Andhra Bank Comp No:8008

(A Government of India Undertaking) (For Individuals and Joint Applicants)

_________________________ Branch
Application Form for opening of
a Term Deposit Account
Please open the Type of Account indicated with a tick (
) in the following table.
Type of Term Deposit Account
Fixed Deposit General / NRO
Kalpataruvu General / NRO
 Prescribed option letter should be submitted.
Deposit Amount and Period
(As applicable to schemes)
Name(s) of the Applicant(s) in full and in capital letters
Sole/First Applicant:
1
Date of birth (DD-MM-YY)
If PAN is available
(Enclose Copy of PAN)
Second Applicant:
2
Date of birth (DD-MM-YY)
If PAN is available
(Enclose Copy of PAN)
Third Applicant:
3
Date of birth (DD-MM-YY)
If PAN is available
(Enclose Copy of PAN)
Repayable
If not repayable Singly
(For Joint Accounts only)
Account of Minor
Interest (for Fixed Deposits)
Mobile No
Address for communication
(Please tick (
) in the appropriate box)
Account No: (For bank's use)
Sweccha Deposit
Recurring Deposit General / NRO


Cash Certificate



AB Tax Saver Fixed/Reinvestment


Per Month for _________Months for Recurring Deposit
Rs._ _ _ _ _ _ _ _ _ _ _
For ____Days / ____ Months / ____Years for other Deposits
Customer ID (For bank's use)
PAN If PAN is not available Form 60
/ Form 61

No: (Submit Form 60 or 61) Enclosed in duplicate.
Customer ID (For bank's use)
PAN If PAN is not available Form 60
/ Form 61

No: (Submit Form 60 or 61) Enclosed in duplicate.
Customer ID (For bank's use)
PAN If PAN is not available Form 60
/ Form 61

No: (Submit Form 60 or 61) Enclosed in duplicate.
Singly
, Either or Survivor
, Former or Survivor
, Latter or Survivor
Any One or
Survivor
, Jointly
. Any other combination (Specify) ________________________.
The bank may, on receipt of a written application from either/any one or survivor(s) of
us, at its discretion and subject to such terms and conditions as the bank may stipulate
– (a) Grant a loan/overdraft against the security of the Term Deposit or (b) Make
premature payment of the proceeds of the deposit to either or any one of us or
survivor(s) at any time during the period of the deposit.
Amount Deposited by Father
, Mother
, Any Other (Specify)
____________
To the Minor on attaining Majority:
Cust ID
Repayable
To the Guardian:
Cust ID
Pay interest in Monthly
, Quarterly
intervals
Credit to my/our A/C: No ____________________ with your branch at ____________.

Nomination facility Required
Not Required
Submit Form DA1 if Nomination is required.
Source of Funds
TDS-(For deposits other than RD) At Normal Rate
Form 15 G
/ 15 H
/ Exemption Certificate
is enclosed. 
Due Date Notice Required
Not Required
Auto Renewal Required
Not Required

(Applicant(s) and Guardian should submit Personal Data Form along with this Application form if he/she is not an existing
customer.)
Irrespective of my/our option for Auto Renewal of the deposit, unless you receive demand for payment or instructions to
the contrary on or before the date of maturity of the deposit (other than Recurring Deposit), please renew/continue to
renew the deposit together with interest, if any due thereon, for similar period at the prevailing rate of interest.
I/We hereby declare that the information given above is true and correct to the best of my/our knowledge. I/We further
declare that I/We accept the Terms and Conditions of the deposit scheme, which are provided to me/us. I/We agree that
the Terms and Conditions may be modified by the bank from time to time, which will be binding on me/us for conduct of
the account.
Place:___________________ (1) _________________ (2)___________________ (3) ____________________
Date: ___________________ [Signature(s) / Thumb Impression(s) of the Applicant(s)]
(Verification)
Application is filled in completely and is verified. Signature(s) /
Thumb Impression(s) is/are affixed in my presence. Signature of Verifying Officer and Signature No:
Note:-  To avail exemption/concession from TDS annually, Form 15 G / 15 H / Exemption Certificate should be
submitted afresh at the beginning of each Financial Year.
I. ‚¸›šÏ¸ ¤¸ÿˆÅ ˆ¿Å. ¬¸¿‰¡¸¸ : 8008
(ž¸¸£÷¸ ¬¸£ˆÅ¸£ ˆÅ¸ „œ¸ÇÅŸ¸) (¨¡¸¢Æ÷¸¡¸¸½¿ ‡¨¸¿ ¬¸¿¡¸ºÆ÷¸ ‚¸¨¸½™ˆÅ¸½¿ ˆ½Å ¢¥¸‡)
_________________________ ©¸¸‰¸¸ (ˆ¼Åœ¸¡¸¸ ¬¸¿¤¸Ö ¤¸¸ÁƬ¸ Ÿ¸½¿ ¢’ˆÅ (
) ˆÅ£½¿)
‰¸¸÷¸¸ ¬¸¿‰¡¸¸ :
Ÿ¸ú¡¸¸™ú ,¸Ÿ¸¸ ‰¸¸÷¸¸
‰¸¸÷¸¸ ‰¸¸½¥¸›¸½ ˆ½Å ¢¥¸‡ ‚¸¨¸½™›¸ œ¸€¸Ÿ¸Ä
(¤¸ÿˆÅ ˆ½Å œÏ¡¸¸½Š¸ í½÷¸º )
ˆ¼Åœ¸¡¸¸ ¢›¸Ÿ›¸ ’½¤¸º¥¸ Ÿ¸½¿ ¢’ˆÅ (
) ׸£¸ ¬¸»¢3¸÷¸ ‰¸¸÷¸¸ ˆÅ¸ œÏˆÅ¸£ ‰¸¸½¥¸½¿
Ÿ¸ú¡¸¸™ú ,¸Ÿ¸¸ ‰¸¸÷¸¸ ˆÅ¸ œÏˆÅ¸£ ¬¨¸½3Ž¸ ,¸Ÿ¸¸
‚¸¨¸÷¸úÄ ,¸Ÿ¸¸ ¬¸¸Ÿ¸¸›¡¸ / ‡›¸‚¸£‚¸½

¬¸¸¨¸¢š¸ ,¸Ÿ¸¸ ‰¸¸÷¸¸ (¬¸¸Ÿ¸¸›¡¸) / ‡›¸‚¸£‚¸½
›¸ˆÅ™ú œÏŸ¸¸µ¸œ¸°¸

ˆÅ¥œ¸÷¸²¨¸º ¬¸¸Ÿ¸¸›¡¸ / ‡›¸‚¸£‚¸½
‡¤¸ú ’¾Æ¬¸ ¬¸½¨¸£ Ÿ¸ú¡¸¸™ú / œ¸º›¸¢›¸Ä¨¸½©¸ 

 ¢›¸š¸¸Ä¢£÷¸ ¢¨¸ˆÅ¥œ¸ œ¸°¸ œÏ¬÷¸º÷¸ ¢ˆÅ¡¸¸ ,¸¸›¸¸ í¾.
,¸Ÿ¸¸ £¸¢©¸ ‡¨¸¿ ‚¨¸¢š¸ œÏ¢÷¸ Ÿ¸íú›¸¸ ______________________________ Ÿ¸íú›¸¸½¿ ˆ½Å ¢¥¸‡ - ‚¸¨¸÷¸úÄ ,¸Ÿ¸¸ ˆ½Å ¢¥¸‡
².
(¡¸¸½,¸›¸¸‚¸½¿ œ¸£ ,¸¾¬¸¸ ¥¸¸Š¸») __________¢™›¸¸½¿ ___________ Ÿ¸íú›¸¸½¿__________¨¸«¸¸½ô ˆ½Å ¢¥¸‡ - ‚›¡¸ ,¸Ÿ¸¸‚¸½¿ ˆ½Å ¢¥¸‡
¤¸”õ½ ‚®¸£¸½¿ Ÿ¸½¿ ‚¸¨¸½™ˆÅ (ˆÅ¸½¿) ˆ½Å œ¸»£½ ›¸¸Ÿ¸
‡ˆÅ¥¸ / œÏ˜¸Ÿ¸ ‚¸¨¸½™ˆÅ
1 ,¸›Ÿ¸ ¢÷¸¢˜¸ (¢™›¸ -Ÿ¸¸í-¨¸«¸ÄÄ) ŠÏ¸íˆÅ ‚¸ƒÄ”ú (¤¸ÿˆÅ ˆ½Å œÏ¡¸¸½Š¸ í½÷¸º)
¡¸¢™ œ¸¾›¸ „œ¸¥¸¤š¸ í¸½ œ¸¾›¸ ¡¸¢™ œ¸¾›¸ „œ¸¥¸¤š¸ ›¸ í¸½ œ¸€¸Ÿ¸Ä 60
/ œ¸€¸Ÿ¸Ä 61

(œ¸¾›¸ ˆÅú œÏ¢÷¸ ¬¸¿¥¸Š›¸ ˆÅ£½¿) ›¸¿¤¸£ (œ¸€¸Ÿ¸Ä 60 ¡¸¸ 61 œÏ¬÷¸º÷¸ ˆÅ£½¿) ™¸½ œÏ¢÷¸¡¸¸Â ¬¸¿¥¸Š›¸ íÿ
¢×÷¸ú¡¸ ‚¸¨¸½™ˆÅ
2 ,¸›Ÿ¸ ¢÷¸¢˜¸ (¢™›¸ -Ÿ¸¸í-¨¸«¸ÄÄ) ŠÏ¸íˆÅ ‚¸ƒÄ”ú (¤¸ÿˆÅ ˆ½Å œÏ¡¸¸½Š¸ í½÷¸º)
¡¸¢™ œ¸¾›¸ „œ¸¥¸¤š¸ í¸½ œ¸¾›¸ ¡¸¢™ œ¸¾›¸ „œ¸¥¸¤š¸ ›¸ í¸½ œ¸€¸Ÿ¸Ä 60
/ œ¸€¸Ÿ¸Ä 61

(œ¸¾›¸ ˆÅú œÏ¢÷¸ ¬¸¿¥¸Š›¸ ˆÅ£½¿) ›¸¿¤¸£ (œ¸€¸Ÿ¸Ä 60 ¡¸¸ 61 œÏ¬÷¸º÷¸ ˆÅ£½¿) ™¸½ œÏ¢÷¸¡¸¸Â ¬¸¿¥¸Š›¸ íÿ
÷¸¼÷¸ú¡¸ ‚¸¨¸½™ˆÅ
3 ,¸›Ÿ¸ ¢÷¸¢˜¸ (¢™›¸ -Ÿ¸¸í-¨¸«¸ÄÄ) ŠÏ¸íˆÅ ‚¸ƒÄ”ú (¤¸ÿˆÅ ˆ½Å œÏ¡¸¸½Š¸ í½÷¸º)
¡¸¢™ œ¸¾›¸ „œ¸¥¸¤š¸ í¸½ œ¸¾›¸ ¡¸¢™ œ¸¾›¸ „œ¸¥¸¤š¸ ›¸ í¸½ œ¸€¸Ÿ¸Ä 60
/ œ¸€¸Ÿ¸Ä 61

(œ¸¾›¸ ˆÅú œÏ¢÷¸ ¬¸¿¥¸Š›¸ ˆÅ£½¿) ›¸¿¤¸£ (œ¸€¸Ÿ¸Ä 60 ¡¸¸ 61 œÏ¬÷¸º÷¸ ˆÅ£½¿) ™¸½ œÏ¢÷¸¡¸¸Â ¬¸¿¥¸Š›¸ íÿ
‚ˆ½Å¥¸½
œÏ÷¡¸½ˆÅ ¡¸¸ „÷÷¸£,¸ú¨¸ú
œÏ˜¸Ÿ¸ ¡¸¸ „÷÷¸£,¸ú¨¸ú
‚¿¢÷¸Ÿ¸ ¡¸¸ „÷÷¸£,¸ú¨¸ú
ˆÅ¸½ƒÄ ‡ˆÅ ¡¸¸ „÷÷¸£,¸ú¨¸ú
¬¸¿¡¸ºÆ÷¸
™½¡¸
³œ¸ ¬¸½
‚›¡¸ ˆÅ¸½ƒÄ ¬¸¢ŸŸ¸ªµ¸ („¥¥¸½‰¸ ˆÅ£½¿) ________________________________________.
ퟸ Ÿ¸½¿ ¬¸½ ¢ˆÅ¬¸ú ‡ˆÅ ¡¸¸ „÷÷¸£,¸ú¨¸ú (¡¸¸½¿) ¬¸½ ¢¥¸¢‰¸÷¸ ‚¸¨¸½™›¸ œÏ¸œ÷¸ ˆÅ£›¸½ œ¸£ ¤¸ÿˆÅ ‚œ¸›¸½ ¢¨¸¨¸½ˆÅ ˆ½Å ‚›¸º¬¸¸£ ‡¨¸¿ ¤¸ÿˆÅ ׸£¸ ‚›¸º¤¸Ö
¡¸¢™ ‚ˆ½Å¥¸½ ˆÅ¸½ ™½¡¸ ›¸ í¸½›¸½ œ¸£ ‡½¬¸½ ¢›¸¡¸Ÿ¸ ‡¨¸¿ ©¸÷¸¸½ô ˆ½Å ‚š¸ú›¸ (‡) Ÿ¸ú¡¸¸™ú ,¸Ÿ¸¸ ˆÅú œÏ¢÷¸ž¸»¢÷¸ œ¸£ †µ¸ / ‚¸½¨¸£”ï¸É’ Ÿ¸¿,¸»£ ˆÅ£ ¬¸ˆÅ÷¸¸ í¾ ¡¸¸ (¤¸ú) ,¸Ÿ¸¸ ˆÅú ‚¨¸¢š¸
(¬¸¿¡¸ºÆ÷¸ ‰¸¸÷¸½ ˆ½Å ¢¥¸‡) ˆ½Å ™¸¾£¸›¸ ¢ˆÅ¬¸ú ž¸ú ¬¸Ÿ¸¡¸ ퟸ Ÿ¸½¿ ¬¸½ ¢ˆÅ¬¸ú ˆÅ¸½ ¡¸¸ ¢ˆÅ¬¸ú ‡ˆÅ ˆÅ¸½ ¡¸¸ „÷÷¸£,¸ú¨¸ú (¡¸¸½¿) ˆÅ¸½ ,¸Ÿ¸¸ ˆÅú œÏ¸¢œ÷¸¡¸¸½¿ ˆÅ¸ ‚œ¸¢£œ¸Æ¨¸ ž¸ºŠ¸÷¸¸›¸
ˆÅ£ ¬¸ˆÅ÷¸¸ í¾.
›¸¸¤¸¸¢¥¸Š¸ ˆÅ¸ ‰¸¸÷¸¸ ׸£¸ £¸¢©¸ ,¸Ÿ¸¸ ¢ˆÅ¡¸¸ Š¸¡¸¸ ¢œ¸÷¸¸
Ÿ¸¸÷¸¸
‚›¡¸ ˆÅ¸½ƒÄ (¢¨¸¨¸£µ¸ ™½¿)
_______________________________
™½¡¸ ¨¸¡¸¬ˆÅ÷¸¸ œ¸¸›¸½ œ¸£ ›¸¸¤¸¸¢¥¸Š¸ ˆÅ¸½
ŠÏ¸íˆÅ ‚¸ƒÄ”ú
¬¸¿£®¸ˆÅ ˆÅ¸½ À ŠÏ¸íˆÅ ‚¸ƒÄ”ú
¤¡¸¸,¸ (¬¸¸¨¸¢š¸ ,¸Ÿ¸¸‚¸½¿ ˆ½Å ¢¥¸‡) Ÿ¸¸¢¬¸ˆÅ
¢÷¸Ÿ¸¸íú
‚¿÷¸£¸¥¸¸½¿ Ÿ¸½¿ ¤¡¸¸,¸ ˆÅ¸ ž¸ºŠ¸÷¸¸›¸ ˆÅ£½¿
_____________________ œ¸£ ¢¬˜¸÷¸ ‚¸œ¸ˆÅú ©¸¸‰¸¸ Ÿ¸½¿ Ÿ¸½£¸ / ퟸ¸£¸ ‰¸¸÷¸¸ ¬¸¿‰¡¸¸ À ________________Ÿ¸½¿ ,¸Ÿ¸¸ ˆÅ£½¿
Ÿ¸¸½¤¸¸ƒ¥¸ ›¸¿¤¸£
œ¸°¸¸3¸¸£ ˆ½Å ¢¥¸‡ œ¸÷¸¸
›¸¸Ÿ¸¸¿ˆÅ›¸ ¬¸º¢¨¸š¸¸ ‚œ¸½¢®¸÷¸
‚œ¸½¢®¸÷¸ ›¸íì
›¸¸Ÿ¸¸¿ˆÅ›¸ ‚œ¸½¢®¸÷¸ í¸½›¸½ œ¸£ œ¸€¸Ÿ¸Ä ”ú‡ 1 œÏ¬÷¸º÷¸ ˆÅ£›¸¸ 3¸¸¢í‡
¢›¸¢š¸¡¸¸½¿ ˆÅ¸ 踸½
踸½÷¸
’ú”ú‡¬¸ - (‚¸£”ú ˆÅ¸½ Ž¸½”ˆÅ£ ‚›¡¸
¬¸¸Ÿ¸¸›¡¸ ™£ œ¸£
œ¸€¸Ÿ¸Ä 15 ,¸ú
/ 15 ‡3¸
/ Ž»’ œÏŸ¸¸µ¸ œ¸°¸
¬¸¿¥¸Š›¸ ¢ˆÅ¡¸¸ Š¸¡¸¸ í¾. 
,¸Ÿ¸¸‚¸½¿ ˆ½Å ¢¥¸‡)
¢›¸¡¸÷¸ ÷¸¸£ú‰¸ ¬¸»3¸›¸¸ ‚œ¸½¢®¸÷¸
‚œ¸½¢®¸÷¸ ›¸íì
¬¨¸÷¸À ›¸¨¸úˆÅ£µ¸ ‚œ¸½¢®¸÷¸
‚œ¸½¢®¸÷¸ ›¸íì

(¢¨¸Ô¸Ÿ¸¸›¸ ŠÏ¸íˆÅ ›¸ í¸½›¸½ œ¸£ ƒ¬¸ ‚¸¨¸½™›¸ œ¸€¸Ÿ¸Ä ˆ½Å ¬¸¸˜¸ ‚¸¨¸½™ˆÅ(ˆÅ¸½¿), ¬¸¿£®¸ˆÅ, ‚¢š¸™½©¸ / ,¸úœ¸ú‡ š¸¸£ˆÅ ˆÅ¸½ ¨¡¸¢Æ÷¸Š¸÷¸ ”¸’¸ œ¸€¸Ÿ¸Ä œÏ¬÷¸º÷¸ ˆÅ£›¸¸ í¾.)
,¸Ÿ¸¸ ˆ½Å ¬¨¸÷¸À ›¸¨¸úˆÅ£µ¸ ˆ½Å ¢¥¸‡ Ÿ¸½£½ / ퟸ¸£½ ¢¨¸ˆÅ¥œ¸ œ¸£ ¢¨¸3¸¸£ ¢ˆÅ¡¸½ ¢¤¸›¸¸ ,¸Ÿ¸¸ ˆÅú œ¸¢£œ¸Æ¨¸÷¸¸ ˆÅú ÷¸¸£ú‰¸ ˆÅ¸½ ¡¸¸ „¬¸ˆ½Å œ¸»¨¸Ä ¡¸¢™ ‚¸œ¸ ž¸ºŠ¸÷¸¸›¸ ˆÅú Ÿ¸¸¿Š¸ ¡¸¸ „¬¸ˆ½Å ¢¨¸œ¸£ú÷¸ ˆÅ¸½ƒÄ
‚›¸º™½©¸ œÏ¸œ÷¸ ›¸ ˆÅ£÷¸½ í¸½¿ ÷¸¸½ (‚¸¨¸÷¸úÄ ,¸Ÿ¸¸ ˆÅ¸½ Ž¸½”ˆÅ£) ˆ¼Åœ¸¡¸¸ ,¸Ÿ¸¸ ˆÅ¸ ›¸¨¸úˆÅ£µ¸, ¤¡¸¸,¸ ¬¸Ÿ¸½÷¸ ¡¸¢™ ¤¸ˆÅ¸¡¸¸ í¸½, ¬¸Ÿ¸¸›¸ ‚¨¸¢š¸ ˆ½Å ¢¥¸‡ œÏ3¸¢¥¸÷¸ ¤¡¸¸,¸ ™£ Ÿ¸½¿ ˆÅ£½¿.

Ÿ¸ÿ / ퟸ ‹¸¸½¢«¸÷¸ ˆÅ£÷¸¸ /ˆÅ£÷¸ú í» / ˆÅ£÷¸½ íÿ ¢ˆÅ Ÿ¸½£ú / ퟸ¸£ú „÷÷¸Ÿ¸ ,¸¸›¸ˆÅ¸£ú ˆ½Å ‚›¸º¬¸¸£ ™ú Š¸¡¸ú „Æ÷¸ ¬¸»3¸›¸¸ ¬¸íú í¾. Ÿ¸ÿ / ퟸ ,¸Ÿ¸¸ ¡¸¸½,¸›¸¸ ˆ½Å ¢›¸¡¸Ÿ¸ ‡¨¸¿ ©¸÷¸½ô ¬¨¸úˆÅ¸£ ˆÅ£÷¸¸ /
ˆÅ£÷¸ú í» / ˆÅ£÷¸½ íÿ ,¸¸½ Ÿ¸ºS¸½ / ퟸ½¿ ¢™¡¸½ Š¸¡¸½ íÿ. Ÿ¸ÿ / ퟸ ¬¸íŸ¸÷¸ í»Â / íÿ ¢ˆÅ ¬¸Ÿ¸¡¸-¬¸Ÿ¸¡¸ œ¸£ ¤¸ÿˆÅ ׸£¸ ¢›¸¡¸Ÿ¸ ‡¨¸¿ ©¸÷¸¸½ô ˆÅ¸½ ‚¸©¸¸½¢š¸÷¸ ¢ˆÅ¡¸½ ,¸¸ ¬¸ˆÅ÷¸½ íÿ ,¸¸½ ‰¸¸÷¸½ ˆ½Å ¬¸¿3¸¸¥¸›¸ ˆ½Å ¢¥¸‡
Ÿ¸ºS¸ / ퟸ œ¸£ ¥¸¸Š¸» í¸½¿Š¸½.
¬˜¸¸›¸ À _____________ (1) ______________________________ (2)_____________________________ (3) ____________________________
¢™›¸¸¿ˆÅ : _____________ [ ‚¸¨¸½™ˆÅ (ˆÅ¸½¿) ˆ½Å í¬÷¸¸®¸£ / ‚¿Š¸»“¸ ¢›¸©¸¸›¸ ]

(¬¸÷¡¸¸œ¸›¸)
‚¸¨¸½™›¸ œ¸°¸ œ¸»µ¸Ä ³œ¸ ¬¸½ ž¸£¸ Š¸¡¸¸ í¾ ÷¸˜¸¸ ¬¸÷¡¸¸¢œ¸÷¸ ¢ˆÅ¡¸¸ Š¸¡¸¸ í¾. Ÿ¸½£ú „œ¸¢¬˜¸¢÷¸ Ÿ¸½¿ í¬÷¸¸®¸£ ¢ˆÅ¡¸¸ Š¸¡¸¸ í¾
/ ‚¿Š¸»“¸ ¢›¸©¸¸›¸ ¥¸Š¸¸¡¸¸ Š¸¡¸¸ í¾. ¬¸÷¡¸¸œ¸›¸ ‚¢š¸ˆÅ¸£ú ˆ½Å í¬÷¸¸®¸£ ‡¨¸¿ í¬÷¸¸®¸£ ¬¸¿‰¡¸¸

 ’ú”ú‡¬¸ ¬¸½ œÏ÷¡¸½ˆÅ ¨¸«¸Ä Ž»’ / ¢£¡¸¸¡¸÷¸ú ˆ½Å ¢¥¸‡ ¢œ¸€£ ¬¸½ œ¸€¸Ÿ¸Ä 15 ,¸ú / 15 ‡3¸ / Ž»’ œÏŸ¸¸µ¸ œ¸°¸ œÏ÷¡¸½ˆÅ ¢¨¸÷÷¸ú¡¸ ¨¸«¸Ä ˆ½Å ‚¸£¿ž¸ Ÿ¸½¿ œÏ¬÷¸º÷¸ ˆÅ£›¸¸ 3¸¸¢í‡.