Professional Documents
Culture Documents
Account Opening Form For Resident Individuals (Single/Joint) (SF/CA/FD/RD/OD/CC)
Account Opening Form For Resident Individuals (Single/Joint) (SF/CA/FD/RD/OD/CC)
Instructions : PNB 1228A/2017 (Customer Master/KYC Form) must also be taken for new accounts as well as for KYC update request.
1. TYPE OF ACCOUNT : I/We wish to open the following type of account [Tick]
1. Saving Fund Account GENERAL/ POWER SAVING (WOMEN)/VIDYARTHI/SALARY/RAKSHAK/PENSION/ SHIKSHAK/
STAFF/SENIOR CITIZEN/OTHERS PL. SPECIFY________________
2. Current Account GENERAL
3. Recurring / Flexi Monthly Installment / Core Amt Rs. ____________ No. of installments_______
Deposit Period : ______ year(s) ______month(s)
Standing instruction, if any. Debit A/c no. ________________________________
On maturity, credit proceeds to account number : ________________________________________
4. Term Deposit (FD) SUGAM/ MBFD/ANUPAM*/TAX SAVER**/ OTHERS_____________________Fill Details at S. No. 9
(*) OD facility in Anupam- Ann.”B” annexed with RBD-R cir.35 dt.10.08.17 be obtained
(**) A “Declaration” in Tax Saver, annexed with RBD-R cir.27 dt.10.08.17 be obtained
5. PNB Prudent Sweep SF Sweep Facility Required for______days
6. PNB Smart Banking CA Variant ________________________ Sweep facility required for ______days
7. OD/Cash Credit
2. FULL NAME IN CAPITAL LETTER : (Leaving a space between first, middle and last name) Mr/Mrs/Ms/TG-Transgender/Others
(Same as given in Aadhar, if there will be any difference in Name, DOB & Gender then it will be taken as prevails in Aadhar)
1st Applicant
2nd Applicant
3rd Applicant
3. Maiden Name (If any) For Married Women (Documentary Proof be enclosed)
1st Applicant
2nd Applicant
3rd Applicant
Affix photo of 1st Applicantwith Affix photo of 2nd Applicantwith Affix photo of 3rd Applicantwith (For official use)
signature/Thumb Impression signature/Thumb Impression signature/Thumb Impression
across photo across photo across photo
Signature verified
Signature of official
GBPA/PF No.
Name :
Date :
Signature 1st Applicant Signature 2nd Applicant Signature 3rd Applicant
Account Number
Customer ID Number 1. 2. 3.
4. MODE OF OPERATION Self Either or Former or Any one of us Jointly Any Other
(Tick whichever is Applicable) Survivor Survivor or Survivor{s) (Specify)
5. Regd. Mobile Number
PNB-1227A / 2017 Page 1 of 4
6. REQUISITION FOR PRODUCTS / FACILITIES : I/We wish to avail following facility/ies :-
i. WELCOME KIT ( Non- Personalized Classic Debit Card & Cheque Book W ithout Name) Yes/No
ii. E- statement: If Yes, Email Id _________________________________________ Yes No
iii Personalized cheque book Yes/No
iv. SMS Alerts Chargeable language : English Hindi Others
v. Non – personalized Debit Card Personalized Debit card (Tick any One)
vi. Internet Banking services VIEW TXN Mobile Banking Services VIEW TXN Yes/No
vii. Atal Pension Yojna (Application to be submitted Separately) Yes/No
viii. Pradhan Mantri Jeevan Jyoti Yojna (Application to be submitted Separately) Yes/No
ix. Pradhan Mantri Suraksha Bima Yojna (Application to be submitted Separately) Yes/No
x. Any other, Please specify___________________________________________ Yes/No
7. DEBIT CARD : I/We have read terms and conditions governing use of DEBIT card. In case Personalized Debit Card is issued,
names on the card be printed as follows :-
Name of 1st Cardholder
Name of 2nd Cardholder
Name of 3rd Cardholder
Signature Signature
#Amount Rs. ____________________ Period: Year_______ Months_______ Days_______ Interest Rate : _______ %
Interest payment frequency On Annually Half Quarterly Monthly *Credit Interest/ maturity proceeds to
(Pl. Tick in the appropriate box) maturity Yearly
SF/CA/CC/OD Account No._________________
Instruction for Auto Renewal on maturity Renew for Renew for **Period for which Auto renewal
of deposit (Tick the relevant column) Principal & Interest Principal only required: ______ No. of times______
Are you a tax resident of any country other than India? No Yes If Yes, also obtain Form PNB-1227B
11. DECLARATIONS :
11.1 I/we declare that I/we do not enjoy any credit facilities with your/other bank braches or
11.2 I/we declare that I/we have following deposit account and/or credit facilities with your/other banks branches :
Bank Branch Type of Account/Facility Amount Account No.
Page 2 of 4
11.3 Declaration in case of illiterate customer 11.4 Declaration by guardian for minor account
“The terms & conditions in Annexure I- Section(b) for illiterate” I hereby declare that the date of birth of the minor is ____/____/___
customers have been read out to me/us and I/we have who is my (relationship)____________________and I am his/her
understood the same. natural guardian/lawful guardian appointed vide court order dated
________________(copy enclosed) . I /We have read and agree to
be additionally bound by terms & conditions in Annexure I- Section
(C) for guardian of minors.
Signature of Witness Signature(s)/Thumb
(Name & Address) Impression of Depositors Signature(s) /Thumb Impression of Guardian
Date:
Name GBPA / PF NO
1. In person verification carried out by/ Identity Verification done by
2. Account opening authorized. Copies of documents (Proof of
Identity, Proof of Address & others) obtained and verified from
original. Photograph verified. Customers name checked with
barred list and risk category verified due diligence done by
3. Information entered In the system by
4. Entered Information Verified by
5. Signature scanned by
6. DEBIT CARD (In case of Non-Personalised card)
Date of Issue Card No. Signature of Customer : Issued by :
Page 4 of 4
ACKNOWLEDGEMENT
PUNJAB NATIONAL BANK BO :______________________ D.No. _____________________
Registration of Nomination : The nomination is registered at serial no _______________in respect of (Type of Account_____________)