Form No.

èÚóÔÈ Ñ<#õ æÚÍµÈ à×÷¸Èûõ

Pension +
æúæºÆ ÍõëºçðæÆ
º ëº çâôëº
ACCOUNT OPENING FORM
÷Àù
Ú × D D M M Y Y Y Y ý`‘æÝµÓ ûܵ×$ßíù× &úÀ{$/ ôñºæð çáäºçèìºâ÷ºÆ ëìºÌëº/For Bank Use Only
êðæêð
Date

Account
æ}´ù$æØ` / Ëæèéëáèóõº / The Manager Number

CIF Number
í$õÚæ áõÚÍæÚÍµÈ ý`‘æÝ< /Îêòðá ÎòëðçºÇ ôñºæð /
National Savings Bank
………………………………………………………

´$µèß ùÈùß NSB Pension + èÚó´

Ô æß Ñ<#õ æØùßù. Manager’s signature

êáÔ îòáºÊ öäÊ îçáõðùº NSB Pension + æúæºîæèäºé÷

ÍõëºçðæºæÔëº
Please open a NSB Pension + account in my name

(1) ´ÔÙæÝØ` &´è ù´ (´{õ$ / ´{õßÆ× / µ´ùÑ× / ............) / ËêîùÏêºÊæºæÓìäº îçáõº(êðÕ êðÕëêð îòùºôð ……….) /
Name with initials (Rev / Mr / Mrs / Miss / ..........)

Ú µß <ù ùÈ /ËêîùÏêºÊæºæóº Æ÷ðæºÆëº îçáõº / Names denoted by initials

´ÔÙæÝØ` <ÙÚùß {`úÀù

{`ú¸ùÈ
Ô ûõß à‘æ× /í.í.¹ù / NIC No. ûÔØ<`&Úþ$<× / ¹äëº / Nationality

<×& / ôáÊ / Age

Ú × çð÷庺ê êðæêð / Date of Birth

ãûùß ÷Àù ãûùß &ßö$ù× / çð÷åºê ¹ìëº / Place of Birth à<Ô. ôÕ Y ´$& ëè M ÷Àù
Ú êð .D
D D M M Y Y Y Y

&ßöØ Ú ×/ åðõåºêõ Ëæôõð / Permanent Address

Ú ÙÚûù

÷¸Øæöù à‘æ×/ îêèéùÎçòð ¹ùæºæëº /Telephone No. í‘è´ ÷¸Øæöó à‘æ× / îòùºùðìçºÎçòð ¹ù/ Mobile No.

â - µÈÙß / ëðäº íѺòùº / E - Mail

Ú / Îôéù íùºùÊ îêèïðùº / Occupation or Profession

’æÚ×$< µ{$ß <#õßõ×

’æÚ×$<æ ùÚ×æ Ô õ Ú × /îêèïðùº îòáºçôõèæ ¹Õåºêèùº îêèïðùº êÕåõðóº îçáÕëº ËæôõðÁëº /

ß ùÈ, µ&ß<$ µ×$ßíæ×$µèß ù´ {$ ÙÚûù
If employed, the Name and Address of the Employer

* ´´ à$÷À$×È ý÷¸ µè<ùßùæÚ / µè<ùßµùæß µù$µÓ. * à$÷À$×È ý÷¸ ÙÚûµÚ è$óÔ à‘æ×
åèäº ôõðáð×çºçèóõº / ôõðáð×çºçèóõº íùºù ôõðÎæèçºÇ ¹ùæºæëº
I am / not an Income Tax payer Income Tax file No.

õ`ùßûõß ´Ô÷Ù
À àæݵØùß Ø`: õ`ùßûõß ´Ô÷Ù
À áÙæßæµ´ùß Ø`.
îêèéæ öÏêºêðùº ……………………...................…… éôçºÇêº îêèéæ ¹ùæºæêºêðùº ¶.
Amount (in words) Rs: Deposit amount in figures Rs.

à.ûÚ.ý. / P.T.O.
ù$´µ×$ßíù$< / åðáëäëº / Nomination
èÚóÈÔ µÁßÂ× à<&ùßÒ´ð ûÜö´ ´$ Æ×èÚ×µ{$õß ä<æð µ´´ èÚóµÔ È ý`Øð à`õÚ ´ð Ù`Ã× ×ÔõÝ ´Ô÷Ù
À ß Ù`Ä´ &úÀ{$ 1971 à‘æ 30 ÷ÀØó í$õÚæ
áõÚÍæÚÍµÈ ý`‘æÝ ûóµõß à‘æ 44 <èùßõ×
Ú ×ðµõß û{õ &úÀ{ùß ù$´ µ×$ßíù$< æØÆ.

1971¹äº 30Íëº ¹ùæºæ Îêòðá ÎòëðçºÇ ôñºæðòº òìºìêºêðäº 44Íëº çðõðôð÷ºÆ íéëôèæ åèäº åðáëäêºêõº øÕôéõ åðáëðêºêðÕçºçðäº öäÊ ¹÷çºçðäº
ÎçèÊ íôõº æúæºæðÙóºó ëÐêðæºÆ ãõðêºÊéìáôõèôèõº. íôºôè÷èä åðáëäêºêõº øÕôõº åðáëðæºæçºçìèêðÕçºçðäº æúæºæðÙóºó öäÊ ëðÆêðæÓæºÆ
öäÊ òìºì õÐêðáèä ôèõðÒæóº ãõðêºÊéìáôõèôõº

I the holder of the above account do hereby make the following nomination under Section 44 of the National Savings Bank Act No. 30 of
1971 to receive upon my death the monies lying to the credit of this account.

ù$´µ×$߬õ×$µèß
õ×$µèß / ×ùßµèß / &ÈûÕ
&ÈûÌ
Õ ó ù´ / ùÈ ÙÚûù
Ú × / ×ùß {`ú¸ùÈ
Ô ûõß à‘æ× / à‘æ
åðáëêºêõº/æóº ËÏçºîçáõº / æóº Ëæôõð íéìáèó íìºéì ¹ùæºæëº
Full Name/s of Nominee/s Address / es Identity Card No. / s

µ´´ èÚó´ Ô û<õß<$µèù ×$´ &Èýùßøµ×ùß µ´×ð à´Ôó$ à`õÚ ùÛõÎ Ú õÚ, <]<&ßö$ {$ µØèÝÙ$&Ú ´´ æÚ×<$ µõßØ`Èèõß ý< µ´×Úùß &{õÚæ æØù àõØ,
ûÔ÷è
Àß ÙÚæ< ´$ µ<õ ÷À`ùÔÈ÷À´ Û æß µù$æ}÷À µ´´ èÚó´
Ô &Èýùßø ùÛõÎ
Ú õÚ {$ µØèÝÙ$&Ú<Ùð äæêÒ´ð &{ á÷ÀÍ Ú µ×ß÷ÀÛ æÙÚùß æÙð ý`‘æÝ< ûù<ùÔ Ùýù
ùÛõÎ Ú õÚ ûÚ}Úû`÷À´
Û ðõß áùß ý`úÀ&
Û ¯
Ú ´ðõß äæê µ<Æ.

¹æº æúæºéæ îòá÷ºçÌêºÊëº ôðêðæéóÁëº åðçåºêéäæéóÁëº åèäº ôèòðêºÊ ôðóñºæðæº îæèúºâÕæºæðäÎ

º ÷äº öäº×ëº ¹æº æúæºÆ îêèìõºçèæ
ôñºæðáðäèùº îòá÷ºçÌêºêçºçìºÌóºóÊëº íùºùÊ ôðêðæºæçºçÌôÊëèä ôðêðæÓæºÆëº åðçåºêéäæÓæºÆëº ë÷º×ëº öäæºÆ Îåõâáèæ í÷ðôðáèêðÕçºçðÄëº
ôñºæðáðäèùº åéìËé÷æºÆæº îæèúºÌ ôõçºçÌôÊëº æèùêºêð÷ºÆæº æèùëº åðé÷Îô÷º÷çºçÌôÊëèä ôðêðæÓæºÆëº åðçåºêéäæÓæºÆëº ¹úñºæð øÏæÔëº
æìºÌçºçìÔëº åèäº ¹êºêèùº òëºëêðææ
º ðäºÎ÷äº.

I have read & understood the rules & regulations mentioned in the attached form on the conduct of this account, and I hereby agree to comply with and be
bound by the rules and regulations made or imposed by the Bank with regard to this account and which may come into effect and be enforced by the Bank
from time to time, notwithstanding the fact that such rules and regulations have not been personally notified to me.

Ô Ø`µèß àõß&ù /ôèâæºéæáèóõº øçºçëº / Customer’s Signature

èóÔµ÷Àùæ

ý`‘æÝµÓ ûܵ×$ßíù× &úÀ{$ û´óÚ /ôñº

ôñºæðçº çèôéäæºÆ ëìºÌëº / For Bank use only

ùÚû`×ÔÈ &‘µæßõ× àùÔ´õ æØù Ù÷Àµß ÷Àß µõ$ØõÝØ` à`õÝ}õß æØù Ù÷Àµß ÷Àß
ã÷ºçêºêðæº Æ÷ðáÐÌ íêðæèõëóðççº ôõº ãóºóì
Ð ºìèóõº
Product Code Authorized by ............................................ Input by ......................................

Ridee Rekha Certificate No.