>tµåV| þ«V\ kºþ ïðÂz mkºzD ýkD (>M åÃì)

¼Ät©A (ØÃVm / ¶½©Ãç¦ / ¨¹B)

................................................. þçá 妩A, çk©A W], \V> çk©A ïðÂz
¨ªÂz/¨ºïÓÂz >ºïÓç¦B þçál_ ïðÂz ¨õ :
åV[/åVºï^ ¼ïâ|ÂØïVõ¦Ã½ ïðÂz ¼>] :
mkºþ >« ¼kõ|þ¼Å[/¼kõ|þ¼ÅVD. (kºþBV_ W«©Ã©Ã¦ ¼kõ|D)
x>_ sõð©Ã>V«ì : (kºþl[ >u¼ÃVç>B kV½ÂçïBVáì : gD / Ö_çé) kºþl[ >u¼ÃVç>B kV½ÂçïBVáì ¨[ÅV_
ØÃBì : ........................................................................................... x>_ sõð©Ã>V«ö[ Öçð©A ¼Ät©A / 妩A ïðÂz ¨õ :
xïkö : ..........................................................................................
...................................................................................................... x>_ sõð©Ã>V«ö[ CIF ¨õ.
Ø>Vçé¼ÃE ¨õ. ..........................................................................
Ö«õ¦Vkm sõð©Ã>V«ì : (kºþl[ >u¼ÃVç>B kV½ÂçïBVáì : gD / Ö_çé) kºþl[ >u¼ÃVç>B kV½ÂçïBVáì ¨[ÅV_
ØÃBì : ........................................................................................... Ö«õ¦Vkm sõð©Ã>V«ö[ Öçð©A ¼Ät©A / 妩A ïðÂz ¨õ :
xïkö : ..........................................................................................
...................................................................................................... Ö«õ¦Vkm sõð©Ã>V«ö[ CIF ¨õ.
Ø>Vçé¼ÃE ¨õ. ..........................................................................
(A]B kV½ÂçïBVáì ¨[ÅV_, CIF ýkÝç>© ¯ìÝ] ØÄFm ÖçðÂï¡D )
1. ïðÂz kçï ( °¼>ÐD Î[çÅ ØÄFB¡D)
¼Ät©A ïðÂz ¶½©Ãç¦/ E¤B ïðÂz 妩A ïðÂz çk©A W] ïðÂz RD/VRD

2. Wìkþ©Ãkì / ÖBÂzÃkì / å¦ÝmÃkì ( °¼>ÐD Î[çÅ ØÄFB¡D)

Öòkì (¶) x>éV\kì (¶) BV«Vkm Îòkì
·B\Vï
cl¼«V½ò©Ãkì cl¼«V½ò©Ãkì (¶) cl¼«V½ò©Ãkì
¶çªk«VKD Ö>«

3. ¼>çk©Ã|D ¼Äçkï^ ( °¼>ÐD Î[çÅ ØÄFB¡D)

1. ATM ïVì| ¼>çk ¼>çk Ö_çé
(¶çé¼ÃE ¨õ ¶Ý]BVkEB\Vªm)
2. ïV¼ÄVçé AÝ>ïD ¼>çk ¼>çk Ö_çé
(ØÃVm ¼Ät©A / 妩A ïðÂzïÓÂz \â|D)
(¶½©Ãç¦ / ¨¹B ¼Ät©A ïðÂþuz ÖÍ> kÄ] þç¦BVm)
3. z®ÞØÄF] >ïk_ ØîD kÄ] (ïâ¦ðD cõ|) ¼>çk ¼>çk Ö_çé
4. çk©A W] ïðÂz sëD ( °¼>ÐD Î[çÅ ØÄFB¡D)

STD FD RIP Tax Saver FD Tax Saver RIP

kºþ cüBVïÝ]uz \â|D
x]ì¡ Ø>Vçï Ô.
ئÃVEâ Ø>Vçï : Ô .................................. Ô. (¨¿Ý]_) ..........................
x]ì¡ ¼>]
.......................................................................................................................... JÝ> z½\ÂïáVªV_
¸ÅÍ> ¼>]
ïVéD ..........................kò¦D ......................\V>D..........................åV^
kâ½ kVºï sò©ÃD : \V>D Îò xçÅ ïVéVõ|Âz Îò xçÅ x½s_
çk©AÂïVé x½s_ - çk©A ïðÂçï >V¼ª Am©¸ÂzD xçÅ : ¼>çk ¼>çk Ö_çé
( >V¼ªAm©¸ÂzD xçũý, x]ì¡ Ø>Vçï x¿kmD ¶©¼ÃVç>B kâ½ sþ>Ý]_ ¶¼> ïVé ¶ásuz Am©¸Âï©Ã|D)
5. \V> >kçð çk©A ]â¦D (RD) / \V®D \V> >kçð çk©A ]â¦D (VRD) ( °¼>ÐD Î[çÅ ØÄFB¡D)

\V> >kçð* :Ô. .................../- Ô (¨¿Ý>V_)......................................... kºþ cüBVïÝ]uz \â|D

...............................................................................................................
ïVéD : kò¦D \V>D x]ì¡ Ø>Vçï* : Ô.
Wçé gçð* Ø>Vçï ¨|Âï©Ã|D (Debit) ïðÂz ¨õ
(*-VRDÂz ØÃòÍ>Vm) x]ì¡Ý Ø>Vçï k«¡ çkÂï ¼kõ½B
(Credit) ïðÂz ¨õ
6. kò\Vª kö ¸½Ý>D (TDS) - °¼>ÐD Î[çÅ ØÄFB¡D
cöB kò\Vª köçB ¸½Ý>D ØÄFB¡D
åV[ PAN ¶âç¦ åï_ & Form15G/15H ÖçðÝm^¼á[. kò\Vª kö¸½Ý>D ¼>çkl_çé. ¨ªm kâ½ kòkVF ¶«E[ köÄKçï
ÿµ c^ám.
7. c®]Ø\Va ‡ ΩÃÍ>D ¼>çkBVªç> \u®D ¼>çkl_éV>ç> ØÄFB¡D
åV[ / åVºï^ kºþl[ ¶çªÝm s] xçÅïçá¥D ýÝm, sáÂïD ØÃu® ÎÝmÂØïVõ¼¦[/ØïVõ¼¦VD.
¨ªÂz / ¨ºïÓÂz ¸Å kºþï¹_ ¶½©Ãç¦ ¼Ät©A ïðÂz þç¦BVm.
""BV«Vkm Îòkì ¶_ém cl¼«V| Öò©Ãkì'' \u®D ""x>éV\kì ¶_ém cl¼«V| Öò©Ãkì'' xçÅl_ ÖBÂï©Ã|D
ïðÂzïÓÂz \â|D
ïðÂïVáìï¹_ ¨k¼«ÐD Îòkì ÖÅÍmsâ¦V_, ÖÅÍ> ïðÂïVáö[ ÖÅ©A ÄV[® ØÃu® (ÖÅÍ>kö[ kVö· ÄV[®
Ö_éV\_) - cl¼«V| Öò©Ãkì \â|D ïðÂçï ÖBÂï¼kV ïðÂþïçª x½Âï¼kV ÎÝmÂØïV^þ¼ÅVD.

ç\ªì ïðÂïVáì
¶[® ¸ÅÍ> ......................................................(ØÃBì) ¨ªÂz .................................................
cÅ¡xçÅ gzD, ÖkòÂz åV¼ª ÖBuçïBVª / Ä⦩¯ìk ÃVmïVkéì g¼k[. ç\ªì cöB kBm kç« ¶kòÂïVï
åV¼ª k«¡ ØÄé¡ ØÄF¼k[.
ïðÂïVáì TNGB kºþ ÃèBVáì ¨[ÅV_ \â|D ÖÂïðÂþ_ >u¼ÃVm ØÄKÝ>©Ã|D Ø>Vçï ¶_ém ÖÂïðÂþ_ ÖM¼\_
¶Ëk©¼ÃVm ØÄKÝ>©Ã|D Ø>Vçï ¶çªÝmD ¨ªÂzß ØÄVÍ>\Vªm ¨[® c®]B¹Âþ¼Å[.
sõð©Ã>V«ì / sõð©Ã>V«ìï^ çＫçï ¨M_, ÄVâE ¶kEBD
ÄVâEl[ ØÃBì
ÄVâEl[ xïkö
ÄVâEl[ çïØBV©ÃD
ÄVâEl[ Ø>Vçé¼ÃE ¨õ

Ö¦D :
¼>] : (x>_ sõð©Ã>V«ì çïØBV©ÃD) (Ö«õ¦VD sõð©Ã>V«ì çïØBV©ÃD)
8. kVö· WB\ª sëD FORM DA-1 Ã]¡ ¨õ.
Nomination under section 45ZA of the Banking Regulation Act, 1949 and Rules 1985 in respect of Bank Deposits.
WB\ª sëD
åV[ / åVºï^ ............................................ÿµ ïõ¦ åÃç« ¨[Ðç¦B / ¨ºïÓç¦B \«ðÝ]uz ¸[ ¨[Ðç¦B / ¨ºïÓç¦B
ïðÂz Ø>VçïçB TNGB kºþl[ ................................. þçáloòÍm ]òDà ØÃu®Â ØïV^á kVöÄVï WB\ªD ØÄFþ¼Å[ / ØÄFþ¼ÅVD.
kVö· WB\ª sëD ÃVü AÝ>ïÝ]_/ ئÃVEâ «æ]_ Ã]B ¼kõ|þ¼Å[ / ¼kõ|þ¼ÅVD / Ã]B ¼>çkl_çé
ïðÂz sëD (kºþBV_ W«©Ã©Ã|D)
ïðÂz kçï ................................................................... ïðÂz ¨õ
kVö·>V«ì sëD

kVö·>V«ö[ ØÃBì & xïkö

kVö·>V«ö[ g>Vì ¨õ
(sò©ÃD ÖòÍ>V_ \â|D) kVö·>V«ö[ ¸ÅÍ> ¼>]
åï_ ÖçðÂï©Ã¦ ¼kõ|D (kVö·>V«ì ç\ªì ¨[ÅV_ \â|D)
ïðÂïVáòÂz kVö·>V«ö[ (sò©ÃD ÖòÍ>V_ \â|D)
cÅ¡xçÅ
kVö·>V«ö[ çï¼ÃE ¨õ kVö·>V«ö[ kBm
(sò©ÃD ÖòÍ>V_ \â|D)
¼\uý ç\ªì kVö·>V«òÂz, ÃVmïVkéç« WBtÂï sòD¸ªV_ \â|D
ÿµïõ¦ sëºïçá W«©Ã¡D.
ÃVmïVkéö[ ØÃBì & xïkö ÃVmïVkéö[ g>Vì ¨õ
åï_ ÖçðÂïæ ¼kõ|D
ÃVmïVkéö[ çï¼ÃE ¨õ
ÃVmïVkéö[ cÅ¡xçÅ (sò©ÃD ÖòÍ>V_ \â|D)
ÖÂïðÂþ[ x]ì¡ ¼>]l_ ¼\uý ç\ªì cl¼«V| Ö_éVsâ¦V_, ç\ªö[ ÖÅ©A ÄV[® ØÃuŸ[
ÖÂïðÂþ[ Öò©AÝØ>VçïçB, ¼\uý ç\ªö[ ÃVmïVkéì ØÃu®ÂØïV^á ÄD\]Âþ¼Å[ / ÄD\]Âþ¼ÅVD.
¨ªÂz / ¨ºïÓÂz kVö· WB\ªD ¼>çkl_çé

x>_ÄVâE ØÃBì Ö«Võ¦D ÄVâE ØÃBì

x>_ÄVâE çïØBV©ÃD Ö«Võ¦D ÄVâE çïØBV©ÃD

x>_ÄVâE xïkö & Ö«Võ¦D ÄVâE xïkö &
Ø>Vçé¼ÃE Ø>Vçé¼ÃE

Ö¦D :
¼>] : (x>_ sõð©Ã>V«ì çïØBV©ÃD) (Ö«õ¦VD sõð©Ã>V«ì çïØBV©ÃD)
 ïðÂz ¨õ : (¼Ät©A / 妩A / W«Í>« çk©A / Ø>V¦ì çk©A)

sõð©Ã>V«ì c®]Ø\Va
1. åV[ / åVºï^ Öº¼ï ØïV|Ý> >ïk_ï^ ¶çªÝmD cõç\BVªçk/ ÄöBVªçk.
ÖM kòD \Vuźïçá 30 åVâïÓÂz^ c¦ª½BVï kºþÂz Ø>ös©¼Ã[ / Ø>ös©¼ÃVD.
2. kºþ \u®D ¶«E[ ¶Ëk©¼ÃVç>B Ä⦠]⦺ïÓÂz ïâ|©Ãâ| 妩¼ÃD / 妩¼ÃVD.
3. kºþBV_ ¶Ëk©¼ÃVm WìðlÂï©Ã|D ¼Äçk ïâ¦ðºïçá ïðÂþoòÍm ¨|ÝmÂ
ØïV^á ÄD\]Âþ¼ÅD / ÄD\]Âþ¼ÅVD.
4. ï¦¡ß ØÄV_, Ö«ïEB z¤X| ¼ÃV[ÅkuçÅ ¸Åò¦[ ÃþìÍmØïV^á \V⼦[ / \V⼦VD.
5. ¨[ / ¨ºï¹_ BVì *mD Ä⦠οºz å¦k½Âçïï^ °mD þç¦BVm.
6. \Ý]B \VWé ¶«·ï¹[ Ä⦺ïÓÂzD, kò\Vª kö \u®D ¶ÍWB ØÄékVè
Ä⦺ïÓÂzD ïâ|©Ã|¼k[ / ïâ|©Ã|¼kVD.
7. åVºï^ Ä\쩸Ý> gkðºïçá ¼>çk©Ã|D¼ÃVm ¶«· mçÅ﹦D kºþ ÃþìÍmØïV^á
ÄD\]Âþ¼Å[ / ÄD\]Âþ¼ÅVD.
8. >kÅVª >ïk_ï^ ØïV|©Ãm >õ¦çªÂzöB zuÅD ¨[Ãç> å[祿k[ / å[祿kVD.
>kÅVª >ïk_﹪V_ °¼>ÐD Öw©Aï^ °uý[ ¶ç> ¨[M¦tòÍm / ¨ºï¹¦tòÍm
kóoÝm ØïV^áéVD.
9. ïVékç«Bçũý ØïV|Âï©Ã¦ ¼kõ½B gkðºïçá ¶Ëk©¼ÃVm ØïV|Ýms|¼k[ /
ØïV|Ýms|¼kVD
10. ¶çªÝm gkðºïÓD x¿ç\BVï Ä\쩸Âï©Ã|D kç« ïðÂçï ØÄB_æV\_
W®Ý]çkÂï ÄDtÂþ¼Å[ / ÄD\]Âþ¼ÅVD.
11. ïðÂþ_ ÃöÍmç«Âï©Ã⦠zçÅÍ>ÃâÄ Öò©A Ø>VçïçB çkÝ]ò©¼ÃVD. >k®DÃâÄÝ]_
¶>uïVª ¶Ã«V> Ø>VçïçB ¸½Ý>D ØÄFmØïV^á ÄD\]Âþ¼Å[ / ÄD\]Âþ¼ÅVD.
12. ïðÂþ_ ¼ÃV]B Öò©A Ö_éV\_ ïV¼ÄVçé ØïV|©Ãm >õ¦çªÂzöB zuÅD ¨[Ãç>
å[z ¶¤¼k[ / ¶¤¼kVD.
13. ¼Ät©A ïðÂçï kèï ÃB[ÃVâ½uz ÃB[Ã|Ý>\V⼦[ / ÃB[Ã|Ý>\V⼦VD.
14. g>Vì \u®D çï¼ÃE ¨õïçá ïðÂz¦[ ÖçðÝm ØïV^¼k[ / ØïV^¼kVD.

¼>] : sõð©Ã>V«ì çïØBV©ÃD

¶Kkéï cüBVïÝ]uz \â|D
¶Kkéï ÃB[ÃVâ|Âz \â|D
Name of the Office :
SR. NO. : Quene No Initials
Account
Designation :
CIF Linking
Open Account
Personalised Cheque
Date RINB
(Authorised signatory)
MBS
SMS Alert
i) Internet Banking (INB) Kit No:..............................
Removal of Posting
ii) INB Viewing rights Transaction rights given on:
iii) ATM Card data transmitted on: Scanning

iv) Nomination Serial No:

v) Threshold (KYC) limit:
vi) Phone Banking

Tear off
kVö·>V«ì WB\ª ΩAçïß æâ|
1. ïðÂïVáì ØÃBì & xïkö
2. ïðÂþ[ kçï & ¨õ.
3. kVö·>V«ì ØÃBì & cÅ¡ xçÅ
4. kVö·>V«ì Ã]¡ ¨õ & ¼>]

þçá : ¼\éVáì / ¶Kkéì