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Annexure-1A
NOMINATION REGISTRATION ID: UCC/BO ID: DATE :
I (customer name) the sole holder/Guardian (in case of minor) hereby declare that:
I nominate the following person who is entitled to receive security balances lying in my account, Particulars whereof are given below,
in the event of my death
NOMINEE DETAILS 1st NOMINEE 2nd NOMINEE 3rd NOMINEE
Name of the nominee(s)(Mr./Ms)
Percentage of allocation
(If not equally shared, please specify
percentage)
Relationship with the Applicant (if any)
Address of the Nominee
Details of Witness
Witness 1st Witness 2nd Witness
Name:
Address:
Signature:
Name
Sole Holder
Signature