiyand confi al and Whatever MMs. does or causes to do through Onne CUB / SMS Ale / Mole Banking Services. “This author shal continu to bein force unbllany one ofusrevoke(s) his mandateby antic nwrtng Geiveredto you ‘Yours faithuly, 1 ‘Name n Block Ltrs, 2 Nome in BlockLetrs 2 Name in Block Letters (Signatures of Joint lc holris)& a Account No. [TT | NOMINATION FORM No. DA - 1 ‘Nomination under section 45 ZA of the Banking Regulation Act 1949 and Rul 2 (1) Banking Companies (Nomination) ules 1985 in respect of Bank Deposit. We [ ‘nominate the folowing person to whom in the event of my /our/ minor's death the amount of the deposits particulars where of are given below may be returned by City-Union Bank Branch in which the deposit is held alana Nature of] Deposit | Additional sale Ed Rolie ost ot) gg win P| Nominee sino Deposit | No. | Deal if any Bre | | acca a ne ‘$s the nominee is minor of the dete, 1/ We appoint ‘Shum. Ku, hee. Signature (s) Thumb impression (6 of depositor 8) @ Name () Signatures) and Adress (es) of winess (ee) (ame, address & age) to recoive the amount othe de- positon beha ofthe nominge Inthe event of my our minors death during the minority of the nominee. Place 2 ate * Where oposite made nthe name of amino the nomination shouldbe signet bya person law enedio act on boa ofthe minx. '$ Strke ouithe nominee is nota minor {@ “Thumb impression) shallbe atest by two witnessCUSTOMER PROFILE 4. Name 2 Status Individual Entity A) INDIVIDUALS Nature of Activity (Source of funds) Employment{_] Business 1] Others 1) Employees: ) Employed in Govt. Service [] Public Sector [] Private Sector]. Others [7] 1b) Position held ©) Annual nome ) Threshold Limit Rs. (Credit Summation in the account sll be upto Two Times of the declared Annual Income) 1) tfln business 2) _ Name ofthe Organisation b) Nature of Ownership Proprietor [] Partner [] Director [[]_ Others [7] ) Nature of business activity 4) Location of Business Non risk areas[—] Risk areas [_] Both ) Annual Business Turnover f) Threshold Limit > [Rs (Credit Summation inthe account shall be upto Four Times ofthe declared Annual Business Tumover) MM) Others 2) Brief deta of activity b) Annual Income ©) Threshold Limit RS. (Credit Summation inthe account shal be upto Two Times ofthe declared Annual Income) IN) Any other information to decide the social status: B) ENTITIES (other than individuals) Nature of Business activity Location of Business Non sk areas[—] Risk areas [[] Both [1] Annual Business Tumover “Threshold Limit (Credit Summation inthe account shall be upto Four Times of he declared Annual Business Tumover) 3. Mode of receipts Cash] Cheque [] Electronic [7] 4. Purpose of Opening 5, ASSESSMENT OF RISK (common to individual as wel s entities) Classifcaton of Rskis mate tang nto account he typeof cent, Business ati, Loctn, Turnover andthe socal & rani tats 2s specified in ou poly RISK CLASSIFICATION tow) weoium [_) HIGH (1) ‘ACCOUNT NO CUSTOMER ID SIGNATURE OF THE OFFICER / MANAGER. Note: fesh frm shouldbe used for Updaton of Customer Profle, there are perceptible changes inthe cusomer data a the time of review of transaction and shouldbe kept along wih profile obtained eater.