Application Form Form No: BMD/PRA/01/V01

For office use only

C I F 01
C I F 02
Account No.

YdLdj Èkh
fpis jpfjp D D M M Y Y Y Y
Branch Date
;ekam;alre$lrejkaf.a úia;r itg;ghsh;$fspd; tpguk; Details of the Depositor/s
;ekam;alre 1 itg;ghsh; 1 Depositor 1
iïmQ¾K ku( uhd$fuh$ñh
KOg; ngau;: jpU$jpUkjp$nry;tp
Full Name: Mr/Mrs/Ms
,smskh
Kftup
Address
cd;sl ye÷kqïm;a wxlh
Njrpa milahs ml;il ,y.
National Identity Card No.
Wmka Èkh ÿrl:k wxlh
gpwe;j jpfjp D D M M Y Y Y Y njhiyNgrp ,y.
Date of Birth Contact No.
B - fï,a $ kpd; mQ;ry;/
E-mail
wdodhï nÿ f.jñ $fkdf.jñ f.jhs kï ,smsf.dkq wxlh
ehd; tup fl;Lgtu; / fl;Lgtu; my;y fl;Lgtu; Mapd; Nfhg;G ,y.
I am/am not an income tax payer If so, file No.
;ekam;alre 2 itg;ghsh; 2 Depositor 2
iïmQ¾K ku( uhd$fuh$ñh
KOg; ngau;: jpU$jpUkjp$nry;tp
Full Name: Mr/Mrs/Ms
,smskh
Kftup
Address
cd;sl ye÷kqïm;a wxlh
Njrpa milahs ml;il ,y.
National Identity Card No
Wmka Èkh ÿrl:k wxlh
gpwe;j jpfjp D D M M Y Y Y Y njhiyNgrp ,y.
Date of Birth Contact No.
B - fï,a $ kpd; mQ;ry;
E-mail
wdodhï nÿ f.jñ $fkdf.jñ f.jhs kï ,smsf.dkq wxlh
ehd; tup fl;Lgtu; / fl;Lgtu; my;y fl;Lgtu; Mapd; Nfhg;G ,y.
I am/am not an income tax payer If so, file No.
b;=reï iy;slfha úia;r Nrkpg;G rhd;wpjopd; tpguk; Details of the Savings Certificate
wjYH iy;slfha l,amsÍfï jákdlu
^wod< fldgqfõ ,l=K fhdokak& Rs. 25,000/- Rs. 50,000/- Rs. 100,000/-
tpzz ; g;gpfF
; k; rhd;wpjopd; KjpuT
; ngWkjp
(cupa $l;bw;Fs; milahskpLf) Rs. 250,000/- Rs. 500,000/- Rs. 1,000,000/-
Maturity value of the required certificate Rs.5,000,000/- Rs. 10,000,000/-
(Please mark ‘√’ in the appropriate cage)
wjYH l,amsÍfï ld, iSudj ^wjuh jirla iy Wmßuh jir 20la&
tpz;zg;gpf;Fk; jtiz (Fiwe;jJ 1 tUlk;$ $baJ 20 tUlq;fs;)
Required Maturity Period ( Minimum 1 Year and Maximum 20 Years)
uQ,sl ;ekam;a uqo, ^wl=frka& re'
Muk;g itg;Gj; njhif (vOj;jpy;) &.
Amount of the Initial Deposit (In Words) Rs.
uQ,sl ;ekam;a uqo, ^b,lalfuka& re'
&.
Muk;g itg;Gj; njhif (,yf;fj;jpy;) Rs. .
Amount of the Initial Deposit (In Figures)
 ;ekam;alre 1 itg;ghsh; 1 Depositor 1 ;ekam;alre 2 itg;ghsh; 2 Depositor 2

jD;a ; s h njhopy; Profession ................................................................................................................................................................. .................................................................................................................................................................

fiajd fhdaclhd njhopy; toq;Fgtu; Employer ................................................................................................................................................................. .................................................................................................................................................................

fiajd fhdaclhdf.a ,smk

s h njhopy; toq;Fgupd; Kftup
Address of the Employer ................................................................................................................................................................. .................................................................................................................................................................

noaO .sKqula kï $l;Lf; fzf;F Mapd; If it is a Joint Account

tla whl= ñh.sh úg .sKf
q ï fYaIh cSj;ajk .sKï
q ysñhdg ysñjkq we;'

vq;fspy; xUtu; ,wg;gpd; capUld; cs;s fzf;F itg;ghsu; fzf;fpd; Kjpu;T njhiff;F cupj;Jilatuhthu;.

In the event of the death of any of us, the surviving account holder will be entitled to the maturity value.

fuu .sKu
q mj;ajd f.k hdu iïnkaOfhka mj;akd kS;Í s ;s" jHjia:d fr.=,dis uu$wms lshjd f;areï.;a nj fuhska iy;sl lrk w;r" mqo. a ,slj ud $ wm fj;
±kqï §ula fkdl<o" fuu .sKu
q iïnkaO kS;Í
s ;s yd fr.=,dis j,g tlÕ ùug iy bÈßfha§ l,ska l,g nexl=j mkjkq ,nk kS;Í s ;s ms<m
s e§ug;a bka ne|S isàug;a
tlÕ fjñ$fjuq

,f; fzf;if nraw;gLj;Jk; tpjpKiwfis thrpjJ ; tpsq;fpf; nfhz;Nld; / nfhz;Nlhk;; vd;Wk; ,f;fzf;F njhlu;ghf tq;fpapdhy; tpjpff ; g;gl;l
tpjpKiwfSf;Fk; epge;jidfSf;Fk; fl;Lg;gl;L ,zq;fp xOfTk; tq;fpapdhy;; Neubahf mwptpahjpUg;gpDk; fhyj;jpwF; fhyk; tq;fpapdhy;
eilKiwf;F nfhz;L tug;gLk; tpjpKiwfSf;Fk; epge;jidfSf;Fk; fl;Lg;gl;L ,zq;fp xOfTk; ,j;jhy; rk;kjpff ; pdN; wd; / rk;kjpff
; pdN; whk;.

I/We have read and understood the rules and regulations for the conduct of this account and I/We 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 not withstanding the fact that such
rules and regulations have not been personally notified to me / us.

1jk ;ekam;alref.a w;aik 2jk ;ekam;alref.a w;aik

1Mk; itg;ghsupd; ifnahg;gk; 2Mk; itg;ghsupd; ifnahg;gk;
............................
Signature of the 1st Depositor Signature of the 2nd Depositor Èkh jpfjp Date

iy;slh Ndr .kakd ,oS' For office use only

rhd;wpjo; ngwg;gl;lJ.
Certificate Received. Date of maturity D D M M Y Y Y Y
Amount initially deposited:
1jk ;ekam;alref.a w;aik .
1Mk; itg;ghsupd; ifnahg;gk;
Serial No:
Signature of the 1st Depositor

2jk ;ekam;alref.a w;aik

2Mk; itg;ghsupd; ifnahg;gk; Authorized Officer Manager
Signature of the 2nd Depositor

fldkafoais
1 uQ , s l ;eka m ;= j g''''''''''''''''''''']l jd¾Is l fmd,s h la tl;= ù fï moku u; fuu iy;s l h u.s k a ks r EmKh jk .s K q f ï l,a m s Í fï jákdlu .Kkh lr we;'
2 l,a m s Í fï Èkfhka miq fuu iy;s l h u.s k a ks r EmKh jk .s K q f ï jákdlu rcfha wkq u ; nÿ iy .dia ; = j,g hg;a j ys ñ lre$ys ñ lrejka g ys ñ fõ'
3 l,a m s f rk f;la fuu iy;s l h u.s k a ks r EmKh jk .s K q f ï uq o ,a wdmiq .ekS u g wjir fokq fkd,efí'
4 iy;s l h u.s k a ks r EmKh jk .s K q u l,a m s r S u g m% : u wjika ls r S f ïoS l,a ms Í fï jákdlu wvq ls r S u g hg;a f õ'
5 iy;s l h u.s k a ks r EmKh jk .s K q u l,a m s Í fï§ uq o ,a wdmiq ,nd fkd.ka f ka kï wod< uq o ,a tla wjq r eÿ ia : djr ;eka a m ;a .s K q u lg udre lrk w;r"
t;eka mgka ia : djr ;eka m ;= .s K q ï j,g wod< kS ; s Í ;s n,meje;a f jkq we;'
epge;jidfs;
1. toq; f g; g Lk; rhd; w pjopy; Fwpg; g pl; l fzf; f pd,; Kjph; t pd; Nghjhd ngWkjpahdJ Muk; g itg; G j; njhiff; F Mz; b w; F …….% $l; L tl; b Ald; Nrh; f ; f g; g Lk;
vd; w mbg; g ilapy; fzpf; f g; g l; L s; s J.
2. toq; f g; g Lk; rhd; w pjopy; Fwpg; g pl; l fzf; f pd,; Kjpu; T jpfjpapd; gpd; Kjpu; T ngWkjp mDkjpf; F l; g l; l mur thpfs; kw; W k; fl; l zq; f Sf; F cl; g l; L
,jd; chpikahsh; / chpikahsu; f Sf; F chpj; j hFk; .
3. toq; f g; g Lk; rhd; w pjopy; Fwpg; g pl; l fzf; f pd; , Kjph; T fhyj; j pw; F Kd; gz kP s g; ; n gwy; mDkjpf; f g; g l khl; l hJ.
4. toq; f g; g Lk; rhd; w pjopy; Fwpg; g pl; l fzf; f pd,; Kjph; T fhyj; j pw; F Kd; ,f; f zf; f pid %Ltjhapd; cupj; j hd KjpuT ; ngWkjp Fiwf; f g; g Lk; .
5. toq; f g; g Lk; rhd; w pjopy; Fwpg; g pl; l fzf; F , Kjph; t ilfpd; w NghJ Fwpj; j njhifia kP s g; n gwhtpbd,; mj; n jhif xU tUl epiyahd itg; G f; fzf; n fhd; W f; F
khw; w g; g LtJld; ,f; f zf; F md; W Kjy; epiyahd itg; G fzf; ; F fSf; f hd tpjpfSf; F cl; g Lj; j g; g Lk; .
CONDITIONS
1. The maturity value of this account represented by the certificate, has been calculated on the basis that its initial deposit will accrue an interest
at the rate of........% per annum.
2. The holder/s will be entitled to the proceeds of this account represented by the certificate, after the maturity date subject to government taxes
and levies.
3. Premature withdrawals are not allowed from this account, represented by the certificate.
4. Premature termination of this account represented by the certificate, will be subjected to a reduction in the Maturity Value.
5. If the proceeds of the account represented by the certificate, are not claimed by the beneficiary at maturity, it will be transferred to a one
year Fixed Deposit Account and thereafter, such deposits will be governed by the rules applicable to Fixed Deposit Accounts.