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APPLICATION FOR TERM / FIXED DEPOSIT

Date: ___________________
We request you to please open a Term / Fixed Deposit Account as per details below:

ACCOUNT NO.

ACCOUNT NAME

In case of minor please provide copy of birth certificate or furnish declaration as follows:
I/We, ..............................................................declare that I am/we are the
parent(s)/bonafide guardian of .............................................................and I
am/we declare minor's Date of Birth as ..........................................

Signature(s)

PERMANENT ADDRESS

PRESENT ADDRESS

MAILING ADDRESS

DEPOSIT REQUEST SCHEMES

[ ] New [ ] Fixed Deposit Amount NPR:
[ ] Renewal [ ] Call Deposit
[ ] Enhancement [ ] _______________ In Words:
[ ] _______________
For Renewal & Enhancement
[ ] _______________ In payment please receive
please indicate existing
Term Deposit No. [ ] Cash [ ] Cheques/Draft
Period _____________
Account No. Drawn on Bank:

SPECIAL INSTRUCTIONS:_____________________________________________________________________________

INTEREST FREQUENCY: [ ] Semi Annually

INTEREST PAYMENT OPTION:
MODE OF OPERATIONS:
DOCUMENTS ENCLOSED:
[ ] Credit to my account _________________________________________
[ ] Credit to Savings/Current Account No. _____________ of ______________
[ ] Single [ ] Joint
[ ] Copy of Citizenship Certificate/Passport
[ ] Registration Certificate
[ ] Income Tax Certificate / PAN Certificate
[ ] MOA & AOA / Partnership Deed
[ ] Board Resolution

DISPOSAL INSTRUCTION:____________________________________________________________________________

I/We hereby sign declaring that the information given and as stated above, is true and correct. I/We agree
to abide by the terms and conditions governing the deposit from time to time.

APPLICANT'S NAME SIGNATURE(S)

CBIL-FD-3
 for Bank's Use Only

Account Number _________________________________

Interest Rate ____________________________________ [ ] Taxable [ ] Non Taxable

Interest Frequency _______________________________

Fixed Deposit No. ________________________________

Va l u e D a t e

Maturity Date

Enhancement Enhancement Renewal Date Renewal Amount Signature

Date Amount

Required Documents

Received Follow-up

Copy of Citizenship Certificate / Passport

Registration Certificate

Income Tax Certificate

MOA & AOA / Partnership Deed

Board Resolution

Miscellaneous:

_________________ _________________ _________________ _________________

Prepared by Approved by Entered by Reviewed by

CBIL-FD-3