NÊ ˛ .Ã.

8001

EÁãá¿ Á §¯N˛ §Yo §¯N˛ QÁoÁ QÁz¬åz N˛Á ¢˛Á™|

(ßÁ∫o Ã∫N˛Á∫ N˛Á GúN¿˛™)

∆ÁQÁ N˛Á åÁ™ EÁ{∫ NÓ˛b ÃÊPÆÁ

úÁÃúÁzb| - EÁN˛Á∫ N˛Á
T¿Á“N˛ EÁF|gy ¢˛ÁzbÁz ¬TÁLÊ
QÁoÁ åʧ∫
(ZÁzbz QÁoÁı Nz˛ u¬L)
1. úÓ∫Á åÁ™ (»y/»y™oy/NÏ˛™Á∫y):

2. uúoÁ / úuo / EußßÁƒN˛ N˛Á åÁ™:

3. EÁƒÁÃyÆ úoÁ
˚Á∫Á
™N˛Áå åÊ. EÁ{∫ åÁ™:
T¬y åÊ. EÁ{∫ åÁ™:
ú“YÁå/¬¯g™ÁN|˛:
TÁƒ/åT∫: u\¬Á:
∫Á[Æ: uúåN˛Ázg:
tÓ∫ßÁ  ¬¯g¬ÁFå: ™Áz§ÁF|¬ åʧ∫:
4. u¬ÊT: ................................................. [gygyL™]* \ã™uous : ..................................... [gygyL™]*
5. N˛) √ƃÃÁÆ : ......................................... [gygyL™]* Q) »zmy : ..................................... [gygyL™]*
6. Nz˛ƒÁF|Ãy ü¬zQ üÀoÏo uN˛L TL “Á … å“Î … [gygyL™]*
7. åÁ™ÁÊN˛å Eúzuqo “Á … å“Î … [gygyL™]*
8. LbyL™ gzu§b N˛Ág| “zoÏ EÁƒztå “Á … å“Î … [gygyL™]* LÃL™Là L¬b| “Á … å“Î … [gygyL™]*
9. úu∫YÆ (Æut ¬ÁTÓ “Áz)
úu∫YÆN˛oÁ| N˛Á åÁ™
T¿Á“N˛ EÁF|gy QÁoÁ åʧ∫
™¯ »y / »y™oy ________________________________N˛Áz uúZ¬z________ƒ |/™“yåÁı Ãz \ÁåoÁ/\Áåoy “Ó @ ƒ“ GúÆÏ|O˛ úoz ú∫ ∫“ ∫“Á/∫“y “{@
utåÁÊN˛ ____________ úu∫YÆN˛oÁ| Nz˛ “ÀoÁq∫ ____________________________ __________________________________
(\ÁÂYN˛oÁ| §¯N˛ EuáN˛Á∫y N˛Á åÁ™, LÃLà åÊ. ƒ “ÀoÁq∫)
Nw˛úÆÁ »y/»y™oy _______________________________ (üs™/LN˛™Áfi EÁƒztåN˛oÁ|) EÁ{∫ »y / »y™oy _____________________________________
(u˚oyÆ EÁƒztåN˛oÁ|)**. Nz˛ åÁ™ Ãz §Yo §¯N˛ QÁoÁ QÁz¬ı @ “™ı ZÁzbz QÁoz Ãu“o §Yo §¯N˛ uåÆ™ EÁ{∫ uƒuåÆ™ Ù^ÁL TL “¯ EÁ{∫ ™¯ / “™ FåN˛Á úÁ¬å N˛∫åz
“zoÏ Ã“™o “¯@ LN˛™Áfi/ünÆzN˛ EÁƒztåN˛oÁ| Nz˛ Euou∫Mo ¢˛ÁzbÁz ÃʬTí “¯@
utåÁÊN˛: ___________________
ÀsÁå: ____________________ üs™ / LN˛™Áfi EÁƒztåN˛oÁ| Nz˛ “ÀoÁq∫/EÊTÓez N˛Á uå∆Áå u˚oyÆ EÁƒztåN˛oÁ| Nz˛ “ÀoÁq∫/EÊTÓez N˛Á uå∆Áå
§yÃy/§yL¢˛ N˛Á åÁ™ LƒÊ åʧ∫
√ÆÁúÁ∫ üuouåuá/ÃϬßN˛oÁ| Nz˛ “ÀoÁq∫____________________________\ÁÂYN˛oÁ| §¯N˛ EuáN˛Á∫y N˛Á åÁ™, LÃLà åÊ. ƒ “ÀoÁq∫_____________________________
* gygyL™ - g~Áú gÁGå ™zåÓ ** ÃÊ Æ Ï M o QÁoÁáÁ∫N˛ (EsÁ| o Ω u˚oyÆ EÁƒz t åN˛oÁ| ) EåÏ ú Ó ∫ N˛ ¢˛Á™| ß∫ı T z )

    
 Comp.No. 8001

(A Govt. of India Undertaking)

SAVINGS BANK ACCOUNT OPENING FORM
For Bank Use Only

Name & Code of the Branch

Affix
Passport Size
Cust ID
Photo
A/C No.

[FOR SMALL ACCOUNT]

1. Name in Full (Mr/Ms):

2. Father/ Husband/Guardian Name:

3. Residential address:
C/o
House No. and Name :
Street No. and name :
Landmark :
Village /City : District :
State : Pincode :
Telephone/Landline Mobile No.
4. Sex : .................................. [DDM]* Date of Birth: .............................. [DDM]*
5. a) Occupation : ......................................... [DDM] * (b) Category: ............................. [DDM]*
6. KYC Documents Provided Yes No [DDM]*
7. Nomination Required Yes No [DDM]*
8. Request for ATM Debit Card : Yes No [DDM]* SMS Alert : Yes No [DDM]*
9. Introduction [if applicable]:
Name of the introducer :
Customer ID Account No.
I know Shri/Smt________________________for the past________Years/months. He/she is residing at the address given above.
Date : ________ Signature of the introducer___________________ __________________________________
(Name, SS No & Signature of the verifying Branch official)
Please open a Savings Bank account in the name of Mr./Ms. ___________________________(first/sole applicant) and Mr./Ms.
______________________(second Applicant)**. The Saving Bank rules and regulations including those relating to Small Account have been
explained to me/us and I/we agree to abide by the same. An additional photograph of sole/each applicant is attached.

Date: ___________________

Place:___________________
Signature/Thumb Impression of first/sole Applicant Signature/Thumb Impression of second Applicant
Name & No. of BC/BF.

Signature of Business Correspondent/Facilitator____________________________ Name, SS No & Signature of the verifying Branch official_____________________________
* DDM - Drop Down Menu ** The Joint Account holder (i.e. second applicant) shall fill up a supplementary Form.

    
 EÁãá¿Á §¯N˛ ∆ÁQÁ .............................................................

¢˛Á™| gyL-1 : åÁ™ÁÊN˛å

§¯N˛ \™Á Nz˛ ÃʧÊá ™ı §¯uN˛ÊT uƒuåÆ™å EuáuåÆ™ N˛y áÁ∫Á 45 „\zg L EÁ{∫ §¯uNÊ˛T NÊ˛úåy (åÁ™ÁÊN˛å) uåÆ™ 1985 Nz˛ EÊoT|o åÁ™ÁÊN˛å@
™¯/“™ _____________________________________________uåƒÁÃy_________________________________________
________________________________________________________________________________________________________________________________________________
LotΩ˚Á∫Á uå©åu¬uQo N˛Áz åÁu™o N˛∫oz “¯, u\ã“ı ™z∫z/“™Á∫z/åÁ§Áu¬T N˛y ™wnÆ ™Á™¬z ™ı EÁãá¿Á §¯N˛, ∆ÁQÁ N˛ÁÆÁ|¬Æ ____________________________
˚Á∫Á QÁoz ™ı \™Á ∫Áu∆ ¬Á{bÁF| \Á ÃN˛oy “{@
\™Á åÁu™oy
Euou∫Mo \™ÁN˛oÁ| Nz˛ ÃÁs
QÁoz N˛Á üN˛Á∫ QÁoÁ åʧ∫ uƒƒ∫m, Æut åÁ™ úoÁ ÃʧÊá, Æut “Áz EÁÆÏ \ã™uous
“Áz

*YÓÊN˛y åÁu™oy Fà oÁu∫Q N˛Áz åÁ§Áu¬T “{, ™¯/“™ åÁu™oy Nz˛ åÁ§Áu¬T “Ázåz Nz˛ tÁ{∫Áå ™z∫z / “™Á∫z / åÁ§Áu¬T N˛y ™wnÆÏ “Áz \Áåz ú∫ »y / »y™oy
_______________________________________________________EÁÆÏ ________úoÁ ________________________
______________________________________________________________________________________________
N˛Áz åÁu™oy N˛y EÁz∫ Ãz \™Á ∫Áu∆ üÁõo N˛∫åz “zoÏ uåÆÏMo N˛∫oz “¯@
ÀsÁå: ________________________ 1. 2.
utåÁÊN˛:________________________ \™ÁN˛oÁ| Nz˛ “ÀoÁq∫ @ / # EÊTÓez N˛Á uå∆Áå
@ \“Á \™Á åÁ§Áu¬T Nz˛ åÁ™ ú∫ N˛y TF| “{, åÁ™ÁÊN˛å ú∫ åÁ§Áu¬T Nz˛ ÀƒÁßÁuƒN˛/uƒuáN˛ EußßÁƒN˛, \Áz åÁ§Áu¬T N˛y EÁz∫ Ãz N˛ÁÆ| N˛∫ıTz, ˚Á∫Á “ÀoÁqu∫o “Áz@
# åÁu™oy åÁ§Áu¬T å “Ázåz ú∫ N˛Áb tı@

ÃÁflÆ
üs™ ÃÁflÆ N˛Á åÁ™ EÁ{∫ “ÀoÁq∫ u˚oyÆ ÃÁflÆ N˛Á åÁ™ EÁ{∫ “ÀoÁq∫

åÁ™:___________________________________________ åÁ™:___________________________________________
“ÀoÁq∫:__________________________________________ “ÀoÁq∫:__________________________________________
úoÁ:_____________________________________________ úoÁ:_____________________________________________
______________________________________________ ______________________________________________
ÀsÁå:___________________________________________ ÀsÁå:___________________________________________
utåÁÊN˛__________________________________________ utåÁÊN˛__________________________________________
tÓ∫ßÁ  ÃÊPÆÁ_____________________________________ tÓ∫ßÁ  ÃÊPÆÁ_____________________________________
# EÊTÓez Nz˛ uå∆Áå N˛Á tÁz ÃÁflÆÁı ˚Á∫Á EåÏü™Ámå uN˛ÆÁ \ÁL; EãÆsÁ FÃN˛Á LN˛ ÃÁflÆ ˚Á∫Á EåÏü™Ámå uN˛ÆÁ \ÁL _________________________
____________________________________________________________________________________________________
åÁ™ÁÊN˛å úÊ\yNw˛o åÁ™ÁÊN˛å úÊ\yN˛∫m ÃÊ _______________________

    
GúÆÏ|Mo åÁ™ÁÊN˛å _________________________ (QÁoz N˛Á üÁN˛Á∫) \™Á QÁoÁ åÊ ____________ Nz˛ ÃʧÊá ™ı N¿˛™ÁÊN˛ ________ ú∫ úÊ\yNw˛o “{@
utåÁÊN˛:_____________________. Nw˛oz _____________________
(üÁuáNw˛o EuáN˛Á∫y) LÃLà åÊ. ___________________
 Branch .............................................................

FORM DA-1: NOMINATION

Nomination under Section 45 ZA of Banking Regulation Act, 1949 and Rule 2(1) of the Banking Companies (Nomination)
Rules 1985 in respect of Bank Deposits,
I/ We ( Name(s)) ______________________________________________________________________________________
R/o___________________________________________________________________________________________________
nominate the following person to whom in the event of my/our/ minor's death, the amount of deposit in the account may be
returned by Andhra Bank, Branch Office_____________________

DEPOSIT NOMINEE
Nature Additional Relationship Age Date of birth
of Account No. Details, Name Address with depositor,
Account if any if any

* As the nominee is minor on this date, I/we appoint Mr/Ms_____________________________________________________

Age________Address______________________________________________________________________________________
_________________________________________________________________________________________________________
to receive the amount of the deposit on behalf of the nominee in the event of my/our/minor's death during the minority of the
nominee.

Place:_______________________ 1. 2.
Date:________________________ @ Signature(s) / #Thumb impression(s) of depositors
@Where the deposit is made in the name of minor, the nomination is to be signed by natural/legal guardian of the minor to
act on behalf of the minor.
*Strike out if nominee is not a minor
WITNESSES
Name & Signature of the first witnesses Name & Signature of the second witnesses

Name_______________________________________
Signature:____________________________________
Address:_____________________________________
_____________________________________________
Place:_______________________________________
Date:________________________________________
Telephone No._________________________________
Name_______________________________________
Signature:____________________________________
Address:_____________________________________
_____________________________________________
Place:_______________________________________
Date:________________________________________
Telephone No._________________________________

#Thumb impression(s) shall be attested by two witnesses; otherwise it shall be attested by one witness.……................……………
……………………………………………………………………………………
NOMINATION REGISTERED Nomination Regn.No. _______________________

    
The above mentioned nomination is registered at serial no ____________________________________ in respect of (Type of
Account.) _________________ Deposit Account No.___________________________________________.
Date_____________________. For _____________________
(Authorised Official) SS No.___________________
 EÁãá¿Á §¯N˛ ∆ÁQÁ ............................................................. Comp.No. 8002
§Yo §¯N˛ QÁoÁ QÁz¬åz N˛Á ¢˛Á™| - Euou∫Mo ÃÓYåÁ
[úÓm| Nz˛ƒÁF|Ãy EåÏúÁ¬å “zoÏ]
1. úu∫YÁ¬å N˛Á üN˛Á∫: LN˛¬ … N˛ÁzF| LN˛ ÆÁ Gno∫\yƒy … ú“¬Á ÆÁ Gno∫\yƒy … ú∫ƒoy| ÆÁ Gno∫\yƒy …
N˛ÁzF| ßy LN˛ ÆÁ Gno∫\yƒy … ÃÊÆÏMo øú Ãz … N˛ÁzF| EãÆ N¿˛™ … (uƒuåut|…b N˛∫ı) (gygyL™)*
2. úyLLå / \yEÁF|EÁ∫ åÊ./¢˛Á™| 60/61 ........................................................................................................................

3. EÁÆ üuo ƒ |: ................................................................................ (gygyL™)*

4. ∆{uqN˛ E“|oÁ: ............................................................................... (gygyL™)*
5. F|-™z¬ EÁF| gy:
6. Nz˛ƒÁF|Ãy ü¬zQ: ú“YÁå ÃÁflÆ: (gygyL™)* úoÁ ÃÁflÆ: (gygyL™)*
7. Lzg EÁ}å “zoÏ EåÏ∫Ázá:

N¿ ˛ .ÃÊ . GnúÁt
1 QÁoz N˛Á F| - uƒƒ∫m “Á …/ å“Î …
2. Y{N˛ §ÏN˛ “Á …/ å“Î …
3. ™Áz§ÁF|¬ §¯uN˛ÊT “Á …/ å“Î …
4. FÊb∫åzb §¯uN˛ÊT “Á …/ å“Î …
5. N¿˛zugb N˛Ág| “Á …/ å“Î …
6. EãÆ “Á …/ å“Î …

8. N¿˛Áà Ãzu¬ÊT “zoÏ Euou∫Mo ÃÓYåÁ

™¯ uå©åu¬uQo N˛Á ßy ¬Áß GeÁåÁ YÁ“ÓÂTÁ / YÁ“ÓÂTy
N¿ ˛ .ÃÊ . GnúÁt
1 EÁƒÁà J m “Á …/ å“Î …
2. ƒÁ“å J m “Á …/ å“Î …
3. ©ÆÓYÏE¬ ¢Ê˛g “Á …/ å“Î …
4. \yƒå / ÃÁ™ÁãÆ §y™Á “Á …/ å“Î …
5. úı∆å “Á …/ å“Î …
6. EãÆ “Á …/ å“Î …

™Ï^z / “™ı rÁo “ÏEÁ “{ uN˛ ßÁ∫oyÆ §{ÊuN˛ÊT NÓ˛b LƒÊ ™ÁåN˛ §Ázg| (§yÃyLçyEÁF|) ú∫ LN˛ úÏuÀoN˛Á EÁúN˛y ƒ{§ÃÁF|b ú∫ Gú¬£á “{ EÁ{∫ ™Ï^z ™ÁÂTåz ú∫ Gú¬£á N˛∫ƒÁF|
\ÁLTy@
uåÆ™ LƒÊ ∆oz˙
™¯/“™ úÏu…b N˛∫oz “¯ uN˛ ™¯åz/“™åz QÁoz Nz˛ uåÆ™ üÁõo N˛∫ ú‰j EÁ{∫ Ù^ u¬L “¯ - (N˛) ™z∫z / “™Á∫z ˚Á∫Á QÁz¬z \Áåz ƒÁ¬z QÁoÁı N˛Áz ∆ÁuÃo N˛∫åz ƒÁ¬z Få uåÆ™Áı
EÁ{∫ ∆oÁz˙ N˛Á úÁ¬å N˛∫åz N˛y Ó™uo tzoz “¯ (Q) uåÆ™Áı EÁ{∫ §¯N˛ ˚Á∫Á ütno uƒußãå ÃzƒÁEÁzÊ, u\åN˛Á “™ ¬Áß GeÁoz “¯, Nz˛ ÃʧÊá ™ı §¯N˛ ˚Á∫Á Eúåz åÁzubà §Ázg|
ÆÁ ƒ{§ÃÁF|b ú∫ ütu∆|o uN˛L \Áåz ú∫ EÁ{∫ §¯N˛ ˚Á∫Á ütno ÃzƒÁLÊ, u\Ùı gzu§b N˛Ág|, N¿˛zugb N˛Ág|, FÊb∫åzb §¯uNÊ˛T, ™Áz§ÁF|¬ §¯uNÊ˛T EÁ{∫ Fà ¢˛Á™| ™ı ÃÓYy§Ú EãÆ
ÃÏuƒáÁLÊ ∆Áu™¬ “¯ ¬zuN˛å Få oN˛ Ãyu™o å“Î “¯, Nz˛ ÃʧÊá ™ı ÙÆ-Ã™Æ ú∫ uN˛L TL ÃÊ∆Ázáå@ Få ÃÏuƒáÁEÁzÊ N˛Á GúÆÁzT §¯N˛ ˚Á∫Á ÙÆ-Ã™Æ ú∫ uåáÁ|u∫o uåÆ™
LƒÊ ∆oÁz˙ ú∫ “{@

utåÁÊN˛: ___________________

ÀsÁå: ____________________

üs™ / LN˛™Áfi EÁƒz t åN˛oÁ| Nz ˛ “ÀoÁq∫ / EÊ T Ó e z N˛Á uå∆Áå u˚oyÆ EÁƒz t åN˛oÁ| Nz ˛ “ÀoÁq∫ / EÊ T Ó e z N˛Á uå∆Áå
 Branch :............................................................. Comp.No. 8002
SAVING BANK ACCOUNT OPENING FORM -ADDITIONAL INFORMATION
[For full KYC Compliance]

1. Mode of Operation : Singly Either or survivor Former or Survivor Latter or Survivor

Anyone or Survivor Jointly Any other combination

(Specify) [DDM]

2. PAN /GIR NO./FORM 60/61 ........................................................................................................................

3. Income Per annum : ....................................................................... [DDM]

4. Educational Qualification : .............................................................. [DDM]

5. Email ID

6. KYC Document : Identification Proof : [DDM] Address Proof : [DDM]

7. Request for add on:-

S.No. Product
1 e-Statement of Account Yes / No
2. Cheque Book Yes / No
3. Mobile Banking Yes / No
4. Internet Banking Yes / No
5. Credit Card Yes / No
6. Others Yes / No

8. Additional Information for Cross Selling

I would like to also avail:-

S.No. Product
1 Housing Loan Yes / No
2. Vehicle Loan Yes / No
3. Mutual Fund Yes / No
4. Life/General Insurance Yes / No
5. Pension Yes / No
6. Others Yes / No

I/we understand that a booklet on the Banking Codes & Standards Board of India Code(BCSBI) posted on your website shall be
provided to me on demand.
Terms & Conditions:
I/we confirm having received, read and understood (a) the accounts rules and hereby agree to be bound by the terms & conditions
outlined in these rules which gover ns the account(s) which I/we am/are opening/will open and (b) amendments to the rules made
from time to time and those relating to various services availed by me/us when displayed by the Bank on its notice board or on its
website and those relating to various services offered by the Bank including but not limited to debit card, credit card, internet banking
mobile banking and other facilities listed in this form. The usage of these facilities is governed by the terms and conditions stipulated
by the Bank from time to time.

Date: ___________________

Place:___________________

Signature/Thumb Impression of first/sole Applicant Signature/Thumb Impression of second Applicant

 EÁãá¿Á §¯N˛
√ÆuO˛ÆÁı Nz˛ QÁoz : Nz˛ ƒÁF| Ãy ü¬zQÁı N˛y ÃÓYy
(ünÆzN˛ ÃÓYy Ãz LN˛ ü¬zQ)
ÃÓ Y y I ÃÓ Y y 2
ú“YÁå Nz˛ ü™Ám Nz˛ øú ™z ÀƒyNw˛o ü¬zQ uåƒÁà Nz˛ ü™Ám Nz˛ øú ™z ÀƒyNw˛o ü¬zQ
1. úÁ∫úfi 1. ∫Á∆å N˛Ág|
2. ú{å N˛Ág| 2. u§\¬y N˛Á u§¬
3. uåƒÁ|Yå ú“YÁå N˛Ág| 3. bz¬y¢˛Ázå u§¬
4. §¯N˛ QÁoÁ uƒƒ∫m
4. g~ÁFuƒÊT ¬ÁFÃzãÃ
5. uåÆÁzMoÁ Ãz úfi (§¯N˛ N˛y ÃÊoÏu…b N˛Á)
5. ∫Á[Æ Ã∫N˛Á∫ Nz˛ EuáN˛Á∫y ˚Á∫Á uƒuáƒoΩ “ÀoÁqu∫o åz∫T z Á ˚Á∫Á \Á∫y \Á}§ N˛Ág| (ZÁzbz QÁoÁı Nz˛ u¬L) 6. uN˛Ãy ™ÁãÆoÁ üÁõo ¬ÁzN˛ üÁuáN˛Á∫y Ãz úfi (§¯N˛ N˛y ÃÊoÏu…b N˛Á)
6. ÆÓEÁF|gyLEÁF| ˚Á∫Á \Á∫y úfi u\Ùı åÁ™, úoÁ EÁ{∫ EÁáÁ∫ åʧ∫ Gú¬£á “Áı@ 7. N¿˛zugb N˛Ág| uƒƒ∫m, oyå ™Á“ Ãz úÏ∫ÁåÁ å “Áz
7. ú“YÁå N˛Ág| (§¯N˛ N˛y ÃÊoÏu…b N˛y ∆o| ú∫) 8. EÁÆ / ÃÊútÁ N˛∫ ™Ï¡ÆÁÊN˛å EÁtz∆
8. §¯N˛ N˛y ÃÊoÏu…b N˛Á, ™ÁãÆoÁ üÁõo ¬ÁzN˛ üÁuáN˛Á∫y ÆÁ ¬ÁzN˛ ÃzƒN˛ Ãz úfi, u\Ùı T¿Á“N˛ N˛y ú“YÁå 9. ÃÁƒ|\uåN˛ qzfi Nz˛ uåÆÁzMoÁ Ãz úfi
EÁ{∫ uåƒÁà N˛Á ÃnÆÁúå uN˛ÆÁ TÆÁ “Áz 10. uN˛Ãy ¬ÁzN˛ üÁuáN˛Á∫y, \Áz ú“YÁå ü™Ám \Á∫y N˛∫åz N˛Á u∫N˛Ág| Ãz \ÁÂY N˛∫åz ÆÁzSÆ GuYo u∫N˛Ág|
9. Ã∫N˛Á∫y / ∫qÁ ú“YÁå N˛Ág| §åÁL ∫Qoz “¯, ˚Á∫Á \Á∫y úfi
11. uåƒÁ|Yå ú“YÁå N˛Ág| (Nz˛ƒ¬ YÁ¬Ó úoÁ “Ázåz ú∫)
10. uƒPÆÁo ÃÁƒ|\uåN˛ qzfi uåÆÁzMoÁEÁzÊ Nz˛ ú“YÁå N˛Ág|
12. Nı˛¸ Ã∫N˛Á∫y uƒßÁTÁı, ÃÁƒ|\uåN˛ GúN¿˛™Áı ˚Á∫Á ÃzƒÁ uåƒwno N˛™|YÁu∫ÆÁı N˛Áz \Á∫y úı∆å ßÏToÁå
11. Nı˛¸ Ã∫N˛Á∫y uƒßÁTÁı, ÃÁƒ|\uåN˛ GúN¿˛™Áı ˚Á∫Á ÃzƒÁ uåƒwno N˛™|YÁu∫ÆÁı N˛Áz \Á∫y úı∆å ßÏToÁå EÁtz∆ EÁtz∆, Æut YÁ¬Ó úoÁ “Áz@
12. gÁN˛ QÁåz ˚Á∫Á \Á∫y ¢˛ÁzbÁz ú“YÁå N˛Ág| 13. úÊ\yNw˛o ZÏbΩby LƒÊ ¬ÁFÃzãà N˛∫Á∫ / u§N¿˛y ü¬zQ / úbΩbÁ N˛∫Á∫ N˛y üuoÆÁÊ
13. uƒ≈ƒuƒ˘Á¬Æ EåÏtÁå EÁÆÁzT (ÆÓ \y Ãy) ˚Á∫Á EåÏ™Átå üÁõo uƒ≈ƒuƒ˘Á¬Æ EÁ{∫ / ÆÁ EuQ¬ 14. uƒ≈ƒuƒ˘Á¬Æ / ÃÊÀsÁ, \“Á ZÁfi ∫“oz “¯, Nz˛ ZÁfiÁƒÁà Nz˛ ƒÁgz|å ˚Á∫Á \Á∫y ü™Ám úfi EÁ{∫ uåƒÁÃ
ßÁ∫oyÆ oN˛åyN˛y u∆qÁ úu∫ t (LEÁF|ÃybyF|) ˚Á∫Á EåÏ™Ázuto ÃÊÀsÁ ˚Á∫Á §ÁzåÁ¢˛ÁFg ZÁfiÁı N˛Áz \Á∫y N˛Á ü™Ám, u\Ùı ÀsÁåyÆ úoÁ osÁ ÀsÁÆy úoÁ tÁzåÁı ∆Áu™¬ “¯, uƒ˘Ásy| N˛¡ÆÁm Nz˛ ∫u\Àb~Á∫ /
¢˛ÁzbÁz ú“YÁå N˛Ág| üÁYÁÆ| / NÏ˛¬úuo ˚Á∫Á uƒuáƒoΩ üuo“ÀoÁqu∫o@ osÁuú LzÃz QÁoÁı N˛Áz u∆qÁ N˛y ÙÁuõo / uƒ≈ƒuƒ˘Á¬Æ
14. ¬ÁzN˛ üÁuáN˛Á∫y, \Áz ú“YÁå ü™Ám \Á∫y N˛∫åz N˛Á u∫N˛Ág| Ãz \ÁÂY N˛∫åz ÆÁzSÆ GuYo u∫N˛Ág| §åÁL / ÃÊÀsÁ ZÁz‰goz Ã™Æ §Êt uN˛ÆÁ \ÁåÁ YÁu“L §∆oz| uN˛ T¿Á“N˛ §¯N˛ N˛Áz N˛ÁzF| EãÆ ÀƒyN˛ÁÆ| uåƒÁÃ
∫Qoz “¯, ˚Á∫Á \Á∫y ¢˛ÁzbÁz ú“YÁå ü™Ám üÀoÏo å“Î N˛∫oÁ “{@
15. u∫≈oztÁ∫Áı Nz˛ ÃÁs ∫“ ∫“z uƒ˘Áus|ÆÁı Nz˛ u¬L, u∫≈oztÁ∫Áı N˛Á úoÁ ü™Ám, GåNz˛ ú“YÁå ü™Ám Nz˛
15. ¢˛ÁzbÁz Ãu“o ßÓoúÓƒ| Ã{uåN˛ N˛Ág|
ÃÁs, ÀƒyN˛Á∫ uN˛ÆÁ \Á ÃN˛oÁ “{ §∆oz| uN˛ u∫≈oztÁ∫ ˚Á∫Á VÁz mÁ N˛y \Áoy “{ uN˛ uƒ˘Ásy| GåÃz
16. ¢˛ÁzbÁz Ãu“o §Á∫ N˛ÁGuãì / uYuN˛nÃÁ ÃÊV / EÁF|ÃyLEÁF| / EÁF|Ãyg£¬ÆÓLEÁF| / EÁF|ÃyLÃEÁF| ÃʧÊuáo “{ EÁ{∫ GåNz˛ ÃÁs ∫“ ∫“Á / ∫“y “{@
N˛Ág| 16. Nı˛¸ / ∫Á[Æ Ã∫N˛Á∫ EÁ{∫ ÃÁƒ|\uåN˛ qzfi Nz˛ GúN¿˛™Áı Nz˛ ÃʧÊá ™ı, \Áz §¯N˛ “zoÏ uå©å \ÁzuQ™ T¿Á“N˛
17. uƒPÆÁo ™Á“uƒ˘Á¬ÆÁı ˚Á∫Á úÁeΩÆN¿˛™ Eƒuá Nz˛ tÁ{∫Áå ƒ{áoÁ ÆÏMo uƒ˘Ásy| ú“YÁå N˛Ág| “¯, ∆ÁQÁ üáÁå, ÀƒoÊfi ÃÓfiÁı Ãz Eúåy ÃÊoÏu…b N˛Áz ¢˛ÁzbÁz / ú“YÁå N˛y \ÁÂY N˛∫ ÃN˛oz “¯ EÁ{∫ LzÃz
18. ¢˛ÁzbÁz Ãu“o ∫qÁ EÁu»o N˛Ág| EuáN˛Áu∫ÆÁı Nz˛ EÁƒÁÃyÆ úoz N˛y úÏu…b N˛∫ QÁoÁ QÁz¬åz N˛y EåÏ™uo tz ÃN˛oz “¯@ Æ“ ÃÏuƒáÁ Nz˛ƒ¬
19. uƒƒÁu“o ™u“¬Á N˛Á N˛ãÆÁ åÁ™ Ãz ú“YÁå ü™Ám, Æut uƒƒÁ“ ü™Ám - úfi N˛y ÃnÆÁuúo üuo ˚Á∫Á Nı˛¸/∫Á[Æ Ã∫N˛Á∫ Nz˛ ∫Á\úufio EuáN˛Áu∫ÆÁı EÁ{∫ ÃÁƒ|\uåN˛ GúN¿˛™Áı Nz˛ ƒu∫…e ü§Êáå EÁ{∫ GXYo∫
Ùus|o “Áz N˛ÁÆ|úÁ¬N˛Áı N˛Áz Gú¬£á “{@
17. uN˛Ãy ßy bz¬y¢˛Ázå ÃzƒÁ ütÁoÁ EÁ{∫ ™Áz§ÁF|¬ ÃzƒÁ ütÁoÁ Ãz ú≈Ytno E˘oå bz¬y¢˛Ázå u§¬, \Áz 2
20. ¢˛ÁzbÁz Ãu“o N¿˛zugb N˛Ág|, LzÃz N˛Ág| Nz˛ uƒƒ∫m Ãu“o, \Áz oyå ™Á“ Ãz úÏ∫ÁåÁ å “Áz
™Á“ Ãz EuáN˛ úÏ∫ÁåÁ å “Áz@
21. ¢˛ÁzbÁz ú“YÁå Ãu“o úÊ\yNw˛o ÃÊúuno ü¬zQ 18. GúßÁzMoÁ T{à N˛åzM∆å N˛Ág| / úÏÀoN˛ / úÁF|ú T{à u§¬@
22. ßÁ∫o Nz˛ ∫Á[Æ / Nı˛¸ Ã∫N˛Á∫ ˚Á∫Á \Á∫y “usÆÁ∫ ¬ÁFÃzãà 19. EÁƒztåN˛oÁ| Nz˛ úoz N˛Áz ü™Áumo N˛∫oz “ÏL uåƒÁ|Yå ∫Áz¬ §åÁL ∫Qåz ƒÁ¬z ƒÁg| / ÙoÏ¡Æ ∫¯N˛ Nz˛
23. EÁƒztåN˛oÁ| Nz˛ ¢˛ÁzbÁz Nz˛ ÃÁs Tw“ ™ÊfiÁ¬Æ, ßÁ∫o Ã∫N˛Á∫ ˚Á∫Á \Á∫y ÀƒoÊfioÁ ÃzåÁåy úÁà EuáN˛Á∫y Ãz ü™Ám úfi@
24. ¢˛ÁzbÁz Ãu“o N˛™|YÁ∫y ∫Á[Æ §y™Á N˛Ág| (F|LÃEÁF|Ãy), E˘oå ™ÁuÃN˛ ƒzoå úYy| ˚Á∫Á Ùus|o 20. gÁN˛ QÁåÁ §Yo úÁà §ÏN˛
25. ∫§g ™Áz“∫ EÁ{∫ “ÀoÁq∫ ˚Á∫Á o¬Áoy / úbƒÁ∫y (ÀsÁåyÆ Ã∫N˛Á∫y EuáN˛Á∫y) N˛Á EåÏü™Ámå@ ∫§‰g 21. EuáƒÁà ü™Ám úfi, ÃÊüz m úoz EÁ{∫ ¢˛ÁzbÁz Nz˛ ÃÁs
22. T¿Á™ uƒÀoÁ∫ EuáN˛Á∫y (ƒyF|EÁz) / T¿Á™ üáÁå ÆÁ ÙoÏ¡Æ ÆÁ GXYo∫ ∫¯N˛ EuáN˛Á∫y Ãz ü™m - úfi@
™Áz“∫ EÁ{∫ “ÀoÁq∫ ˚Á∫Á T¿Á™ Ã∫úÊY / ™ÏuQÆÁ N˛Á EåÏü™Ámå (ZÁzbz QÁoÁı Nz˛ u¬L)
∆ÁQÁ ü™Ám - úfi N˛y ƒÁÀouƒN˛oÁ EÁ{∫ GMo út áÁu∫o N˛∫åz ƒÁ¬z √ÆuO˛ ˚Á∫Á FÃN˛Á \Á∫y uN˛ÆÁ
åÁzb : Æut ú“YÁå ü™Ám Nz˛ øú ™ı ƒo|™Áå úoÁ ÆÏMo úÁ∫úfi utÆÁ \ÁL oÁz ÃÓYy 2 Ãz E¬T úoÁ \ÁåÁ ü™Áumo N˛∫ı@
ü™Ám tzåz N˛y EÁƒ≈ÆN˛oÁ å“Î “{@ 23. ãÆÁÆÁ¬Æyå uƒƒÁ“ - uƒXZzt EÁtz∆ ãÆÁÆÁ¬Æ ˚Á∫Á \Á∫y uƒƒÁ“ uå∫ÁN˛∫m EÁtz∆

LzÃz √ÆuMoÆÁı ˚Á∫Á ß∫Á \ÁL u\åN˛Á úyLLå / \yEÁF|EÁ∫ å“Î “{@
¢˛Á™| åÊ. 60 ¢˛Á™| åÊ. 61
(uåÆ™ 114 §y N˛Á u˚oyÆ ú∫ÊoÏN˛ tzQı) (uåÆ™ 114 Ãy (1) Nz˛ QÊg (N˛) N˛Á ú∫ÊoÏN˛ tzQı)
VÁz mÁ ¢˛Á™|, \Áz LzÃz √ÆuO˛ ˚Á∫Á ß∫Á \ÁL u\åN˛Á ÀsÁÆy QÁoÁ åʧ∫ å“Î “{ VÁz mÁ úfi, \Áz LzÃz √ÆuO˛ ˚Á∫Á ß∫Á \ÁL u\åN˛y Nw˛u  EÁÆ “{ EÁ{∫ uåÆ™
EÁ{∫ uåÆ™ 114 §y ™ı uåut|…b ¬zåtzå N˛∫oÁ “{@ 144 §y ™ı uåut|…b ¬zåtzåÁı Nz˛ ÃʧÊá ™ı EÁÆ-N˛∫ N˛Áz üßÁÆ| N˛ÁzF| EãÆ EÁÆ
1. VÁz mÁN˛oÁ| N˛Á úÓ∫Á åÁ™ EÁ{∫ úoÁ __________________________________ üÁõo å“Î “{@
_____________________________________________________
1. VÁz mÁN˛oÁ| N˛Á úÓ∫Á åÁ™ EÁ{∫ úoÁ __________________________________
2. ¬zåtzå Nz˛ uƒƒ∫m ___________________________________________
3. ¬zåtzå N˛y ∫Áu∆ ____________________________________________ _______________________________________________________

4. MÆÁ EÁúN˛Á N˛∫-™Ó¡ÆÁÊN˛å “ÁzoÁ “{? “Á … å“Î … 2. ¬zåtzå Nz˛ uƒƒ∫m ___________________________________________

5. Æut “Á ( i) ƒÁg| / ÃN|˛¬ / ∫ı\ N˛Á uƒƒ∫m \“Á uúZ¬y EÁÆN˛∫ uƒƒ∫my tÁÆ∫ N˛y TF| “{ 3. N˛Á}¬™ (1) ™ı úoz Nz˛ Ùs|å ™ı üÀoÏo ü¬zQÁı N˛Á £ÆÁ{∫Á (1):
___________________________________________ “Á … å“Î …
(ii) ÀsÁÆy QÁoÁ åʧ∫ å“Î ∫Qåz Nz˛ N˛Á∫m
™¯ LotΩ˚Á∫Á VÁz mÁ N˛∫oÁ / N˛∫oy “Ó uN˛ ™z∫y œÁÁzo Nw˛u  Ãz “{ EÁ{∫ ™Ï^z uN˛Ãy EãÆ EÁÆ, Æut N˛ÁzF| “Áz,
___________________________________________
6. N˛Á}¬™ (1) ™ı úoz Nz˛ Ùs|å ™ı üÀoÏo ü¬zQÁı N˛Á £ÆÁ{∫Á ú∫ EÁÆ-N˛∫ N˛Á ßÏToÁå N˛∫åz N˛y EÁƒ≈ÆN˛oÁ å“Î “{@

ÃnÆÁúå
™¯, ______________________, LotΩ˚Á∫Á VÁz mÁ N˛∫oÁ / N˛∫oy “Ó uN˛ GúÆÏ|Mo ™z∫y Gno™ \ÁåN˛Á∫y EÁ{∫ uƒ≈ƒÁà Nz˛ EåÏÃÁ∫ ÃnÆ “{@ EÁ\ ÃnÆÁuúo ________________ ™Á“ N˛y
________________________ oÁ∫yQ

utåÁÊN˛: _____________ ÀsÁå: _______________ VÁz mÁN˛oÁ| Nz˛ “ÀoÁq∫

 ACCOUNTS OF INDIVIDUALS : LIST OF KYC DOCUMENTS
(one document from each list)
LIST I
Documents accepted as proof of identity
1 Passport
2 PAN card
3 Voter's Identity Card
4 Driving licence
5 Job card issued by NREGA duly signed by an officer of the State
Government(For Small Accounts)
6 The letter issued by UIDAI containing details of name, address and
Aadhaar number
7 Identity card (subject to the bank's satisfaction)
8 Letter from a recognized public authority or public servant verifying
the identity and residence of the customer to the satisfaction of bank.
9 Government/Defence ID card
10 ID cards of reputed Public Sector employers
11 Pension Payment Orders issued to the retired employees by Central/
State Government Departments, Public Sector Undertakings
12 Photo ID cards issued by Post Offices
13 Photo identity cards issued to bonafide students by a University,
approved by the University Grants Commission (UGC) and/or an Institute
approved by All India Council for Technical Education (AICTE).
14 Photo identity issued by any public authority having proper record of
issuance of identity proof which is verifiable from records
15 Ex-Servicemen Card with photograph
16 Bar Council/Medical Association/ICAI/ICWAI/ICSI Card with photograph
17 Student Identity Card with photo issued by reputed colleges with
validity during the course period.
18 Defense Dependent's Card with photograph'
19 Married woman identity proof with maiden name, if supported with a
verified true copy of marriage certificate
20 Credit card with photo together with statement of such card, not more
than three months old.
21 Registered Property document with photo identity
22 Arms License issued by State / Central Government of India.
23 Freedom fighter's pass issued by Ministry of Home Affairs, Government
of India with photograph of applicant.
24 Employee State Insurance Card (ESIC) with photograph supported by
latest month's pay slip..
25 Talati / Patwari (a local govt. official) attestation by way of putting
rubber stamp and signature. Gram Sarpanch / Mukhiya attestation by
way of putting rubber stamp and signature (For Small Accounts)
NOTE: If passport having current address is given as proof of identity,
there is no need to give separate proof for address from list 2.
To be filled by those who do not have either PAN/GIR
FORM NO. 60
[See second proviso rule 114B]
Form of declaration to be filed by a person who does not have
a permanent account number and who enters into any
transaction specified in rule 114B
1. Full name and address of the declarant______________________
_____________________________________________________
2. Particulars of transaction_________________________________
3. Amount of the transaction_________________________________
4. Are you assessed to tax? Yes No
5. If yes,(i) Details of Ward/Circle/Range where the last return of
income was filed_________________________________
(ii) Reasons for not having permanent account
Number:________________________________________
6. Details of the document being produced in support of address In column(1)
VERIFICATION
I, ______________________, do hereby declare that what is stated above is true to the best of my knowledge and belief.
Verified today, the ________________ day of ________________________
Date:_____________ Place:_______________
LIST 2
Documents accepted as proof of residence
1 Ration Card
2 Electricity Bill
3 Telephone Bill
4 Bank account statement
5 Letter from employer (to the satisfaction of the Bank)
6 Letter from any recognized public authority (to the satisfaction of the Bank)
7 Credit Card Statement- not more than 3 months old
8 Income/Wealth Tax Assessment Order
9 Letter from Public Sector employer
10 Letter from any recognized public authority having proper and verifiable record
of issuance of such certificates.
11 Voter ID Card (only if it contains the current address)
12 Pension Payment Orders issued to retired employees by Government
Departments/Public Sector Undertakings, if they contain current address.
13 Copies of Registered Leave & License agreement/Sale Deed/Lease Agreement.
14 Certificate and also proof of residence, incorporating local address as well as
permanent address, issued by the Hostel Warden of the University/Institute,
where the student resides, duly countersigned by the Registrar/Principal/Dean
of Student Welfare. Such accounts shall however, be required to be closed on
completion of education/leaving the University/Institute provided the constituent
does not give any other acceptable proof of residence to the Bank.
15 For students residing with relatives, address proof of relatives, along with their
identity proof, can also be accepted provided declaration is given by the
relative that the student is related to him/her and is staying with him/her.
16 In respect of officials of Central/State Governments and Public Sector
undertakings, who are low risk customers for Bank, Branch Heads may verify the
photo/identity and confirm residential address of such officials from independently
verifiable sources, to their satisfaction, and permit opening of accounts. This
facility is extended only to the Gazetted officers of Central/State Government
and Senior Management and above functionaries of Public Sector Undertakings.
17 Latest telephone bills from any telephone service providers and mobile service
providers not more than 2 month old, postpaid.
18 Consumer gas connection card/book/Pipe gas bill
19 Certificate from ward/equivalent rank officer, maintaining election roll certifying
address of the applicant
20 Post Office Savings Pass Book
21 Domicile Certificate with communication address and photograph
22 Certificate by Village Extension Officer (VEO) / Village Head or equal or higher
rank officer. Branch to confirm the authenticity of the certificate and that it has
been issued by the person who is holding the said office.
23 Court divorce order - Marriage annulment order issued by Court
FORM NO. 61
[See proviso to clause (a) of rule 114C (1)]
Form of declaration to be filed by a person who has agricultural
income and is not in receipt of any other income chargeable to
income-tax in respect of transactions specified in rule 114B
1. Full name and address of the declarant_____________________
______________________________________________________
2. Particulars of transaction________________________________
3. Details of the documents being produced in support of
Address in column (1): Yes No
I hereby declare that my source of income is from agriculture and
I am not required to pay income-tax on any other income, if any.
Signature of the declarant
 Comp.No. 8003

EÁãá¿Á §¯N˛
∆ÁQÁ:..........................................................
§Yo §¯N˛ QÁoÁ QÁz¬åz N˛Á ¢˛Á™|
(u˚oyÆ EÁƒztåN˛oÁ| “zoÏ EåÏúÓ∫N˛ ¢˛Á™|)
Nz˛ƒ¬ §¯N˛ Nz˛ GúÆÁzT “zoÏ

∆ÁQÁ N˛Á åÁ™ EÁ{∫ NÓ˛b ÃÊPÆÁ

úÁÃúÁzb| - EÁN˛Á∫ N˛Á
¢˛ÁzbÁz ¬TÁLÊ
T¿Á“N˛ EÁF|gy
QÁoÁ åʧ∫

úÓ∫Á åÁ™ (»y/»y™oy/NÏ˛™Á∫y):

u˚oyÆ EÁƒztåN˛oÁ|)
1. uúoÁ / úuo / EußßÁƒN˛ N˛Á åÁ™:
2. EÁƒÁÃyÆ úoÁ
˚Á∫Á
™N˛Áå åÊ. EÁ{∫ åÁ™:
T¬y åÊ. EÁ{∫ åÁ™:
ú“YÁå/¬¯g™ÁN|˛:
TÁƒ/åT∫: u\¬Á:
∫Á[Æ:
uúåN˛Ázg:
tÓ∫ßÁ  ¬¯g¬ÁFå: ™Áz§ÁF|¬ åʧ∫:

3. u¬ÊT: ................................................. [gygyL™]* \ã™uous : ..................................... [gygyL™]

4. N˛) √ƃÃÁÆ : ......................................... [gygyL™]* Q) »zmy : .....................................
[gygyL™]*
5. Nz˛ƒÁF|Ãy ü¬zQ üÀoÏo uN˛L TL “Á … å“Î … [gygyL™]*

u˚oyÆ EÁƒztåN˛oÁ| Nz˛ “ÀoÁq∫ / EÊTÓez N˛Á uå∆Áå

§yÃy / §yL¢˛ N˛Á åÁ™ LƒÊ åʧ∫

√ÆÁúÁ∫ üuouåuá / ÃϬßN˛oÁ| Nz˛ “ÀoÁq∫ _____________________________________

\ÁÂYN˛oÁ| §¯N˛ EuáN˛Á∫y N˛Á åÁ™, LÃLà åÊ. ƒ “ÀoÁq∫ __________________________

* (gygyL™) - g~Áú gÁGå ™zåÓ
 Comp.No. 8003

SAVINGS BANK ACCOUNT OPENING FORM

(Supplementary form for second applicant)
For Bank Use Only

Name & Code of the Branch Affix

Passport Size
Photo
Cust ID

A/C No.

Name in Full (Mr/Ms)

(second applicant)

1. Father/ Husband/Guardian Name

2. Residential address:
C/o

House No. and name :

Street No. and name :

Landmark :

Village /City : District

State

Pincode

Telephone/Landline Mobile No.

3. Sex : ....................... [DDM]* Date of Birth: .................................. [DDM]*

4. a) Occupation : .................................... [DDM] * (b) Category: .................................. [DDM] *
5. KYC Documents Provided Yes No [DDM]*

Signature/Thumb Impression of second Applicant

Name & No. of BC/BF.

Signature of Business Correspondent/Facilitator________________________

Name, SS No & Signature of the verifying Branch official__________________

* DDM - Drop Down Menu