Account Opening Form - "¸àA¡àl¡ü–i¡ ëJàºà¹ ó¡³ - DCB Bank

For Individuals

DCB Bank Limited

Account Opening Form

"¸àA¡àl¡ü–i¡ ëJàºà¹ ó¡³¢

Instruction for filling Account Opening Form / "¸àA¡àl¡ü–i¡ ìJàºà¹ ó¡³¢ šè¹o A¡¹à¹ [>ìƒ¢Å>à

Please write your NAME as it appears in all your support documents"àš>à¹ Î³Ñz >[=šìy ë™³>®¡àì¤ šøƒ[Å¢t¡ ">åNøÒ A¡ì¹ [k¡A¡ ëÎÒü®¡àì¤ "àš>à¹ >à³ [ºJå>

Hint boxes give tips and highlight important points across the form[Ò–i¡ ¤GP¡[º [i¡šÎ šøƒà> A¡ì¹ &¤} ó¡³¢ \åìØl¡ P¡¹ç¡â«šèo¢ šìÚ–i¡P¡[ºìA¡ ÒàÒüºàÒüi¡ A¡ì¹

Please fill the form preferably in ‘BLACK’ ink only">åNøÒ A¡ì¹ ó¡³¢[i¡ ëA¡¤º³ày 'A¡àìºà' A¡à[º ‡à¹à šè¹o A¡¹ç¡>

Please countersign in full for any overwriting / alterationë™ ëA¡àì>à \àÚKàÚ *®¡à¹-¹àÒü[i¡} / š[¹¤t¢¡ì>¹ \>¸ Î´šèo¢ A¡àl¡ü–i¡à¹ ÎàÒü> A¡¹ç¡>

ABC

Specify the addresses along with City, State and PIN CodeÅÒ¹, ¹à\¸ &¤} [š> ëA¡àl¡ ÎÒ [k¡A¡à>àÎ³èÒ [>[ÆW¡t¡ A¡¹ç¡>

Please tick the appropriate boxes">åNøÒ A¡ì¹ Î[k¡A¡ ¤ìG [i¡A¡ [W¡Òû¡ [ƒ>

Please use in CAPITAL LETTERS only">åNøÒ A¡ì¹ Òü}ì¹\ãìt¡ ¤Øl¡ Ò¹ìó¡¹ "Û¡¹ ¤¸¤Òà¹ A¡¹ç¡>

ALL PHOTOCOPIES of documents to be SELF-ATTESTED by the applicantÎ³Ñz >[=šìy¹ ">å[º[šP¡[ºìt¡ "àì¤ƒ>A¡à¹ã¹ Ñ¬àÛ¡¹ "à¤Å¸A¡

Description of Document Can be obtained for / >[=šìy¹ [¤¤¹oã¹ \>¸ KõÒãt¡ Òìt¡ šàì¹

Address / [k¡A¡à>àIdentity / š[¹W¡Ú

Indicative List of Documents that can be provided to open a Bank Account

Passport / šàÎìšài¢¡

Voter's Identity Card / Î[W¡y ë®¡ài¡à¹ š[¹W¡Úšy

Driving License / l¡öàÒü[®¡} ºàÒüìÎX

Proof of Possession of Aadhaar Number / "à‹à¹ >´¬¹ ‹à¹ì>¹ šø³ào

Òül¡ü[i¡[º[i¡ [¤ºÎ³èÒ - Òüìº[C¡ö[Î[i¡, ëi¡[ºìó¡à>, \ìº¹ [¤º, šàÒüšlô¡ K¸àÎ, ëšàÐ¡ìšÒül¡ ë³à¤àÒüº (2 ³àìÎ¹ "[‹A¡ šå¹àì>à [¤º >Ú), Î´š[v¡ ¤à [³l¡ü[>[Îš¸àº i¡¸àìG¹ ¹[Îƒ, Î¹A¡à[¹ [¤®¡àK ¤à [š&ÎÒül¡ü ‡à¹à \à[¹Aõ¡t¡ "¤Î¹šøàœ¡ A¡³¢ãìƒ¹ ëš>Å> ¤à šà[¹¤à[¹A¡ ëš>Å> šøƒàì>¹ "àìƒÅšy, ¹àÊ¡öãÚ / ëA¡–ƒøãÚ Î¹A¡à¹ A¡tõ¢A¡ \à[¹Aõ¡t¡ A¡³¢ã¹ "à¤àÎ> ¤¹à„A¡¹ì>¹ šy, Î}[¤[‹¤‡ý¡ ¤à [>Ú”|A¡ Î}Ñ‚àÎ³èÒ, šà¤[ºA¡ ëÎC¡¹ "à“¡à¹ìi¡[A¡}Î, t¡ó¡[Îº®å¡v¡û¡ ¤à[o[\¸A¡ ¤¸àS¡Î³èÒ, "à[=¢A¡ šø[t¡Ë¡à>Î³èÒ &¤} t¡à[ºA¡à®å¡v¡û¡ ëA¡à´šà>ãÎ³èÒ &¤} Î¹A¡à[¹ "à¤àÎ> ¤¹à„A¡¹o šy ÎÒ A¡³¢ãìƒ¹ áå[i¡ &¤} ºàÒüìÎìX¹ Wå¡[v¡û¡šy¡ú (&Òü >[=šyP¡[º \³à ëƒ*Úà¹ Î³ìÚ¹ ì=ìA¡ [¤Kt¡ 3 ³àìÎ¹ ³ì‹¸ ¤t¢¡³à> [k¡A¡à>à¹ Îàì= "àšìl¡i¡ Ò*Úà "[ó¡[ÎÚàº í¤‹ >[=šy šøƒà> A¡¹ìt¡ Òì¤)

Utility bills – Electricity, Telephone, Water Bill, Piped Gas, Postpaid Mobile (not more than 2 months old), Property or Municipal Tax receipts, Pension or Family Pension Payment Orders issued to retired employees by Govt. Departments or PSU, Letter of allotment of accommodation from employer issued by State / Central Govt, Statutory or Regulatory bodies, Public Sector Undertakings, Scheduled Commercial Banks, Financial Institutions and Listed companies and Leave and Licence agreements with such employers allotting official accommodation.(Provided that customer must submit Official Valid Document with updated current address within a period of 3 months of submitting these documents)

Passport / šàÎìšài¢¡

Voter's Identity Card / Î[W¡y ë®¡ài¡à¹ š[¹W¡Úšy

Driving License / l¡öàÒü[®¡} ºàÒüìÎX

Proof of Possession of Aadhaar Number / "à‹à¹ >´¬¹ ‹à¹ì>¹ šø³ào

Job Card issued by NREGA duly signed by Officer of the State Government¹à\¸ Î¹A¡àì¹¹ "à[‹A¡à[¹A¡ ‡à¹à ™=à™=®¡àì¤ Ñ¬àÛ¡[¹t¡ &>ì¹Kà \¤ A¡àl¢¡

Please Note / ">åNøÒ A¡ì¹ ë>ài¡ A¡¹ì¤>:1. Customer must sign the Account Opening Form (AOF) in the presence of Bank officials.1. NøàÒA¡ìA¡ "¤Å¸Òü ¤¸àìS¡¹ A¡³¢A¡t¢¡àìƒ¹ l¡üš[Ñ‚[t¡ìt¡ "¸àA¡àl¡ü–i¡ *ìš[} ó¡³¢ (&*&ó¡)-& Ñ¬àÛ¡¹ A¡¹ìt¡ Òì¤¡ú

Letter issued by National Population Register containing details of name and address>à³ * [k¡A¡à>à¹ [¤Åƒ [¤¤¹oÎÒ \àt¡ãÚ \>Î}J¸à [>¤Þê¡A¡ ‡à¹à \à[¹Aõ¡t¡ šy

PAN Card / š¸à> A¡àl¢¡ H

&A¡[i¡ ¤¸àS¡ "¸àA¡àl¡ü–i¡ ëJàºà¹ \>¸ šøƒà> A¡¹à ë™ìt¡ šàì¹ &³> >[=šìy¹ ÎèW¡A¡ t¡à[ºA¡à

Job Card issued by NREGA duly signed by Officer of the State Government¹à\¸ Î¹A¡àì¹¹ "à[‹A¡à[¹A¡ ‡à¹à ™=à™=®¡àì¤ Ñ¬àÛ¡[¹t¡ &>ì¹Kà \¤ A¡àl¢¡

Letter issued by National Population Register containing details of name and address>à³ * [k¡A¡à>à¹ [¤Åƒ [¤¤¹oÎÒ \àt¡ãÚ \>Î}J¸à [>¤Þê¡A¡ ‡à¹à \à[¹Aõ¡t¡ šy

Rupay Platinum - Scheme Code List / ¹ç¡ìš šÃ¸à[i¡>à³ - ë™à\>à¹ ëA¡àìl¡¹ t¡à[ºA¡à

SB104 DCB Benefit Savings Account Yes [l¡[Î[¤ ë¤[>[ó¡i¡ ëÎ[®¡}Î "¸àA¡àl¡ü–i¡ Òò¸à

SB105 Gold Mortgages - Savings Account Yes ëÎà>à ¤Þê¡A¡Î}yû¡à”z - ëÎ[®¡}Î "¸àA¡àl¡ü–i¡ Òò¸à

SB102 DCB Shubh-Labh Savings Account Yes [l¡[Î[¤ Ç¡®¡-ºà®¡ ëÎ[®¡}Î "¸àA¡àl¡ü–i¡ Òò¸à

SB106 DCB Bank Staff Savings Account Yes [l¡[Î[¤ ¤¸àS¡ Ð¡àó¡ ëÎ[®¡}Î "¸àA¡àl¡ü–i¡ Òò¸à

SB109 DCB Max Savings Account Yes [l¡[Î[¤ ³¸àG ëÎ[®¡}Î "¸àA¡àl¡ü–i¡ Òò¸à

SB110 DCB Junior Saver Account Yes [l¡[Î[¤ \å[>Ú¹ ëÎ®¡à¹ "¸àA¡l¡ü–i¡ Òò¸à

Codes Scheme Description Rupay PlatinumëA¡àl¡Î³èÒ ë™à\>à¹ [¤¤¹o ¹ç¡ìš šÃ¸à[i¡>à³

SB103 DCB Family Savings Account Yes [l¡[Î[¤ ó¡¸à[³[º ëÎ[®¡}Î "¸àA¡àl¡ü–i¡ Òò¸à

SB111 SB Classic Yes &Î[¤ AÃ¡à[ÎA¡ Òò¸à

SB113 DCB Free Style Savings Account Yes [l¡[Î[¤ [óø¡ Ð¡àÒüº ëÎ[®¡}Î "¸àA¡àl¡ü–i¡ Òò¸à

SB114 DCB Basic Savings Bank Deposit Account No [l¡[Î[¤ ë¤[ÎA¡ ëÎ[®¡}Î ¤¸àS¡ [l¡ìšà[\i¡ "¸àA¡àl¡ü–i¡ >à

SB115 DCB Privilege HNI Savings Account Yes [l¡[Î[¤ [šø[®¡ìº\ &ÒüW¡&>"àÒü ëÎ[®¡}Î "¸àA¡àl¡ü–i¡ Òò¸à

SB124 DCB Elite Savings Account Yes [l¡[Î[¤ &[ºi¡ ëÎ[®¡}Î "¸àA¡àl¡ü–i¡ Òò¸à

SB118 DCB Corporate Payroll Account (Plus) Yes [l¡[Î[¤ A¡ìš¢àì¹i¡ ëšì¹àº "¸àA¡àl¡ü–i¡ (šÃàÎ) Òò¸à

SB132 DCB Basic Savings Bank Deposit Account (Small) No [l¡[Î[¤ ë¤[ÎA¡ ëÎ[®¡}Î ¤¸àS¡ [l¡ìšà[\i¡ "¸àA¡àl¡ü–i¡ (ìáàìi¡à) >à

SB121 DCB Kisan Mitra Savings Account No [l¡[Î[¤ [A¡Èà> [³y ëÎ[®¡}Î "¸àA¡àl¡ü–i¡ >à

SB133 PMJDY Account No [š&³ì\[l¡*ÚàÒü "¸àA¡àl¡ü–i¡ >à

Codes Scheme Description Rupay PlatinumëA¡àl¡Î³èÒ ë™à\>à¹ [¤¤¹o ¹ç¡ìš šÃ¸à[i¡>à³

SB117 DCB Corporate Payroll Account (Basic) Yes [l¡[Î[¤ A¡ìš¢àì¹i¡ ëšì¹àº "¸àA¡àl¡ü–i¡ (ì¤[ÎA¡) Òò¸à

SB122 DCB Golden Savings Account Yes [l¡[Î[¤ ëKàìÁ¡> ëÎ[®¡}Î "¸àA¡àl¡ü–i¡ Òò¸à

SB125 DCB CashBack Saving Account Yes [l¡[Î[¤ A¡¸àÅ¤¸àA¡ ëÎ[®¡}Î "¸àA¡àl¡ü–i¡ Òò¸à

SB138 DCB Saahas Savings Account Yes [l¡[Î[¤ ÎàÒÎ ëÎ[®¡}Î "¸àA¡àl¡ü–i¡ Òò¸à

SB119 DCB Student Savings Account Yes [l¡[Î[¤ Ð¡åìl¡–i¡ ëÎ[®¡}Î "¸àA¡àl¡ü–i¡ Òò¸à

3

Bank Use only (*Fields are Mandatory)

Ç¡‹å³ày ¤¸àìS¡¹ ¤¸¤Òàì¹¹ l¡üì„ìÅ¸ (* [W¡[Òû¡t¡ Ñ‚à>P¡[º "¤Å¸Òü šè¹o A¡¹ìt¡ Òì¤)

Customer ID:

NøàÒA¡ "àÒü[l¡

Account No.:

"¸àA¡àl¡ü–i¡ >}.

Application No. / "àì¤ƒ> >}.: IND

SOL Code:&Î*&º ëA¡àl¡

Relationship Form / Î´šA¢¡ ó¡³¢ “I / We hereby apply for a relationship with your Bank under which I / we wish to open an account.”''"à[³ / "à³¹à &t¡‡à¹à "àš>à¹ ¤¸àìS¡¹ Îàì= &A¡[i¡ Î´šA¢¡ Ñ‚àšì>¹ l¡üì„ìÅ¸ "àì¤ƒ> A¡¹[á ™à¹ "‹ãì> "à[³ / "à³¹à &A¡[i¡ "¸àA¡àl¡ü–i¡ Jåºìt¡ ÒüZáåA¡¡ú''

Funding:ó¡à[“¡}

Txn. / ID No.:ìº>ìƒ> / "àÒü[l¡ >}. YYYYMMDD

Date:t¡à[¹J YYYMMDD

Value Date:³à> t¡à[¹J Y

* Occupation Code:*\ã[¤A¡à ëA¡àl¡

Applicant 1:"àì¤ƒ>A¡à¹ã 1

Joint Applicant 1:ë™ï= "àì¤ƒ>A¡à¹ã 1

Joint Applicant 2:ë™ï= "àì¤ƒ>A¡à¹ã 2

*Segment Code*[¤®¡àK ëA¡àl¡

RM / CSE / RO / CBE (Code):"à¹&³ / [Î&ÎÒü / "à¹* / [Î[¤Òü (ìA¡àl¡)

Branch:ÅàJà

Date:t¡à[¹J YYYYMMDD

Please specify the occupation code as mentioned by customer in the form. ó¡ì³¢ l¡ü[À[Jt¡ \ã[¤A¡à ëA¡àl¡[i¡ NøàÒA¡ ‡à¹à [>[ƒ¢Ê¡ A¡¹ç¡>¡ú

Employee Code:A¡³¢W¡à¹ã ëA¡àl¡

Savings / ëÎ[®¡}ÎFixed DepositElite

&[ºI¡

Others (please specify including Personal Current A/c.)

">¸à>¸ (">åNøÒ A¡ì¹ ¤¸[v¡û¡Kt¡ A¡àì¹–i¡ "¸àA¡àl¡ü–i¡ÎÒ [>[ƒ¢Ê¡ A¡¹ç¡>)

ClassicAÃ¡à[ÎA¡

ShauryaëÅï™¢

Corporate Payroll (Basic)A¡ìš¢àì¹i¡ ëšì¹àº (ì¤[ÎA¡)

Shubh-LabhÇ¡®¡-ºà®¡

Corporate Payroll (Plus)A¡ìš¢àì¹i¡ ëšì¹àº (šÃàÎ)

Suraksha Fixed DepositÎå¹Û¡à [ó¡Gl¡ [l¡ìšà[\i¡

SaahasÎàÒÎ

Cash BackA¡¸àÅ ¤¸àA¡

BSBDA[¤&Î[¤[l¡&

Privilege[šø[®¡ìº\

Personal Details: Primary Applicant / ¤¸[v¡û¡Kt¡ [¤¤¹oÎ³èÒ: ³åJ¸ "àì¤ƒ>A¡à¹ã (* Fields are Mandatory / * [W¡[Òû¡t¡ Ñ‚à>P¡[º "¤Å¸Òü šè¹o A¡¹ìt¡ Òì¤)

*Account Type:

KYC Number:

(First Name / >àì³¹ šø=³à}Å) (Middle Name / >àì³¹ ³‹¸³à}Å) (Last Name / >àì³¹ ëÅÈà}Å)

*Date of Birth:YYYYMMDD

*Nationality: Indian Other (pl. specify)

*Short Name: Maximum 19 characters.

This namewould appear on the Debit Card

Îì¤¢àZW¡ 19 [i¡ "Û¡¹Î³èÒ¡ú &Òü >à³[i¡

ël¡[¤i¡ A¡àl¢¡-& šøƒ[Å¢t¡ Òì¤

*Status: Minor Sr. Citizen Pensioner Staff, if yes, Employee No.Other General

Maximum 32 characters.

Îì¤¢àZW¡ 32 [i¡ "Û¡¹ š™¢”z:

*Name:

Existing Customer ID: (If applicable)

Mr. Mrs. Ms. Dr. Prof. Capt. Others

*Gender: Male Female Third Gender

Marital Status: Single Married

*Country of Birth: *Place of Birth: Please fill FATCA

Declaration Form if you are U.S.A. or other country citizen / resident

"àš[> ™[ƒ Òül¡ü.&Î.&.-&¹ ¤à ">¸ ëA¡àì>à ëƒìÅ¹

>àK[¹A¡ / ¤à[Î–ƒà Ò> t¡àÒìº ">åNøÒ A¡ì¹ &ó¡&[i¡[Î& [¤¤õ[t¡ ó¡³¢[i¡ šè¹o A¡¹ç¡>

*Citizenship: *Residence for Tax Purposes:

U.S. Person: Yes No

Religion: Hindu Muslim Christian Sikh Buddhist Jain Parsi Others

*Mother’s Full Name:

*Father / Spouse Full Name:

*Mother’s Maiden Name:

*Permanent Account Number (PAN): Form 60If PAN is not

available please fill in Form 60™[ƒ š¸à> >à =àìA¡ t¡àÒìº ">åNøÒ A¡ì¹ ó¡³¢ 60 šè¹o A¡¹ç¡>

Passport Number:YYYMMDD

Expiry Date:Y

Driving Licence:YYYMMDD

Expiry Date:Y

Required if Passport or

Driving licence provide as Identity /

Address proof™[ƒ šàÎìšài¢¡ ¤à l¡öàÒü[®¡} ºàÒüìÎX š[¹W¡Ú / [k¡A¡à>à¹ šø³ào [ÒìÎì¤ šøƒà> A¡ì¹ =àìA¡> t¡àÒìº

šøìÚà\>

*Residential Status: Resident Individual Non Resident Indian Foreign National Person of Indian Origin

Passport

NREGA Job Card:

Others: (any document notified by the central government) / ">¸à>¸: (ìA¡–ƒøãÚ Î¹A¡à¹ ‡à¹à \à¹ãAõ¡t¡ ë™ ëA¡àì>à >[=šy)

Identification Number:

*Proof of Address: Driving Licence UID (Aadhaar)

NREGA Job Card Others

Simplified Measures Account Document Type CodeÎ¹ºãAõ¡t¡ š[¹³àìš¹ "¸àA¡l¡üì–i¡¹ >[=šìy¹ ëA¡àl¡

Voter Identity Card:

Your unique identification number / "àš>à¹ Òül¡ü[>A¡ "àÒüìl¡[–i¡[ó¡ìA¡Å> >´¬¹*Aadhaar Number:

šìo¸¹ ‹¹ì>¹ l¡üš¹ [>®¢¡¹ A¡ì¹ A¡àl¢¡

&¤} ëW¡A¡ ¤Òü šøƒà> A¡¹à ÒÚ¡ú

Type of card & cheque book

issuance would be

based upon the product.

Internet BankingDCB – On The Go (Mobile Banking)Online Banking:

*Card: Debit Card required Yes No Rupay Platinum (Optional)

*"¸àA¡àl¡üì–i¡¹ ‹¹oNormalÎà‹à¹o

Simplified (for low risk customers)Î¹ºãAõ¡t¡ ([>³— cåò¡[A¡¹ NøàÒA¡ìƒ¹ \>¸)

Smallëáàìi¡à

OTP based KYC*[i¡[š [®¡[v¡A¡ ëA¡*ÚàÒü[Î

ëA¡*ÚàÒü[Î >´¬¹ [¤ƒ¸³à> NøàÒA¡ "àÒü[l¡: (™[ƒ šøì™à\¸ ÒÚ)

*>à³ Åøã Åøã³t¡ã Aå¡³à¹ã l¡à. ìšøàìó¡Î¹ A¡¸àìŸi¡> ">¸à>¸Î³èÒ

*l¡àA¡ >à³

*[Ñ‚[t¡ "šøàœ¡¤ÚÑHþ ¤[¹Ë¡ >àK[¹A¡ ëš>Å>ì®¡àKã ">¸à>¸ Îà‹à¹o Î}Ñ‚à¹ A¡³¢ã, ™[ƒ ÒÚ, t¡àÒìº A¡³¢W¡à¹ã >}.

*\–µ t¡à[¹J *[ºU šå¹ç¡È ³[Òºà tõ¡t¡ãÚ [ºU

*\àt¡ãÚt¡à ®¡à¹t¡ãÚ ">¸à>¸ (">åNøÒ A¡ì¹ [>[ƒ¢Ê¡ A¡¹ç¡>) î¤¤à[ÒA¡ "¤Ñ‚à "[¤¤à[Òt¡ [¤¤à[Òt¡

*\–µA¡àºã> ëƒÅ *\–µA¡àºã> ÅÒ¹

*>àK[¹A¡â« *A¡ì¹¹ l¡üì„Å¸\[>t¡ "à¤àÎÑ‚º

Òül¡ü.&Î.-&¹ >àK[¹A¡ Òò¸à >àCategory:

\à[t¡General

ì\>à¹àºMBC

&³[¤[ÎOBC

*[¤[ÎSC

&Î[ÎST

&Î[i¡Others

">¸à>¸

‹³¢ [Ò–ƒå ³åÎº³à> JøãÐ¡à> [ÅJ ë¤ï‡ý¡ í\> šà[Î¢ ">¸à>¸

*³àt¡à¹ Î´šèo¢ >à³

*[št¡à¹ / Ñ¬à³ã¹ / Ñ|ã¹ >à³

*³àt¡à¹ Aå¡³à¹ã >à³

**"à¤à[ÎA¡ [Ñ‚[t¡

*A¡àl¢¡: ël¡[¤i¡ A¡àl¢¡ šøìÚà\>

">ºàÒü> ¤¸à[S¡}

*šà³¢àì>–i¡ "¸àA¡àl¡ü–i¡ >´¬¹ (š¸à>)

*"à‹à¹ >´¬¹

šàÎìšài¢¡ >´¬¹

l¡öàÒü[®¡} ºàÒüìÎX

Î[W¡y ë®¡ài¡à¹ A¡àl¢¡

&>ì¹Kà \¤ A¡àl¢¡

*[k¡A¡à>à¹ šø³àošy

Ñ¬t¡”| "à¤à[ÎA¡ ">à¤à[ÎA¡ ®¡à¹t¡ãÚ \àt¡ãÚ [¤ìƒÅã ®¡à¹t¡ãÚ ¤}ìÅàŠ±æt¡ ¤¸[v¡û¡

Òò¸à >à ¹ç¡ìš šÃ¸à[i¡>à³ ('[ZáA¡)Please refer page no. 2 for eligible scheme codeë™àK¸ ë™à\>à ëA¡àìl¡¹ \>¸ ">åNøÒ A¡ì¹ 2 >}. šõË¡à ë¹ó¡à¹ A¡¹ç¡>

[l¡[Î[¤-"> ƒ¸ ëKà (ì³à¤àÒüº ¤¸à[S¡}) Òü–i¡à¹ì>i¡ ¤¸à[S¡}

ó¡³¢ 60

Î³à[œ¡¹ t¡à[¹J

Î³à[œ¡¹ t¡à[¹J

"àÒüìl¡[–i¡[ó¡ìA¡Å> >´¬¹

šàÎìšài¢¡ l¡öàÒü[®¡} ºàÒüìÎX Òül¡ü"àÒü[l¡ ("à‹à¹)

Voter Identity Card

Î[W¡y ë®¡ài¡à¹ A¡àl¢¡ &>ì¹Kà \¤ A¡àl¢¡ ">¸à>¸

[ó¡Gl¡ [l¡ìšà[\i¡

4

Customer Profile / NøàÒìA¡¹ [¤¤¹o

*Occupation:

Gross Annual Income (`): 3 Lakhs - < 5 LakhsLess than 50K

5 Lakhs - < 10 Lakhs

50K - < 1.5 Lakhs

10 Lakhs - < 50 Lakhs

1.5 Lakhs - < 3 Lakhs

50 Lakhs and above

Residence: Self Owned Family Owned Rented Company Lease

Existing Credit Facility: House Loan Vehicle Loan Consumer Loan Education Loan Business Loan Credit Card

Education: Graduate Post Graduate Professional Others

Two WheelerVehicle: Four Wheeler Both None

All alerts will besend to thepreferred

Mobile Numberand E-mail ID.

Mobile Numberwill be used forSMS Bankingregistration for

eligibleaccounts.

šá–ƒÎÒü ë³à¤àÒüº >}. &¤} Òüì³º "àÒü[l¡-ìt¡ Î³Ñz

Ît¡A¢¡t¡àÎ³èÒ ìšø¹o A¡¹à Òì¤¡ú ë™àK¸ "¸àA¡àl¡ü–i¡Î³èìÒ¹ ëÛ¡ìy &Î&³&Î ë³à¤àÒüº ¤¸à[S¡}ìÚ¹

\>¸ ë³à¤àÒüº >´¬¹[i¡ ¤¸¤Òê¡t¡ Òì¤¡ú

šyìšø¹ìo¹ [k¡A¡à>à¹ šø³à> šøƒà> A¡¹à ¤à‹¸t¡à³èºA¡¡ú

">¸=àÚ, šè¤¢[>‹¢à[¹t¡ [k¡A¡à>à[i¡ ¤t¢¡³à>

[k¡A¡à>à [ÒìÎì¤ [¤ì¤W¡¸ Òì¤¡ú

Address proofof mailingaddress ismandatory.Otherwise,

default addresspicked would be Current Address

Mailing Address: Office Permanent (You must tick mark one option)Current Address

*Landmark:

Extn.: Fax: (with STD Code)

State: Telephone: (with STD Code)

Office Address:

City: PIN:

*Preferred Email Id:

Permanent Address:

City: PIN:

*Landmark:

Same as Current Address


*Preferred Mobile No.:Telephone: (with STD Code)

State: Country:

Communication Address:

City: PIN:

*Landmark:

ë™àKàì™àìK¹ [k¡A¡à>à

ÅÒ¹ [š>

*º¸à“¡³àA¢¡

¹à\¸ ëƒÅ

ëi¡[ºìó¡à>: (&Î[i¡[l¡ ëA¡àl¡ ÎÒ) *šá–ƒÎÒü ë³à¤àÒüº >}.

*šá–ƒÎÒü Òüì³º "àÒü[l¡

Ñ‚àÚã [k¡A¡à>à ¤t¢¡³à> [k¡A¡à>à¹ ">å¹ê¡š

ÅÒ¹ [š>

*º¸à“¡³àA¢¡

¹à\¸ ëi¡[ºìó¡à>: (&Î[i¡[l¡ ëA¡àl¡ ÎÒ)

"[ó¡ìÎ¹ [k¡A¡à>à

ÅÒ¹ [š>

*º¸à“¡³àA¢¡


ó¡¸àG: (&Î[i¡[l¡ ìA¡àl¡ ÎÒ)

šyìšø¹ìo¹ [k¡A¡à>à ¤t¢¡³à> [k¡A¡à>à "[ó¡Î Ñ‚àÚã ("àš>àìA¡ "¤Å¸Òü &A¡[i¡ [¤A¡¿ìt¡ [i¡A¡ [W¡Òû¡ šøƒà> A¡¹ìt¡ Òì¤)

*\ã[¤A¡à

[ÅÛ¡à Nø¸à\åìÚi¡ ëšàÐ¡ Nø¸à\åìÚi¡ ëšÅàƒà¹ ">¸à>¸

ë³ài¡ ¤à[È¢A¡ "àÚ 50 Òà\àì¹¹ [>ì³— 50 Òà\à¹ - < 1.5 ºÛ¡ 1.5 ºÛ¡ - < 3 ºÛ¡ 3 ºÛ¡ - < 5 ºÛ¡

5 ºÛ¡ - < 10 ºÛ¡ 10 ºÛ¡ - < 50 ºÛ¡ 50 ºÛ¡ ¤à t¡à¹ "[‹A¡

[>\Ñ¬ šà[¹¤à[¹A¡ ®¡àØl¡à ëA¡à´šà>ã¹ ‡à¹à [º\Aõ¡t¡¤àÎÑ‚à>

[¤ƒ¸³à> ìyû¡[l¡i¡ Îå[¤‹à KõÒ ˜¡o ¤àÒ> ˜¡o l¡üšì®¡àv¡û¡à ˜¡o [ÅÛ¡àÎ}yû¡à”z ˜¡o ¤¸¤Îà[ÚA¡ ˜¡o ìyû¡[l¡i¡ A¡àl¢¡

¤àÒ> iå¡ ×Òüºà¹ ìó¡à¹ ×Òüºà¹ l¡ü®¡ÚÒü &A¡[i¡ * >à

&Gìi¡>Å>

Joint Applicant 1 / ë™ï= "àì¤ƒ>A¡à¹ã 1 (* Fields are Mandatory / [W¡[Òû¡t¡ Ñ‚à>P¡[º "¤Å¸Òü šè¹o A¡¹ìt¡ Òì¤ )

##(Guardian to fill a Minor Declaration Form separately) If applicable, please attach age proof * Fields are Mandatory

*Account Type:*"¸àA¡àl¡üì–i¡¹ ‹¹o

NormalÎà‹à¹o


Smallëáàìi¡à


##("[®¡®¡à¤A¡ "àºàƒà A¡ì¹ &A¡[i¡ "šøàœ¡¤ÚÑHþ Î}yû¡à”z [¤¤õ[t¡ šè¹o A¡¹ì¤>) ™[ƒ šøì™à\¸ ÒÚ, t¡àÒìº ">åNøÒ A¡ì¹ ¤ÚìÎ¹ šø³ào šy šøƒà> A¡¹ç¡> * [W¡[Òû¡t¡ Ñ‚à>P¡[º "¤Å¸Òü šè¹o A¡¹ìt¡ Òì¤

Relationship with Primary Applicant:³åJ¸ "àì¤ƒ>A¡à¹ã¹ Îàì= Î´šA¢¡

Please fill FATCA




KYC Number:



Îì¤¢àZW¡ 32 [i¡ "Û¡¹ š™¢”z:

*Name:





*Date of Birth:YYYYMMDD*\–µ t¡à[¹J

*Gender: Male Female Third Gender*[ºU šå¹ç¡È ³[Òºà tõ¡t¡ãÚ [ºU

*Nationality: Indian Other (pl. specify)*\àt¡ãÚt¡à ®¡à¹t¡ãÚ ">¸à>¸ (">åNøÒ A¡ì¹ [>[ƒ¢Ê¡ A¡¹ç¡>)

Marital Status: Single Marriedî¤¤à[ÒA¡ "¤Ñ‚à "[¤¤à[Òt¡ [¤¤à[Òt¡

*Country of Birth: *Place of Birth:*\–µA¡àºã> ëƒÅ *\–µA¡àºã> ÅÒ¹

*Citizenship:*>àK[¹A¡â«

*Residence for Tax Purposes:*A¡ì¹¹ l¡üì„Å¸\[>t¡ "à¤àÎÑ‚º

U.S. Person: Yes No

Òül¡ü.&Î.-&¹ >àK[¹A¡ Òò¸à >à






*[št¡à¹ / Ñ¬à³ã¹ / Ñ|ã¹ >à³

*Mother’s Maiden Name:*³àt¡à¹ Aå¡³à¹ã >à³

*Residential Status: Resident Individual Non Resident Indian Foreign National Person of Indian Origin**"à¤à[ÎA¡ [Ñ‚[t¡ Ñ¬t¡”| "à¤à[ÎA¡ ">à¤à[ÎA¡ ®¡à¹t¡ãÚ \àt¡ãÚ [¤ìƒÅã ®¡à¹t¡ãÚ ¤}ìÅàŠ±æt¡ ¤¸[v¡û¡

5

YYYMMDD Y

YYYMMDD Y

Maximum 19 characters. This name would appear on the Debit CardÎì¤¢àZW¡ 19 [i¡ "Û¡¹Î³èÒ¡ú &Òü >à³[i¡ ël¡[¤i¡ A¡àl¢¡-& šøƒ[Å¢t¡ Òì¤

If PAN is not available please fill in Form 60™[ƒ š¸à> >à =àìA¡ t¡àÒìº ">åNøÒ A¡ì¹ ó¡³¢ 60 šè¹o A¡¹ç¡>




šøìÚà\>


Your unique identification number / "àš>à¹ Òül¡ü[>A¡ "àÒüìl¡[–i¡[ó¡ìA¡Å> >´¬¹


issuance would be


šìo¸¹ ‹¹ì>¹ l¡üš¹ [>®¢¡¹ A¡ì¹ A¡àl¢¡


*Short Name:*l¡àA¡ >à³

*Status: Minor Sr. Citizen Pensioner Staff, if yes, Employee No.Other General*[Ñ‚[t¡ "šøàœ¡¤ÚÑHþ ¤[¹Ë¡ >àK[¹A¡ ëš>Å>ì®¡àKã ">¸à>¸ Îà‹à¹o Î}Ñ‚à¹ A¡³¢ã, ™[ƒ ÒÚ, t¡àÒìº A¡³¢W¡à¹ã >}.

Category:

\à[t¡General

ì\>à¹àºMBC

&³[¤[ÎOBC

*[¤[ÎSC

&Î[ÎST

&Î[i¡Others

">¸à>¸

*Card: Debit Card required*A¡àl¢¡: ël¡[¤i¡ A¡àl¢¡ šøìÚà\>

Online Banking:">ºàÒü> ¤¸à[S¡}

*Permanent Account Number (PAN):*šà³¢àì>–i¡ "¸àA¡àl¡ü–i¡ >´¬¹ (š¸à>)

*Aadhaar Number:*"à‹à¹ >´¬¹

Passport Number:šàÎìšài¢¡ >´¬¹

Driving Licence:l¡öàÒü[®¡} ºàÒüìÎX

Voter Identity Card:Î[W¡y ë®¡ài¡à¹ A¡àl¢¡

NREGA Job Card:&>ì¹Kà \¤ A¡àl¢¡

YesÒò¸à

No>à

Rupay Platinum (Optional)¹ç¡ìš šÃ¸à[i¡>à³ ('[ZáA¡)

Please refer page no. 2 for eligible scheme codeë™àK¸ ë™à\>à ëA¡àìl¡¹ \>¸ ">åNøÒ A¡ì¹ 2 >}. šõË¡à ë¹ó¡à¹ A¡¹ç¡>

DCB – On The Go (Mobile Banking)

[l¡[Î[¤-"> ƒ¸ ëKà (ì³à¤àÒüº ¤¸à[S¡})Internet BankingÒü–i¡à¹ì>i¡ ¤¸à[S¡}

Form 60ó¡³¢ 60

Expiry Date:Î³à[œ¡¹ t¡à[¹J


Identification Number:"àÒüìl¡[–i¡[ó¡ìA¡Å> >´¬¹

Passport*Proof of Address: Driving Licence UID (Aadhaar) Simplified Measures Account Document Type CodeÎ¹ºãAõ¡t¡ š[¹³àìš¹ "¸àA¡l¡üì–i¡¹ >[=šìy¹ ëA¡àl¡*[k¡A¡à>à¹ šø³àošy šàÎìšài¢¡ l¡öàÒü[®¡} ºàÒüìÎX Òül¡ü"àÒü[l¡ ("à‹à¹)

NREGA Job Card OthersVoter Identity Card



Permanent Address:

City: PIN:

*Landmark:




State: Country:


City: PIN:

*Landmark:


ÅÒ¹ [š>

*º¸à“¡³àA¢¡

¹à\¸ ëƒÅ




ÅÒ¹ [š>

*º¸à“¡³àA¢¡


Joint Applicant 2 / ë™ï= "àì¤ƒ>A¡à¹ã 2 (* Fields are Mandatory / [W¡[Òû¡t¡ Ñ‚à>P¡[º "¤Å¸Òü šè¹o A¡¹ìt¡ Òì¤ )

*Account Type:*"¸àA¡àl¡üì–i¡¹ ‹¹o

NormalÎà‹à¹o


Smallëáàìi¡à


Relationship with Primary Applicant:³åJ¸ "àì¤ƒ>A¡à¹ã¹ Îàì= Î´šA¢¡



Please fill FATCA


KYC Number:



Îì¤¢àZW¡ 32 [i¡ "Û¡¹ š™¢”z:

*Name:





*Date of Birth:YYYYMMDD*\–µ t¡à[¹J

*Gender: Male Female Third Gender*[ºU šå¹ç¡È ³[Òºà tõ¡t¡ãÚ [ºU

*Nationality: Indian Other (pl. specify)*\àt¡ãÚt¡à ®¡à¹t¡ãÚ ">¸à>¸ (">åNøÒ A¡ì¹ [>[ƒ¢Ê¡ A¡¹ç¡>)

Marital Status: Single Marriedî¤¤à[ÒA¡ "¤Ñ‚à "[¤¤à[Òt¡ [¤¤à[Òt¡

*Country of Birth: *Place of Birth:*\–µA¡àºã> ëƒÅ *\–µA¡àºã> ÅÒ¹

*Citizenship:*>àK[¹A¡â«

*Residence for Tax Purposes:*A¡ì¹¹ l¡üì„Å¸\[>t¡ "à¤àÎÑ‚º

U.S. Person: Yes No

Òül¡ü.&Î.-&¹ >àK[¹A¡ Òò¸à >à






*[št¡à¹ / Ñ¬à³ã¹ / Ñ|ã¹ >à³

*Mother’s Maiden Name:*³àt¡à¹ Aå¡³à¹ã >à³

*Residential Status: Resident Individual Non Resident Indian Foreign National Person of Indian Origin**"à¤à[ÎA¡ [Ñ‚[t¡ Ñ¬t¡”| "à¤à[ÎA¡ ">à¤à[ÎA¡ ®¡à¹t¡ãÚ \àt¡ãÚ [¤ìƒÅã ®¡à¹t¡ãÚ ¤}ìÅàŠ±æt¡ ¤¸[v¡û¡

Category:

\à[t¡General

ì\>à¹àºMBC

&³[¤[ÎOBC

*[¤[ÎSC

&Î[ÎST

&Î[i¡Others

">¸à>¸

6

Services / š[¹ìÈ¤à[ƒ

SMS Banking & Alert Facility: / &Î&³&Î ¤¸à[S¡} * Ît¡A¢¡t¡à Îå[¤‹àÎ³èÒ:Alerts facility enables you to receive alerts on your Email and / or Mobile regarding large debit, large credits, Standing Instruction failure, balance below Account Quarterly Balance and balance update. New alerts may be added from time to time. / Ît¡A¢¡t¡à Îå[¤‹à "àš>àìA¡ ¤Øl¡ ‹¹ìo¹ ël¡[¤i¡ , ¤Øl¡ ‹¹ìo¹ ìyû¡[l¡i¡, Ñ‚àÚã [>ìƒ¢ìÅ¹ ¤¸=¢t¡à, "¸àA¡àl¡üì–i¡¹ îy³à[ÎA¡ ¤¸àìºìX¹ [>ì³— ¤¸àìºX &¤} ¤¸àìºX "àšìl¡i¡ Î´š[A¢¡t¡ Òüì³º &¤} / "=¤à ë³à¤àÒüìº Ît¡A¢¡t¡à šøàœ¡ A¡¹ìt¡ ÎÛ¡³ A¡ì¹¡ú Î³Úà>å™àÚã >t¡å> Ît¡A¢¡t¡à Î³èÒ ™åv¡û¡ Òìt¡ šàì¹¡ú

Email Account Statement Utility Bills

Phone Banking Preferred Language Options: English Hindi Marathi Gujarati Tamil Telugu

Investment: Life Insurance Mutual Fund Wealth Management General InsurancePassbook

ë™ï= "¸àA¡àl¡ü–i¡‹à¹A¡¹à ">åNøÒ A¡ì¹ &A¡[i¡ ë³à¤àÒüº ¤¸à[S¡} ë¹[\ìÐ¡öÅ> ó¡³¢

"àºàƒà A¡ì¹ šè¹o A¡¹ì¤>

Please fill a separate Mobile

Banking Registration

Form for Joint Account Holder

Please Note: Authorised signatory/ies of the Firm / Company / Trust / Association / Society are eligible for free Mobile alert facility subject to compliance of terms and conditions as stipulated by the Bank from time to time. / ">åNøÒ A¡ì¹ ë>ài¡ A¡¹ì¤>: ó¡à³¢ / ëA¡à´šà>ã / i¡öàÐ¡ / "¸àìÎà[ÎìÚÅ> / ëÎàÎàÒü[i¡-&¹ ">åì³à[ƒt¡ Ñ¬àÛ¡¹A¡à¹ã/Ko Î³Úà>å™àÚã ¤¸àS¡ A¡t¢õ¡A¡ [>‹¢à[¹t¡ [>Ú³ &¤} Åt¢¡à¤ºã¹ "‹ãì> [¤>à³èìº¸ ë³à¤àÒüº Ît¡A¢¡t¡à Îå[¤‹à šøàœ¡ A¡¹à¹ \>¸ l¡üš™åv¡û¡¡ú

I / We don’t wish to receive any Bank related promotional calls, SMS alerts or emails.

I / We don’t wish to link my/our Aadhaar Number to this account. (Please Note: Any 1 Aadhaar Number is linked to 1 Account Number to receive subsidy on the account)

Please note: Allcheques shouldbe CROSSED

and in favour of‘DCB Bank Limited’ A/c(Your Name)’">åNøÒ A¡ì¹ ë>ài¡ A¡¹ì¤>: Î³Ñz ëW¡A¡

yû¡Î A¡¹à l¡ü[W¡; &¤} '[l¡[Î[¤ ¤¸àS¡ [º[³ìi¡l¡'

"¸àA¡àl¡ü–i¡ ("àš>à¹ >à³)-&¹ šìÛ¡ Ò*Úà l¡ü[W¡;

Initial Payment Details / šøà=[³A¡ ëšì³ì–i¡¹ [¤¤¹o

Amount `: Debit to DCB Bank A/c No.:Amount in words:

Cheque No.: Cheque Dated:YYYYMMDD

Payment By: Cash (To be deposited by the customer at teller counter only) Cash Deposited on: YYYYMMDD

Drawn on (Bank):

Mode of Operation / "šàì¹Åì>¹ ë³àl¡

Others (Please Specify):

Self Either or SurvivorJointly Former or Survivor Guardian Anyone or SurvivorÑ¬Ú} ë™ï= ë™ ëA¡àì>à &A¡\> ¤à \ã[¤t¡ ¤¸[v¡û¡ ®è¡t¡šè¤¢ ¤à \ã[¤t¡ ¤¸[v¡û¡ "[®¡®¡à¤A¡ ë™ ëA¡l¡ü ¤à \ã[¤t¡ ¤¸[v¡û¡

">¸à>¸: (">åNøÒ A¡ì¹ [>[ƒ¢Ê¡ A¡¹ç¡>)

ëšì³–i¡ šøƒv¡ >Kƒ ([>ìƒ¢[Åt¡ A¡àl¡ü–i¡àì¹Òü ëA¡¤º³ày NøàÒA¡ \³à [ƒìt¡ šà¹ì¤>) >Kƒ \³àA¡¹> t¡à[¹J

ëW¡A¡ >}. ëW¡A¡-&¹ t¡à[¹J JàºàÎA¡¹>: (¤¸àS¡)

"=¢¹à[Å i¡àA¡à "=¢¹à[Å Åì¦: [l¡[Î[¤ ¤¸àS¡ "¸àA¡àl¡ü–i¡ >}.-& \³à

"à[³ / "à³¹à ¤¸àS¡ Î´š[A¢¡t¡ ëA¡àì>à šøW¡à¹³èºA¡ A¡º, &Î&³&Î Ît¡A¢¡t¡à ¤à Òüì³ºÎ³èÒ NøÒo A¡¹ìt¡ "[>ZáåA¡¡ú

&Òü "¸àA¡àl¡ü–i¡[i¡ìt¡ "à[³ / "à³¹à "à³à¹ / "à³àìƒ¹ "à‹à¹ [ºS¡ A¡¹àìt¡ "[>ZáåA¡¡ú (">åNøÒ A¡ì¹ ë>ài¡ A¡¹ì¤>: "¸àA¡àl¡üì–i¡ ®¡tå¢¡[A¡ šà*Úà¹ \>¸ 1[i¡ "¸àA¡àl¡üì–i¡¹ Îàì= ë™ ëA¡àì>à 1[i¡ "à‹à¹ >´¬¹ [ºS¡ A¡¹àìt¡ Òì¤)

"¸àA¡àl¡üì–i¡¹ [¤¤õ[t¡¹ Òüì³º Òül¡ü[i¡[º[i¡ [¤ºÎ³èÒ

ìó¡à> ¤¸à[S¡} šá–ƒÎÒü ®¡àÈà¹ [¤A¡¿ Òü}¹à\ã [Ò[–ƒ ³à¹à[k¡ P¡\¹à[t¡ t¡à[³º ët¡ºåP¡

šàÎ¤Òü [¤º[N—A¡¹> \ã¤> ¤ã³à [³l¡üWå¡¸Úàº ó¡à“¡ Î´šƒ ¤¸¤Ñ‚àš>à ì\>àì¹º ÒüXå¸ì¹X

YYYMMDD Y

YYYMMDD Y

Maximum 19 characters. This name would appear on the Debit CardÎì¤¢àZW¡ 19 [i¡ "Û¡¹Î³èÒ¡ú &Òü >à³[i¡ ël¡[¤i¡ A¡àl¢¡-& šøƒ[Å¢t¡ Òì¤

If PAN is not available please fill in Form 60™[ƒ š¸à> >à =àìA¡ t¡àÒìº ">åNøÒ A¡ì¹ ó¡³¢ 60 šè¹o A¡¹ç¡>




šøìÚà\>


Your unique identification number / "àš>à¹ Òül¡ü[>A¡ "àÒüìl¡[–i¡[ó¡ìA¡Å> >´¬¹


issuance would be


šìo¸¹ ‹¹ì>¹ l¡üš¹ [>®¢¡¹ A¡ì¹ A¡àl¢¡


*Short Name:*l¡àA¡ >à³

*Status: Minor Sr. Citizen Pensioner Staff, if yes, Employee No.Other General*[Ñ‚[t¡ "šøàœ¡¤ÚÑHþ ¤[¹Ë¡ >àK[¹A¡ ëš>Å>ì®¡àKã ">¸à>¸ Îà‹à¹o Î}Ñ‚à¹ A¡³¢ã, ™[ƒ ÒÚ, t¡àÒìº A¡³¢W¡à¹ã >}.

*Card: Debit Card required*A¡àl¢¡: ël¡[¤i¡ A¡àl¢¡ šøìÚà\>

Online Banking:">ºàÒü> ¤¸à[S¡}

*Permanent Account Number (PAN):*šà³¢àì>–i¡ "¸àA¡àl¡ü–i¡ >´¬¹ (š¸à>)

*Aadhaar Number:*"à‹à¹ >´¬¹

Passport Number:šàÎìšài¢¡ >´¬¹

Driving Licence:l¡öàÒü[®¡} ºàÒüìÎX

Voter Identity Card:Î[W¡y ë®¡ài¡à¹ A¡àl¢¡

NREGA Job Card:&>ì¹Kà \¤ A¡àl¢¡

YesÒò¸à

No>à

Rupay Platinum (Optional)¹ç¡ìš šÃ¸à[i¡>à³ ('[ZáA¡)

Please refer page no. 2 for eligible scheme codeë™àK¸ ë™à\>à ëA¡àìl¡¹ \>¸ ">åNøÒ A¡ì¹ 2 >}. šõË¡à ë¹ó¡à¹ A¡¹ç¡>

DCB – On The Go (Mobile Banking)

[l¡[Î[¤-"> ƒ¸ ëKà (ì³à¤àÒüº ¤¸à[S¡})Internet BankingÒü–i¡à¹ì>i¡ ¤¸à[S¡}

Form 60ó¡³¢ 60



Identification Number:"àÒüìl¡[–i¡[ó¡ìA¡Å> >´¬¹

Passport*Proof of Address: Driving Licence UID (Aadhaar) Simplified Measures Account Document Type CodeÎ¹ºãAõ¡t¡ š[¹³àìš¹ "¸àA¡l¡üì–i¡¹ >[=šìy¹ ëA¡àl¡*[k¡A¡à>à¹ šø³àošy šàÎìšài¢¡ l¡öàÒü[®¡} ºàÒüìÎX Òül¡ü"àÒü[l¡ ("à‹à¹)

NREGA Job Card OthersVoter Identity Card



Permanent Address:

City: PIN:

*Landmark:




State: Country:


City: PIN:

*Landmark:


ÅÒ¹ [š>

*º¸à“¡³àA¢¡

¹à\¸ ëƒÅ




ÅÒ¹ [š>

*º¸à“¡³àA¢¡


7

Tax Deduction at Source / l¡ü;ìÎ¹ l¡üš¹ A¡¹ áàØl¡

If No, TDS Exemption Reference No.

TDS to be deducted if applicable: Yes No TDS Exemption submission date :YYYYMMDD

Enclose TDS Certificate for exemption. / áàìØl¡¹ \>¸ [i¡[l¡&Î Å}Îàšy Î}™åv¡û¡ A¡¹ç¡>¡ú

Form 15G / 15H, etc. to be

submitted at thebeginning of

every financialyear and whilemaking fresh

deposits duringthe year.

šø[t¡ "à[=¢A¡ ¤áì¹¹ Ç¡¹ç¡ìt¡ &¤} ¤áì¹ ë™

ëA¡àì>à Î³ìÚ [l¡ìšà[\i¡Î³èìÒ¹ >¤ãA¡¹ì>¹ Î³Ú

15[\ / 15&ÒüW¡ ó¡³¢ Òüt¡¸à[ƒ \³à [ƒìt¡

Òì¤¡ú

Facility required: Yes No (please tick appropriate options)2-Way Sweep Deposit Details:

Please Note: Reverse Sweep to Fixed Deposit account shall happen only, if the balance in the account exceeds threshold limit and Sweep shall happen if the balance in the account goes below the threshold limit. All deposits will be under Re-investment scheme with Auto Renewal Facility, this facility may differ from product to product and from time to time. / ">åNøÒ A¡ì¹ ë>ài¡ A¡¹ì¤>: [ó¡Gl¡ [l¡ìšà[\i¡ "¸àA¡àl¡üì–i¡ [¹®¡àÎ¢ ÎåÒüš ëA¡¤º³ày t¡J>Òü Qi¡ì¤, ™J> &Òü "¸àA¡àl¡üì–i¡¹ ¤¸àìºX [º[³i¡ "[t¡yû¡³ A¡¹ì¤ &¤} &Òü "¸àA¡àl¡üì–i¡¹ ¤¸àìºX ™J> [º[³ìi¡¹ [>ì³— W¡ìº ™àì¤ t¡J> ÎåÒüš Òì¤¡ú Î³Ñz [l¡ìšà[\i¡Î³èÒ šå>¹àÚ [¤[>ìÚàK šøA¡ì¿¹ "à*t¡àÚ šå>>¢¤ãA¡¹> Îå[¤‹à¹ Îàì= =àA¡ì¤¡ú &Òü Îå[¤‹à[i¡ šìo¸¹ ¹A¡³ìó¡ì¹¹ Îàì= Î³Úà>å™àÚã šõ=A¡ Òìt¡ šàì¹¡ú &Òü "¸àA¡àl¡üì–i¡ \>¸ ™J> šøà=[³A¡ ó¡à[“¡} šøƒà> A¡¹à Òì¤ t¡J>Òü &ó¡&ó¡[l¡ Îå[¤‹à[i¡ l¡üšº§¡ Òì¤¡ú

Account Statement: Frequency of statement would be as per the product feature. / "¸àA¡àl¡üì–i¡¹ [¤¤õ[t¡: [¤¤õ[t¡[i¡ šøƒàì>¹ Î³ìÚ¹ "”z¹ šo¸ í¤[ÅìÊ¡¸¹ ‹¹o ">å™àÚã Òì¤¡ú

2-*ìÚ ÎåÒüš [l¡ìšà[\ìi¡¹ [¤¤¹oÎ³èÒ: Îå[¤‹à šøìÚà\>: Òò¸à >à (">åNøÒ A¡ì¹ Î[k¡A¡ [¤A¡ì¿ [i¡A¡ [W¡Òû¡ [ƒ>)

™[ƒ šøì™à\¸ ÒÚ t¡àÒìº [i¡[l¡&Î ëA¡ìi¡ ë>*Úà Òì¤ Òò¸à >à [i¡[l¡&Î áàØl¡šy \³à ëƒ*Úà¹ t¡à[¹J

™[ƒ >à =àìA¡, t¡àÒìº [i¡[l¡&Î \³à¹ ë¹ó¡àì¹X >}.

Term Deposit Details / i¡à³¢ [l¡ìšà[\ìi¡¹ [¤¤¹oÎ³èÒ (* Fields are Mandatory / )[W¡[Òû¡t¡ Ñ‚à>P¡[º "¤Å¸Òü šè¹o A¡¹ìt¡ Òì¤

Quarterly Interest Payout (QIC)

Repay Principal and Interest

Please tick if you wish to receive hard copy of the Deposit Confirmation Advice (DCA) otherwise the DCA will be sent at your registered email ID with the Bank. / "àš[> ™[ƒ [l¡ìšà[\i¡ A¡>ó¡àì³¢Å> "¸àl¡®¡àÒüÎ ([l¡[Î&)-&¹ Òàl¢¡ A¡[š ëšìt¡ W¡à> t¡àÒìº [i¡A¡ [W¡Òû¡ [ƒ> ">¸=àÚ ¤¸àìS¡¹ Îàì= "àš>à¹ [>¤[Þê¡t¡ Òüì³º "àÒü[l¡ìt¡ [l¡[Î& ìšø¹o A¡¹à Òì¤¡ú

Transfer to DCB Bank A/c. No.:

Issue Demand Draft Payable at

Through NEFT

Transfer to DCB Bank A/c. No.:

Issue Demand Draft Payable at

Through NEFT

¤[¹Ë¡ >àK[¹A¡ Î}yû¡à”z Îå[¤‹à

šà*Úà¹ \>¸ \–µ t¡à[¹ìJ¹ ([l¡*[¤) šø³àošy "à¤Å¸A¡¡ú

Date of Birth (DOB) proof required to

avail benefits for Senior Citizens.

Amount of Deposit Please issue Fixed Deposit in the name(s) of

by Cash / Debit to Account No.:

Amount `

(Rupees only)

ëA¡¤º³ày 6 ³àìÎ¹* A¡³ Î³ìÚ¹

\>¸ \³àAõ¡t¡ [l¡ìšà[\i¡Î³èìÒ¹

\>¸ Î¹º Òàì¹ Îåƒ šøìƒÚ

ONLY Simple Interest

payable for deposits of less than 6 months

tenor

Fixed Deposit (FD) DCB Suraksha FDType of Deposit Tax Saver FD

Interest Payout Frequency

Monthly Interest Payout (MIC)

Simple Interest (for deposits less than 6 months)

Half Yearly Interest Payout (only applicable for FD)

On Maturity

*Maturity Instruction s(Tick any one) / ³¸àWå¡[¹[i¡ Î}yû¡à”z [>ìƒ¢Åà¤ºã (ì™ ëA¡àì>à &A¡[i¡ìt¡ [i¡A¡ [W¡Òû¡ [ƒ>)

Auto Renew Principal and Interest Auto Renew Principal and Pay Interest

*Payment Instructions(upon closure) / šøƒàì>¹ [>ìƒ¢Åà¤ºã (ìAÃ¡à\àì¹¹ l¡üšì¹)

Mode of Operation JointlyFormer or SurvivorSelf

Guardian

Either or Survivor

By anyone or Survivor

Interest PaymentInstructions

Deposit Period Days Months Years (Minimum 7 days maximum 10 years)

Senior Citizen Yes No Interest Rate.

% per annum

[ó¡Gl¡ [l¡ìšà[\i¡ (&ó¡[l¡)[l¡ìšà[\ìi¡¹ ‹¹o [l¡[Î[¤ Îå¹Û¡à &ó¡[l¡ i¡¸àG Îe¡Úã &ó¡[l¡

Îåƒ šøƒàì>¹ ì³ÚàƒA¡àº³à[ÎA¡ Îåƒ šøƒà> (&³"àÒü[Î)

Îà‹à¹o Îåƒ (6 ³àìÎ¹* A¡³ Î³ìÚ¹ \>¸ \³à A¡¹à Òìº)

Îåìƒ¹ "‹¢-¤à;Î[¹A¡ šøƒà> (Ç¡‹å³ày &ó¡[l¡-&¹ ëÛ¡ìy šøì™à\¸)

³¸àWå¡[¹[i¡¹ l¡üš¹

îy³à[ÎA¡ Îåƒ šøƒà> ([A¡l¡ü"àÒü[Î)

[l¡ìšà[\ìi¡¹ ¹à[Å ">åNøÒ A¡ì¹ &¹ >àì³ [ó¡Gl¡ [l¡ìšà[\i¡[i¡ \à[¹ A¡¹ç¡>

"¸àA¡àl¡ü–i¡ >´¬ì¹ >Kƒ / ìl¡[¤i¡ ‡à¹à

"=¢¹à[Å

i¡àA¡à)

[l¡ìšà[\ìi¡¹ ë³Úàƒ [ƒ> ³àÎ ¤á¹ (>è>¸t¡³ 7 [ƒ> ì=ìA¡ Îì¤¢àZW¡ 10 ¤á¹)

¤[¹Ë¡ >àK[¹A¡ Îåìƒ¹ Òà¹ šø[t¡ ¤á¹

Îåƒ šøƒàì>¹ [>ìƒ¢Åà¤ºã

[l¡[Î[¤ "¸àA¡àl¡ü–i¡ >}.

[l¡³à“¡ l¡öàóô¡i¡ \à¹ãA¡¹> šøìƒÚ

&>Òü&ó¡[i¡-&¹³à‹¸ì³

³èº‹> &¤} Îåìƒ¹ "ìi¡à [¹[>l¡ü ³èº‹> &¤} šøìƒÚ Îåìƒ¹ "ìi¡à [¹[>l¡ü ³èº‹> &¤} Îåìƒ¹ šå>@šøƒà>

"šàì¹Åì>¹ ë³àl¡ Ñ¬Ú} "š¹ ¤à \ã[¤t¡ ¤¸[v¡û¡ šøàv¡û¡> ¤à \ã[¤t¡ ¤¸[v¡û¡ ƒå\ì> &A¡Îàì=

"[®¡®¡à¤A¡ ë™ ëA¡àì>à &A¡\> ¤à \ã[¤t¡ ¤¸[v¡û¡

[l¡[Î[¤ "¸àA¡àl¡ü–i¡ >}.

[l¡³à“¡ l¡öàóô¡i¡ \à¹ãA¡¹>

&>Òü&ó¡[i¡-&¹³à‹¸ì³šøìƒÚ

Non-callable FD>>-A¡ìº¤º &ó¡[l¡

1. Mandatory to attach a cancelled cheque of the bank account mentioned below / [>³—[º[Jt¡ ¤¸àS¡ "¸àA¡àl¡üì–i¡¹ &A¡[i¡ ¤à[t¡º A¡¹à ìW¡A¡ Î}™åv¡û¡ A¡¹à ¤à‹¸t¡à³èºA¡2. Beneficiary Name (As per Beneficiary’s Bank record - should be same as applicant name): / Ñ¬â«ì®¡àKã¹ >à³ (Ñ¬â«ì®¡àKã¹ ¤¸àS¡ ë¹A¡l¢¡ ">åÎàì¹ - "àì¤ƒ>A¡à¹ã¹ >àì³¹ ">å¹ê¡š Ò*Úà l¡ü[W¡;):

Bank Name: Branch Name:

Instructions for payment of interest & maturity proceeds through NEFT&>Òü&ó¡[i¡-&¹ ³à‹¸ì³ i¡à³¢ [l¡ìšà[\ìi¡¹ \>¸ Îåìƒ¹ "=¢ šøƒà> &¤} ³¸àWå¡[¹[i¡ Î}yû¡à”z [>ìƒ¢Åà¤ºã

This facility is not available

for fixed deposits with

maturity instruction as “Auto Renew Principal &

Pay Interest”[ó¡Gl¡ [l¡ìšà[\i¡

ÎÒ ³¸àWå¡[¹[i¡ [>ìƒ¢Åà¤ºã [ÒìÎì¤ ''"ìi¡à[¹[>l¡ü

[šø[Xšàº &¤} ëš Òü–i¡àì¹Ð¡''-&

&Òü Îå[¤‹à[i¡ l¡üšº§¡ >Ú¡ú

Others (please specify)

Account Type: Savings Current

Overdraft

Account Number:

IFS Code:

Terms and conditions / [>Ú³ &¤} Åt¢¡à¤ºãÎ³èÒ:

I/We abide by the following terms and conditions: 1. It is being understood that the remittance is to be sent at my/our own risk and responsibility and on the distinct understanding that no liability

whatsoever is to be attached to the Bank for any loss or damages arising or resulting from delay in transmission, delivery or non-delivery of the message or for any mistake, exchange or error in

transmission or delivery thereof or in deciphering the message for whatsoever cause or from its misinterpretation when received or the action of the destination Bank or due to RBI (Reserve Bank

of India) RTGS / NEFT system not being available or failure of internal communication system at the recipient bank/branch or incorrect information provided by me/us or any incorrect credit

accorded by the recipient bank/branch due to information provided by me/us or any act or event beyond control or from failure to properly identify the person’s name. 2. I/We understand that the

RTGS / NEFT request is subject to the RBI regulations and guidelines governing the same. 3. I / We agree that the credit will be effected solely on the beneficiary account number information and

beneficiary name particulars will not be used for the same.

"à[³/"à³¹à [>³—[º[Jt¡ Åt¢¡à¤ºã ë³ì> W¡ºì¤à: 1. "à³à¹/"à³àìƒ¹ ì¤à‹K³¸ ÒìÚìá ë™ ìšø[¹t¡ "=¢ "à³à¹/"à³àìƒ¹ [>\Ñ¬ cåò¡[A¡ìt¡ &¤} ƒà[Úìâ« ìšø¹o A¡¹ìt¡ Òì¤ &¤} ìšø¹ìo [¤º´¬ Î}yû¡à”z, ë³ìÎì\¹ [¤t¡¹o ¤à "[¤t¡¹o ¤à ëA¡àì>à ®å¡º Î}yû¡à”z, [¤[>³Ú ¤à

ìšø¹ìo ¤à [¤t¡¹ìo y[i¡ Î}yû¡à”z ¤à ë™ ëA¡àì>à A¡à¹ìo ë³ìÎ\[i¡ šàìk¡à‡àì¹¹ ëÛ¡ìy ¤à šøàœ¡ Ò*Úà¹ šì¹ ë³ìÎ\[i¡¹ ®å¡º ¤¸àJà\[>t¡ ¤à K”z¤¸ ¤¸àìS¡¹ [yû¡Úà ë=ìA¡ ¤à "à¹[¤"àÒü ([¹\à®¢¡ ¤¸àS¡ "ó¡ Òü[“¡Úà) "à¹[i¡[\&Î/&>Òü&ó¡[i¡ [ÎìÐ¡³ NøàÒìA¡¹ ¤¸àS¡/ÅàJàÚ

"à®¡¸”z¹ão ë™àKàì™àK ¤¸¤Ñ‚à¹ ">åš[Ñ‚[t¡ ¤à ¤¸=¢t¡à¹ A¡à¹ìo ¤à "à³à¹/"à³àìƒ¹ ‡à¹à šøƒv¡ ëA¡àì>à ®å¡º t¡ì=¸¹ A¡à¹ìo šøàšA¡ ¤¸àS¡/ÅàJà A¡tõ¢¡A¡ šøàœ¡ ëA¡àì>à ®å¡º ìyû¡[l¡i¡ ¤à ëA¡àì>à "àÒü> ¤à "[>Ú[”|t¡ ëA¡àì>à Qi¡>à¹ \>¸ ¤à ¤¸[v¡û¡[i¡¹ >à³ Î[k¡A¡®¡àì¤ Å>àv¡û¡A¡¹ì>

¤¸=¢t¡à\[>t¡ ëA¡àì>à A¡à¹ìo¹ ó¡ìº ™[ƒ [>\Ñ¬ Û¡[t¡ ¤à ëºàA¡Îà> ÒÚ t¡àÒìº Î}™åv¡û¡ ¤¸àS¡ ëA¡àì>à®¡àì¤ ƒàÚ¤‡ý¡ =àA¡ì¤ >à¡ú2. "à[³/"à³¹à ¤åc¡ìt¡ ëšì¹[á ë™ "à¹[i¡[\&Î/&>Òü&ó¡[i¡ ">åì¹à‹[i¡ "à¹[¤"àÒü-&¹ [¤[‹ &¤} &[i¡ š[¹W¡àº>à¹ [>ìƒ¢Å>à¹ ÎàìšìÛ¡¹

[¤ÈÚ¤Ññ¡ú3. "à[³/"à³¹à Î´¶[t¡ šøƒà> A¡¹[á ë™ ìyû¡[l¡i¡[i¡ ëA¡¤º³ày Ñ¬â«ì®¡àKã "¸àA¡àl¡ü–i¡ >´¬ì¹¹ t¡ì=¸¹ l¡üš¹ šø®¡à¤ ëó¡ºì¤ &¤} Ñ¬â«à[‹A¡à¹ã¹ >à³ [¤¤¹oã¹ \>¸ ¤¸¤Òê¡t¡ Òì¤ >à¡ú

¤¸àìS¡¹ >à³ ÅàJà¹ >à³

"¸àA¡àl¡ü–i¡ >´¬¹ "¸àA¡àl¡üì–i¡¹ ‹¹o ìÎ[®¡}Î A¡àì¹–i¡

"àÒü&ó¡&Î ëA¡àl¡ *®¡à¹l¡öàóô¡i¡ ">¸à>¸ (">åNøÒ A¡ì¹ l¡üìÀJ A¡¹ç¡>)

Òò¸à >à

Preferable for Single & Joint

account holders.

Mandatory for DCB Suraksha

FD&A¡A¡ * ë™ï=

"¸àA¡àl¡ü–i¡‹à¹A¡ìƒ¹ \>¸ '[ZáA¡¡ú [l¡[Î[¤ Îå¹Û¡à &ó¡[l¡-&¹ \>¸ ¤à‹¸t¡à³èºA¡

Name of Father / Mother / Guardian Signature of Father / Mother / Guardian

Minor's Name"šøàœ¡¤ÚÑHþ-&¹

>à³

Declaration where Applicant is Minor / "àì¤ƒ>A¡à¹ã "šøàœ¡¤ÚÑHþ Òìº t¡à¹ [¤¤õ[t¡

I hereby declare that I am the natural guardian / lawful guardian appointed by the Court order dated (copy enclosed) of YYYYMMDD

Master / Miss

I undertake and confirm that I shall avail various services of the Bank (wherever applicable) like Phone Banking, Mobile Banking, Internet Banking, Bill Pay only for the benefit of the minor and I shall abide by all terms and conditions governing the various services and shall intimate the Bank in writing immediately upon the Minor attaining majority. / ëA¡¤º³ày "šøàœ¡¤ÚÑHþ "àì¤ƒ>A¡à¹ã¹ Îå[¤‹àì=¢ šøƒv¡ (šøì™à\¸ ">å™àÚã) ëó¡à> ¤¸à[S¡}, ë³à¤àÒüº ¤¸à[S¡}, Òü–i¡à¹ì>i¡ ¤¸à[S¡}, [¤º šøƒàì>¹ ³t¡ [¤[®¡Ä š[¹ìÈ¤à ¤¸¤Òà¹ A¡¹ì¤à ëÎÒü [¤ÈìÚ "à[³ [>ÆW¡Út¡à &¤} Î´¶[t¡ l¡ü®¡ÚÒü šøƒà> A¡¹[á &¤} "à[³ &ÒüÎ¤ [¤[®¡Ä š[¹ìÈ¤à[ƒ¹ Î³Ñz Åt¢¡à¤ºã ë³ì> W¡ºì¤à &¤} "šøàœ¡¤ÚÑHþ šøàœ¡¤ÚÑHþ Ò*Úà¹ Îàì= Îàì= "[¤ºì´¬ ¤¸àS¡ìA¡ [º[Jt¡®¡àì¤ "¤Kt¡ A¡¹ì¤à¡ú

I shall represent the said minor in operating the Bank Account till he / she attains majority. I agree to indemnify the Bank against any claims for any transactions made in the account(s). / l¡ü[À[Jt¡ "šøàœ¡¤ÚÑHþ "àì¤ƒ>A¡à¹ã ™t¡[ƒ> š™¢”z šøàœ¡¤ÚÑHþ >à ÒìZá t¡t¡[ƒ> "à[³ &Òü "¸àA¡àl¡ü–i¡[i¡ š[¹W¡àº>à A¡¹ì¤à¡ú &Òü "¸àA¡àl¡ü–i¡(Î³èÒ)-& ëA¡àì>à ëº>ìƒì> \>¸ ¤¸àìS¡¹ ëA¡àì>à¹ê¡> Û¡[t¡ Òìº ëÎÒü Û¡[t¡šè¹ìo¹ \>¸ "à[³ ƒàÚ¤‡ý¡ =àA¡ì¤à¡ú

*Customer id:

* Incase Father / Mother / Guardian is an existing customer

šøà=[³A¡ "àì¤ƒ>A¡à¹ã¹ >àì³Òü ëA¡¤º³ày [l¡ìA¡[l¡

ít¡¹ã A¡¹à Òì¤

DKD can be created in the name of the

Primary Applicant only

DCB Diamond Khushiyali Deposit Details / [l¡[Î[¤ l¡àÚ³“¡ Jå[ÅÚà[º [l¡ìšà[\i¡ [¤¤¹oÎ³èÒ

Monthly Instalment Amountšøìt¡¸A¡ ³àìÎ [A¡[Ñz¹ š[¹³ào `

Monthly Instalments tobe collected through

Debit to Account No.

on DD of every month

Maturity Instructions Transfer to DCB A/c No.:

¤[¹Ë¡ >àK[¹A¡ Î}yû¡à”z Îå[¤‹à

šà*Úà¹ \>¸ \–µ t¡à[¹ìJ¹ ([l¡*[¤) šø³àošy "à¤Å¸A¡¡ú

Date of Birth (DOB) proof required to

avail benefits for Senior Citizens.

Deposit Period Days Months Years (Deposit period is minimum 14 days and maximum 10 years)

Interest Rate . %Senior Citizen Yes No

Mode of Operation Self Either or SurvivorJointly

Others: (Please Specify)

Former or Survivor Guardian

\³àA¡¹ì>¹ ë³Úàƒ [ƒ> ³àÎ ¤á¹ ([l¡ìšà[\ìi¡¹ ë³ÚàƒA¡àº >è>¸t¡³ 14 [ƒ> ì=ìA¡ Îì¤¢àZW¡ 10 ¤á¹)

¤[¹Ë¡ >àK[¹A¡ Òò¸à >à Îåìƒ¹ Òà¹

³à[ÎA¡ [A¡[Ñz Î}NøÒ A¡¹à¹ ³à‹¸³"¸àA¡àl¡ü–i¡ >´¬ì¹ ël¡[¤i¡A¡¹>

t¡à[¹ìJ šø[t¡ ³àìÎ¹

³¸àWå¡[¹[i¡ [>ìƒ¢Åà¤ºã [l¡[Î[¤ "¸àA¡àl¡ü–i¡ >}.-& i¡öàXó¡à¹

"šàì¹Åì>¹ ë³àl¡ Ñ¬Ú} ƒå\ì> &A¡Îàì= "š¹ ¤à \ã[¤t¡ ¤¸[v¡û¡ šøàv¡û¡> ¤à \ã[¤t¡ ¤¸[v¡û¡ "[®¡®¡à¤A¡

">¸à>¸: (">åNøÒ A¡ì¹ [>[ƒ¢Ê¡ A¡¹ç¡>)

"à[³ &t¡‡à¹à [¤¤õ[t¡ šøƒà> A¡¹[á ë™ t¡à[¹ìJ¹ "àƒàºìt¡¹ "àìƒÅ ">å™àÚã [>™åv¡û¡ Îà‹à¹o "[®¡®¡à¤A¡ / "àÒü>ã "[®¡®¡à¤A¡

Aå¡³à¹ / Aå¡³à¹ã

(">å[º[š¹ Îàì= Î}™åv¡û¡)

*NøàÒA¡ "àÒü[l¡

*™[ƒ [št¡à / ³àt¡à / "[®¡®¡à¤A¡ &A¡\> [¤ƒ¸³à> NøàÒA¡ Ò>

[št¡à / ³àt¡à / "[®¡®¡à¤A¡-&¹ >à³ [št¡à / ³àt¡à / "[®¡®¡à¤A¡-&¹ Ñ¬àÛ¡¹

Thumb impression isrequired to be

attested by2 witnesses.

In case of signature, no

witness isrequired.

[i¡šÎÒü-&¹ ëÛ¡ìy 2 \> ÎàÛ¡ã¹ ‡à¹à Ît¡¸à[Út¡ Ò*Úà

šøìÚà\>¡ú ™[ƒ Ñ¬àÛ¡¹ A¡¹à ÒÚ, t¡àÒìº ëA¡àì>à ÎàÛ¡ã¹ šøìÚà\> ë>Òü¡úSignature(s) / Thumb Impression(s) of depositor(s)

\³àA¡t¢¡à(Ko)-&¹ Ñ¬àÛ¡¹(Î³èÒ) / [i¡š ÎÒü (Î³èÒ)

Nominationunder Section45ZA of the

BankingRegulation Act, 1949

and Rule 2(1) ofthe Banking Companies (Nomination) Rules 1985 in

respect of bankdeposits.

¤¸à[S¡} ë¹P¡ìºÅ> "àÒü>, 1949-&¹ ‹à¹à 45ë\l¡&-&¹ "‹ã>Ñ‚ &¤} ¤¸à[S¡}

ëA¡à´šà>ã\ (³ì>à>Ú>) "àÒü> 1985-&¹ ¤¸àS¡ [l¡ìšà[\i¡Î³èìÒ¹ "‹ã>Ñ‚ [¤ÈÚ Òº

>[³ì>Å>¡ú

YRelationship with Applicant, if any

YYYMMDDDate of Birth:YearsAge:

* As the nominee is a minor on this date, I / we appoint (Name & Address)

to receive the amount of the deposit / in the account on behalf of the nominee in the event of my /our death during the minority of the nominee.³ì>à>ãt¡ ¤¸[v¡û¡¹ >à¤àºA¡ "¤Ñ‚àÚ "à³à¹/"à³àìƒ¹ ³õtå¡¸ Òìº ³ì>à>ãt¡ ¤¸[v¡û¡¹ šÛ¡ ë=ìA¡ \³àAõ¡t¡/"¸àA¡àl¡üì–i¡ Î[e¡t¡ "=¢¹à[Å šøàœ¡ A¡¹ìt¡ šà¹ì¤>¡ú

In case you have specified a nominee above, please indicate if you wish to make mention of the nominee name on the passbook, statement & DCA issued in respect of your account and / or the passbook issued to you"àš[> ™[ƒ l¡üšì¹ >[³[> [ÒÎàì¤ ëA¡àì>à ¤¸[v¡û¡ìA¡ [>‹¢à¹o A¡ì¹ =àìA¡> t¡àÒìº "àš>à¹ "¸àA¡àl¡ü–i¡ &¤}/"=¤à "àš>à¹ \>¸ \à¹ã A¡¹à šàÎ¤åA¡ Î´š[A¢¡t¡ [¤ÈìÚ ë™³> \à¹ãAõ¡t¡ šàÎ¤åA¡, [¤¤õ[t¡ &¤} [l¡[Î&-ìt¡ >[³[>¹ >à³ l¡üìÀJ A¡¹ìt¡ W¡à> [A¡>à ">åNøÒ A¡ì¹ t¡à [>ìƒ¢Å A¡¹ç¡>¡ú

I / We do hereby declare that what is stated above is true to the best of my / our knowledge and belief."à[³/"à³¹à &t¡‡à¹à ëQàÈoà A¡¹[á ë™ l¡üšì¹ ¤[o¢t¡ Î³Ñz t¡=¸à¤ºã "à³à¹/"à³àìƒ¹ `¡à> &¤} [¤Å«àÎ ">å™àÚã Ît¡¸¡ú

Yes No

"àì¤ƒ>A¡à¹ã¹ Îàì= Î´šA¢¡, ™[ƒ =àìA¡ ¤ÚÎ ¤á¹ \–µ t¡à[¹J

* &Òü t¡à[¹ìJ >[³[> &A¡\> >à¤àºA¡ Ò*ÚàÚ "à[³/"à³¹à [>ìÚàK A¡¹[á (>à³ * [k¡A¡à>à)

Òò¸à >à

Nomination Details (Form DA 1) / ³ì>à>Úì>¹ [¤¤¹o (ó¡³¢ [l¡& 1)Yes, I / we want to nominate the following person No, I / we do not want to nominate anyone

Address:

Nominee Name:

I / we nominate the following person to whom in the event of my / our / minor’s death the amount of the deposit / in the account may be returned by DCB Bank Limited / "à[³/"à³¹à [>³—[º[Jt¡ ¤¸[v¡û¡ìA¡ ³ì>à>ãt¡ A¡¹[á ™àìA¡ "à³à¹/"à³àìƒ¹/>à¤àºìA¡¹ "¤t¢¡³àì> ¤à ³õtå¡¸¹ ëÛ¡ìy \³àAõ¡t¡ "=¢¹à[Å/"¸àA¡àl¡ü–i¡[i¡ šøt¡¸š¢o A¡¹ìt¡ šàì¹ [l¡[Î[¤ ¤¸àS¡ [º[³ìi¡l¡

Òò¸à, "à[³ [>³—[º[Jt¡ ¤¸[v¡û¡ìA¡ ³ì>à>ãt¡ A¡¹ìt¡ W¡àÒü >à, "à[³ ëA¡àì>à ¤¸[v¡û¡ìA¡ ³ì>à>ãt¡ A¡¹ìt¡ W¡àÒü >à

>[³[>¹ >à³

[k¡A¡à>à

8

Yes No Interest Rate % per annumÎåìƒ¹ Òà¹ šø[t¡ ¤á¹Òò¸à >à

9

*Strike out if nominee is not a minor. ** Where deposit is made / account is held in the name of the minor the nomination should be signed by a person lawfully entitled to act on behalf of the minor.

Witness(es) / ÎàÛ¡ã(Ko):

Name:

Signature:

Address:

Place: Date:

>à³

Ñ¬àÛ¡¹

[k¡A¡à>à

Ñ‚à> t¡à[¹J

Risk Classification for Primary Applicant / ³åJ¸ "àì¤ƒ>A¡à¹ã¹ \>¸ còå¡[A¡¹ ìÅøoã[¤>¸àÎ* Kindly fill the following details: / ">åNøÒ A¡ì¹ [>³—[º[Jt¡ [¤¤¹oP¡[º šè¹o A¡ì¹:

Basis of Categorisation: Politically Exposed Person Domiciled in Risk Country Trust Sleeping Partner

High Risk Profession Others (Please specify):

Information: Politically Exposed Person due to position / status as:

If Domiciled in Risk Country - Country Name:

Nature of Business / Occupation:

*Details of Customer’s Source of Funds & Estimated Net Worth: / NøàÒìA¡¹ ó¡à“¡Î³èìÒ¹ l¡ü;Î &¤} t¡à¹ ë³ài¡ ³èº¸ Î´š[A¢¡t¡ [¤¤¹o

Income from Employment Income from Business Income from Investments Inherited Funds

Others (Please specify):

Expected Annual Turnover (`): Upto ` 1 Lakh Upto ` 10 Lakhs Upto ` 50 Lakhs Upto ` 1 Crore

Upto ` 5 Crores Upto ` 10 Crores Upto ` 25 Crores More than ` 25 Crores

Risk Classification of Account (L / M / H):

1 ºÛ¡ i¡àA¡à š™¢”zšøt¡¸à[Åt¡ ¤à[È¢A¡ i¡à>¢*®¡à¹ (i¡àA¡à)

5 ëA¡à[i¡ i¡àA¡à š™¢”z

10 ºÛ¡ i¡àA¡à š™¢”z





25 ëA¡à[i¡ i¡àA¡à¹ "[‹A¡

ìÅøoã¤‡ý¡A¡¹ìo¹ [®¡[v¡ ¹à\î>[t¡A¡®¡àì¤ š[¹[W¡t¡ ¤¸[v¡û¡ cåò¡[A¡šèo¢ ëƒìÅ [>¤àÎ i¡öàÐ¡ [ÑÃ[š} šài¢¡>à¹

l¡üZW¡ cåò¡[A¡¹ ëšÅà / A¡à™¢ ">¸à>¸ (">åNøÒ A¡ì¹ l¡üìÀJ A¡¹ç¡>)

t¡=¸

™[ƒ cåò¡[A¡šèo¢ ëƒìÅ [>¤àÎ ÒÚ - ëƒìÅ¹ >à³

¤¸¤Îà¹ ‹¹o / \ã[¤A¡à

[Ñ‚[t¡ / "¤Ñ‚àì>¹ A¡à¹ìo ¹à\î>[t¡A¡®¡àì¤ š[¹[W¡t¡ ¤¸[v¡û¡

A¡³¢Î}Ñ‚à> ë=ìA¡ "àÚ ¤¸¤Îà ë=ìA¡ "àÚ [¤[>ìÚàKÎ³èÒ ë=ìA¡ "àÚ l¡üv¡¹à[‹A¡à¹ Îèìy šøàœ¡ ó¡à“¡Î³èÒ

">¸à>¸ (">åNøÒ A¡ì¹ l¡üìÀJ A¡¹ç¡>)

"¸àA¡àl¡üì–i¡¹ còå¡[A¡¹ ìÅøoã[¤>¸àÎ ([>³— / ³‹¸³ / l¡üZW¡)

Risk Classification for Joint Applicant 1 / ë™ï= "àì¤ƒ>A¡à¹ã 1-&¹ còå¡[A¡¹ ìÅøoã[¤>¸àÎ

Risk Classification for Joint Applicant 2 / ë™ï= "àì¤ƒ>A¡à¹ã 2-&¹ còå¡[A¡¹ ìÅøoã[¤>¸àÎ

* >[³[> ™[ƒ šøàœ¡¤ÚÑHþ ÒÚ t¡àÒìº ëA¡ìi¡ [ƒ>¡ú ** >à¤àºìA¡¹ >àì³ "¸àA¡àl¡ü–i¡[i¡/ì™Jàì> \³à A¡¹à ÒìÚìá ëÎJàì> >[³[>¹ ëÛ¡ìy >à¤àºìA¡¹ šÛ¡ ë=ìA¡ "àÒü>à>åK "[‹A¡à¹šøàœ¡ ¤¸[v¡û¡¹ Ñ¬àÛ¡¹ A¡¹ìt¡ Òì¤¡ú

Name:

Signature:

Address:

Place: Date:

>à³

Ñ¬àÛ¡¹

[k¡A¡à>à

Ñ‚à> t¡à[¹J

* Kindly fill the following details: / ">åNøÒ A¡ì¹ [>³—[º[Jt¡ [¤¤¹oP¡[º šè¹o A¡ì¹:



















25 ëA¡à[i¡ i¡àA¡à¹ "[‹A¡



t¡=¸


¤¸¤Îà¹ ‹¹o / \ã[¤A¡à





* Kindly fill the following details: / ">åNøÒ A¡ì¹ [>³—[º[Jt¡ [¤¤¹oP¡[º šè¹o A¡ì¹:



















25 ëA¡à[i¡ i¡àA¡à¹ "[‹A¡



t¡=¸


¤¸¤Îà¹ ‹¹o / \ã[¤A¡à





10

Letter From Customer – Opening of “NO FRILL” Accounts in “VALUE SAVINGS SCHEME” under relaxed KYC Norms

NøàÒìA¡¹ šÛ¡ ë=ìA¡ šy - ëA¡*ÚàÒü[Î [>Úì³¹ áàìØl¡¹ "à*t¡àÚ ''®¡¸àºå ëÎ[®¡}Î ÑHþã³''-& ''ìA¡àì>à [óø¡º'' "¸àA¡àl¡ü–i¡ ëJàºà Òì¤ >à

"à[³ / "à³¹à ÎìW¡t¡> &¤} Î´¶[t¡ šøƒà> A¡¹[á ë™ "à³à¹ / "à³ìƒ¹ "¸àA¡àl¡üì–i¡¹ Îà³[NøA¡ ëyû¡[l¡i¡ ™[ƒ [¹\à®¢¡ ¤¸àS¡ "ó¡ Òü[“¡Úà ‡à¹à [>‹¢à[¹t¡ Îã³à "[t¡yû¡³ A¡ì¹, t¡àÒìº "à[³ / "à³¹à ëÎÒü Î³ìÚ šøì™à\¸ Î´šèo¢ ëA¡*ÚàÒü[Î

>ã[t¡³àºà ">åÎ¹o A¡¹à¹ \>¸ Î´¶[t¡ šøƒà> A¡¹[á &¤} [>ÆW¡Út¡à šøƒà> A¡¹[á ë™ ¤¸àS¡ ë™Òü [¤ÈìÚ ¤¸=¢ ÒìÚìá "à[³ / "à³¹à ëÎÒü [¤ÈìÚ ¤¸àìS¡¹ šøìÚà\>ãÚt¡à ">å™àÚã Î³Ñz [\[>Î ë³ì> W¡ºì¤à &¤} 15 [ƒì>¹ ë>à[i¡Å šøƒà> A¡ì¹

¤¸àS¡ A¡à™¢yû¡³[i¡ Ñ‚[Kt¡ ¤à "¸àA¡àl¡ü–i¡ ¤Þê¡ A¡ì¹ ëƒ*Úà¹ "[‹A¡à¹ Î}¹Û¡o A¡ì¹¡ú

The Branch Manager / ÅàJà ¤¸¤Ñ‚àšA¡

Yours faithfully / "àš>à¹ Ç¡®¡à>å‹¸àÚã,

Sir / Madam / ³ÒàÅÚ / ³ÒàÅÚà,

___________________________________

____________________ Branch / ÅàJà

(Signature of the Customer / )"àì¤ƒ>A¡à¹ã¹ Ñ¬àÛ¡¹

DCB Bank Limited / [l¡[Î[¤ ¤¸àS¡ [º[³ìi¡l¡

I / We am / are aware and agree that if the balance in my / our account and / or the aggregate credits in my / our account exceed/s the limits specified by

Reserve Bank of India, I/we agree to be subjected to full KYC norms applicable at that point of time and affirm that I/we shall comply with the same as per

requirements of the Bank failing which, the Bank has the right to suspend the operations or close the account by giving a notice of 15 days.

I am / We are aware of the risks that would arise due to receipt of customer deliverables at the corporate address by any unauthorised person and I / we shall not hold

the Bank responsible and liable for any loss or damage that I / we may suffer, due to the Bank recording and treating the corporate address of my / our company as my

/ our mailing address. / ëA¡àì>à ">>åì³à[ƒt¡ ¤¸[v¡û¡¹ ‡à¹à A¡ìš¢àì¹i¡ [k¡A¡à>àÚ NøàÒA¡ [¤t¡¹oì™àK¸ Î¹¤¹àìÒ¹ ó¡ìº l¡üŠ±ét¡ còå¡[A¡Î³èÒ Î´šìA¢¡ "à[³ / "à³¹à "¤Kt¡ ÒìÚ[á &¤} "à[³ "à³¹à ëA¡àì>à Û¡[t¡ ¤à ëºàA¡Îàì>¹

\>¸ ¤¸àS¡ìA¡ ƒàÚ¤‡ý¡ A¡¹ì¤à >à, ¤¸àS¡ >[=šy Î}¹Û¡ìo¹ \>¸ "à³à¹ / "à³àìƒ¹ Î}Ñ‚à¹ A¡ìš¢àì¹i¡ [k¡A¡à>à[i¡ìA¡ "à³à¹ / "à³àìƒ¹ šyìšø¹ìo¹ [k¡A¡à>à [ÒìÎì¤ Î}¹[Û¡t¡ A¡¹ì¤¡ú

The Branch Manager / ÅàJà ¤¸¤Ñ‚àšA¡


Letter From Customer – Opening of Corporate Payroll Account with Mailing Address as Office Address

NøàÒìA¡¹ šÛ¡ ë=ìA¡ šy - "[ó¡ìÎ¹ [k¡A¡à>à¹ ">å¹ê¡š šyìšø¹ìo¹ [k¡A¡à>à ë¹ìJ &A¡[i¡ A¡ìš¢àì¹i¡ ëšì¹àº "¸àA¡àl¡ü–i¡ Jåºìt¡ ÒüZáåA¡

____________________ Branch / ÅàJà

Yours faithfully / "àš>à¹ Ç¡®¡à>å‹¸àÚã,

Sir / Madam / ³ÒàÅÚ / ³ÒàÅÚà,

___________________________________

(Signature/s of the Customer/s / )NøàÒA¡/Ko-&¹ Ñ¬àÛ¡¹/Î³èÒ


Declaration Regarding Signing in Vernacular Language / By Illiterate / Visually Challenged Person

___________ ___________ ___________ ___________

³àtõ¡®¡àÈàÚ / [>¹Û¡¹ ‡à¹à / ƒõ[Ê¡Òã> ¤¸[v¡û¡-&¹ ‡à¹à Ñ¬àÛ¡¹ Î´š[A¢¡t¡ [¤¤õ[t¡

Name and signatures of Applicants Name and signature of the Declarant / "àì¤ƒ>A¡à¹ã¹ >à³ &¤} Ñ¬àÛ¡¹ &¤} ëQàÈìA¡¹ >à³ &¤} Ñ¬àÛ¡¹

Date / :_____________ Place / :_____________t¡à[¹J Ñ‚à>

I, Mr./Ms._________________________________________________________________ (the Declarant - either Bank Official or customer of Bank) have read out and

explained the contents of this Account Opening Form of DCB Bank Limited (the Bank) to the Applicant(s) Mr. / Ms. ____________________________________________

in _____________________________ language and he / she / they have confirmed that he / she / they has / have understood the same and have agreed to abide by all

the terms and conditions of the said Account Opening Form. Pursuant to the same the aforesaid Applicant(s) is / are affixing his / her / their signature(s)/thumb

impression(s) as given herein below: _________________________________________________________________ / "à[³, Åøã/Åøã³t¡ã (ìQàÈA¡ - ¤¸àS¡ "[ó¡[ÎÚàº ¤à ¤¸àìS¡¹ NøàÒA¡)

"àì¤ƒ>A¡à¹ã(Ko) Åøã/Åøã³t¡ã ____________________ ìA¡ [l¡[Î[¤ ¤¸àS¡ [º[³ìi¡l¡ (¤¸àS¡)-&¹ &Òü "¸àA¡àl¡ü–i¡ ëJàºà¹ ó¡³¢[i¡¹ [¤ÈÚ¤Ññ Î´šìA¢¡ _________________________________________

_____________________________ ®¡àÈàÚ "¤Kt¡ A¡ì¹[á &¤} t¡à¹ ¤¸àJà šøƒà> A¡ì¹[á &¤} [t¡[> / t¡à¹à [>[ÆW¡t¡ A¡ì¹ìá> ë™ [t¡[> / t¡à¹à ëÎP¡[º ¤åc¡ìt¡ ëšì¹ìá> &¤} l¡ü[À[Jt¡ "¸àA¡àl¡ü–i¡ ëJàºà¹ ó¡ì³¢¹ Î³Ñz

Åt¢¡à¤ºã ì³ì> W¡ºà¹ \>¸ Î´¶[t¡ šøƒà> A¡ì¹ìá>¡ú l¡üšì¹àv¡û¡ "àì¤ƒ>A¡à¹ã(Ko) [>ì³— &Jàì> ¤[o¢t¡ ">å™àÚã t¡à¹ / t¡àìƒ¹ Ñ¬àÛ¡¹(Î³èÒ) / [i¡šÎÒü(Î³èÒ) šøƒà> A¡ì¹ìá> / Î}™åv¡û¡ A¡ì¹ìá>:

Declaration / [¤¤õ[t¡

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Ît¡¸, Î[k¡A¡, Î´šèo¢ &¤} "àš-iå¡-ìl¡i¡ Òìt¡ Òì¤¡ú(c¡) &Òü \àt¡ãÚ "à¹* "àì¤ƒ>Î³èìÒ¹ \>¸ t¡=¸ š[¹W¡àº>à¹ Îå[¤‹àì=¢ "àì¤ƒì>¹ ó¡³¢ >´¬¹ &¤} / "=¤à ¤¸àS¡ [>‹¢à[¹t¡ [¤¤¹o "”z®å¢¡v¡û¡ A¡¹ìt¡ Òì¤¡ú(d¡) "à³àìA¡ / "à³àìƒ¹ìA¡ &A¡[i¡ ël¡[¤i¡ A¡à³ &[i¡&³ A¡àl¢¡ \à[¹ A¡¹à¹ \>¸ ¤¸àS¡ìA¡ "à[³ / "à³¹à ">åì³à[ƒt¡ A¡¹[á¡ú(i¡) ël¡[¤i¡ A¡à³ &[i¡&³ A¡àìl¢¡¹ \à[¹A¡¹o &¤} ¤¸¤Òà¹ Î³Úà>å™àÚã šøìÚàK\[>t¡ Åt¢¡à¤ºã ‡à¹à [>Ú[”|t¡ Òì¤ &¤} "à[³ / "à³¹à &¹ ‡à¹à "à¤‡ý¡ Òìt¡ Î´¶t¡¡ú (k¡) &Òü ël¡[¤i¡ A¡à³ &[i¡&³ A¡àìl¢¡¹ [>Ú³ &¤} Åt¢¡à¤ºã Î³Úà>å™àÚã Î}ìÅà‹> A¡¹à¹ \>¸ ¤¸àS¡ ƒàÚ¤‡ý¡¡ú (l¡) "à[³ / "à³¹à Åt¢¡Òã> &¤} "A¡ài¡¸®¡àì¤ ¤¸àS¡ìA¡ ">åì³àƒ> [ƒ[Zá ë™, "à³à¹ / "à³àìƒ¹ "¸àA¡àl¡üì–i¡ ël¡[¤i¡ A¡à³ &[i¡&³ A¡àl¢¡ ¤¸¤Òàì¹¹ \>¸ [ó¡ &¤} W¡àì\¢¹ Î³tå¡º¸ "=¢¹à[Å ¤à[È¢A¡®¡àì¤ "à³à¹ "¸àA¡àl¡ü–i¡ ì=ìA¡ ël¡[¤i¡ A¡¹ìt¡ šàì¹¡ú(n¡) "à[³ / "à³¹à, ë™ï= ‹à¹A¡(¹à), Î´¶[t¡ šøƒà> A¡¹[á ë™ ë™ï= "à³à>t¡A¡à¹ã¹ &A¡ ¤à &A¡à[‹ìA¡¹ ³õtå¡¸¹ ëÛ¡ìy, \ã[¤t¡ "à³>t¡A¡¹ã(ìƒ¹)ìA¡ Îe¡Úã®è¡t¡ "=¢¹à[Å, ">åì¹à‹ A¡¹à Òìº šø[yû¡Úà¹ ë³àl¡ ">å™àÚã [>‹¢à[¹t¡ ë³Úàƒ Î´šèo¢ Ò*Úà¹ šèì¤¢Òü šøƒà> A¡¹à ë™ìt¡ šàì¹¡ú &ìÛ¡ìy [>Ú”|A¡ [>ìƒ¢[ÅA¡à ¤à [¤[Î&Î[¤"àÒü ëA¡àìl¡¹ [¤‹à> ¤à l¡ü®¡Ú ">å™àÚã, ">åì¹àì‹¹ t¡à[¹ìJ¹ ÎàìšìÛ¡, ™[ƒ šøì™à\¸ ÒÚ, t¡àÒìº ¤¸àS¡ \[¹³à>à W¡à\¢Î³èÒ "àƒàÚ A¡¹ìt¡ šàì¹¡ú(o) &A¡³ày ¤¸àìS¡¹ [¤ì¤W¡>à¹ [®¡[v¡ìt¡ ¤¸àìS¡¹ Îàì= "¸àA¡àl¡üì–i¡¹ ‹à¹à¤à[ÒA¡t¡à &¤} ™[ƒ "¸àA¡àl¡ü–i¡ / "¸àA¡àl¡ü–i¡ ‹à¹ìA¡¹ "àW¡¹o Î´šìA¢¡ ¤¸àS¡ "à³àìA¡ / "à³àìƒ¹ &A¡ ³àìÎ¹ ë>à[i¡Î šøƒà> A¡¹à¹ šì¹ "¸àA¡àl¡ü–i¡[i¡ ¤Þê¡ A¡¹à¹ ¤à Î³Ñz áàØl¡ šøt¡¸àÒà¹ A¡¹à¹ "[‹A¡à¹ ¹Û¡à A¡ì¹ ¤à "à³àìA¡ / "à³àìƒ¹ ëƒ*Úà ëA¡àì>à š[¹ìÈ¤à ¤à &Òü \àt¡ãÚ š[¹ìÈ¤à¹ \>¸ šøì™à\¸ Òàì¹ W¡à\¢Î³èÒ ¤¸àS¡ ƒà¤ã A¡¹ìt¡ šàì¹¡ú(t¡) ¤¸àS¡ t¡à¹ Î´šèo¢ [¤ì¤W¡>à¹ [®¡[v¡ìt¡, "à³àìA¡ / "à³àìƒ¹ ëA¡à>* [¤`¡[œ¡ šøƒà> áàØl¡àÒü ëA¡à>* š[¹ìÈ¤à Î´šèo¢ ¤à "à}[ÅA¡®¡àì¤ ¤Þê¡ A¡ì¹ [ƒìt¡ šàì¹¡ú(=) ë™ ëA¡à>* A¡à¹ìo "¸àA¡àl¡ü–i¡ ëJàºà \>¸ "=¢¹à[Å¹ š[¹³ào (&*&) Î}yû¡à”z ëW¡A¡ ëó¡¹ìt¡¹ ëÛ¡ìy, ¤¸àS¡ "à³à¹ / "à³àìƒ¹ ëA¡à>* ë¹ó¡àì¹X áàØl¡àÒü "¸àA¡l¡ü–i¡[i¡ ¤Þê¡ A¡ì¹ ëƒì¤ ¤à [ƒìt¡ šàì¹¡ú(ƒ) ë™ ëA¡àì>à ">åì³à[ƒt¡ Ñ¬àÛ¡¹A¡à¹ã(Ko) &¤} / "=¤à "à³àìƒ¹ \ã[¤t¡ ¤à ë¤òìW¡ =àA¡à A¡àì¹à A¡àá ë=ìA¡ [º[Jt¡ "àì¤ƒ> šøà[œ¡¹ šì¹, ¤¸àS¡ t¡à¹ [>\Ñ¬ [¤ì¤W¡>à¹ [®¡[v¡ìt¡ &¤} &Òü \àt¡ãÚ [>Ú³ &¤} Åt¢¡à¤ºã¹ ÎàìšìÛ¡, ë™ï= >àì³¹ [¤¹ç¡ì‡ý¡ ̃ ¡o / "[Nø³ / šå>>¢¤ãA¡¹> / Îå¹Û¡à¹ l¡üÄt¡A¡¹> Î³à”z¹àº®¡àì¤ \à[¹ A¡¹ìt¡ šàì¹¡ú(‹) [l¡[Î[¤ - "> ƒ¸ ëKà Îå[¤‹à[i¡ Ñ¬t¡”|®¡àì¤ š[¹W¡à[ºt¡ "à¤à[ÎA¡ "¸àA¡àl¡üì–i¡¹ ëÛ¡ìy šøƒà> A¡¹à Òì¤, ë™ï= "¸àA¡àl¡üì–i¡¹ ëÛ¡ìy &Òü Îå[¤‹à[i¡ l¡üšº§¡ Òì¤ >à¡ú(>) &Òü [l¡[Î[¤ ë³à¤àÒüº ¤¸à[S¡} ">à¤à[ÎA¡ "¸àA¡àl¡ü–i¡P¡[º¹ ëÛ¡ìy* šøì™à\¸ >Ú¡ú(š) "à[³ / "à³¹à &t¡‡à¹à "à¹* ¤åc¡ìt¡ ìšì¹[á ë™ ">¸à>¸

Î³Ñz [\[>ìÎ¹ ³ì‹¸ [¤[®¡Ä ÑHþã³ ëA¡àìl¡¹ "à*t¡àÚ ëÎ[®¡}Î ¤¸àS¡ "¸àA¡àl¡üì–i¡¹ [¤A¡¿P¡[º¹ ìÛ¡ìy >è>¸t¡³ ¤¸àìºìX¹ šøìÚà\>ãÚt¡à šøì™à\¸ Òì¤ &¤} ¤¸àìS¡¹ *ìÚ¤ÎàÒüìi¡ Î³Úà>å™àÚã l¡üšº§¡ www.dcbbank.com "àšìl¡i¡Aõ¡t¡ t¡ì=¸¹ Îàì= ÎU[t¡šèo¢ Òì¤¡ú(ó¡) "à[³ / "à³¹à Î´¶[t¡ šøƒà> A¡¹[á ë™ &Òü¹ê¡ìš [l¡ìšà[\i¡/Î³èìÒ¹ ë³Úàƒ ëÅÈ Ò*Úà¹ šèì¤¢ >>-A¡ìº¤º [l¡ìšà[\i¡/Î³èÒ "à³à¹ / "à³àìƒ¹ ‡à¹à ¤Þê¡ A¡¹à ™àì¤ >à¡ú(¤) [l¡[Î[¤ ¤¸àS¡ "àÚA¡¹ [¤‹à> ">å™àÚã šøì™à\¸ [i¡[l¡&Î (A¡¹ áàìØl¡¹ l¡ü;Î) ëA¡ìi¡ ë>ì¤ &Òü [¤ÈìÚ "à[³ / "à³¹à Î´¶[t¡ šøƒà> A¡¹[á¡ú

"à[³ / "à³¹à ¤åc¡ìt¡ ëšì¹[á &¤} Î´¶[t¡ šøƒà> A¡¹[á ë™ [¤>à³èìº¸ ë³à¤àÒüìº Ît¡A¢¡t¡à Îå[¤‹à¹ \>¸ "àšìl¡i¡ / [>¤Þê¡A¡¹o / ">åì¹àì‹¹ \>¸ šøƒv¡ Î´¶[t¡[i¡ "à[³ / "à³¹à [º[Jt¡®¡àì¤ šøt¡¸àÒà¹ >à A¡¹à š™¢”z î¤‹ =àA¡ì¤¡ú [>[ƒ¢Ê¡¹ê¡ìš "¤Kt¡ >à A¡¹à Òìº, ¤¸àS¡ ó¡à³¢ / ëA¡à´šà>ã / i¡öàÐ¡ / "¸àìÎà[ÎìÚÅ> / ëÎàÎàÒü[i¡-&¹ ">åì³à[ƒt¡ Ñ¬àÛ¡¹A¡à¹ã/Ko-&¹ ">åì¹à‹Aõ¡t¡ >´¬ì¹ &Î&³&Î Ît¡A¢¡t¡àÎ³èÒ ìšø¹o A¡¹ìt¡ =àA¡ì¤¡ú >à³/ Î³èÒ, [k¡A¡à>à, ë³à¤àÒüº >´¬¹, ">åì³à[ƒt¡ Ñ¬àÛ¡¹A¡à¹ã/Ko ¤à "}Åãƒà¹ ¤à š[¹W¡àºA¡ ¤à i¡öà[Ð¡ ¤à ó¡à³¢ / ìA¡à´šà>ã / i¡öàÐ¡ / "¸àìÎàà[ÎìÚÅ> / ëÎàÎàÒü[i¡-&¹ ÎƒÎ¸ìƒ¹ š[¹¤t¢¡ì>¹ ó¡ìº ë™ ëA¡àì>à ìA¡àì>à¹ê¡š š[¹o[t¡¹ \>¸ ¤¸àìS¡¹ ëA¡àì>à¹ê¡š ƒàÚ®¡à¹ &¤} ƒàÚ¤‡ý¡t¡à =àA¡ì¤ >à¡ú"à[³ / "à³¹à [¤¤õ[t¡ šøƒà> A¡¹[á, [>ÆW¡Út¡à šøƒà> A¡¹[á, ¤åc¡ìt¡ ëšì¹[á, Ñ¬ãA¡à¹ A¡¹[á &¤} Î´¶[t¡ šøƒà> A¡¹[á:

I / We declare, confirm, understand, accept, acknowledge and agree:

I / We have read, understood and hereby agree to the terms and conditions as applicable to my / our account” set forth on DCB Bank Limited (“the Bank”) website at

www.dcbbank.com. I / We understand that access to any changes / updates in terms and conditions applicable to this relationship shall be available on the Bank's website

only. I / We do hereby declare that information furnished in this Form is true and correct to the best of my / our knowledge and belief. I / We hereby authorize issuance of ATM /

Debit Card and provision of Phone Banking, Mobile Banking Services, Internet Banking and Bill Payment Services. I / We am / are aware of charges applicable for various

services offered and I / we affirm, confirm and undertake that I / we have read and understood the “Terms and Conditions” for usage of the Phone Banking, Mobile Banking

Services, Internet Banking and Bill Payment Services of DCB Bank as set forth in the Bank's website www.dcbbank.com and I / We will adhere to all the terms and conditions

as applicable from time to time. I / We further authorize the Bank to debit my / our Account(s) towards any applicable charges for any / various service / services provided as

applicable from time to time. In the absence of maturity instructions, the deposit will be auto-renewed with the same tenure at the prevailing interest rates with the applicable

terms and conditions.

I / We understand and agree that the consent given for updation / registration / requests for free Mobile alert facility shall be valid till such time I / we withdraw the same in

writing. Unless specifically advised, the Bank will continue to send SMS alerts on the number requested by the authorised signatory/ies of the Firm / Company / Trust /

Association / Society. The Bank shall not be responsible and liable for any consequences which may arise owing to change in name/s, address, mobile number of individual,

authorized signatory/ies or partners or directors or trustees or members of the Firm / Company / Trust / Association / Society.

(a)That all the particulars and information given in this application form (and all documents referred or provided therewith) are true, correct, complete and up-to-date in all

respects and I / We have not withheld any information. I / We understand certain particulars given by me / us are required by the operational guidelines governing banking

companies. I / We agree and undertake to provide any further information as and when the Bank may require. (b) That I / we have had no insolvency proceedings initiated

against me / us nor I / we have ever been adjudicated insolvent. (c) That I / we have read the application form and brochures and am aware of all the terms and conditions of

availing finance or service or products from the Bank. (d) That the Bank reserves the right to reject any application without providing any reason and reference to me / us. I /

We agree and understand that the Bank reserves the right to retain the application forms, and the documents provided therewith, including photographs, and shall not return

the same to me / us. (e) To inform the Bank regarding change in my residence /employment and to provide any further information as and when the Bank may require from

time to time. (f) That if the Account is under corporate salary scheme: I / We have also read and understood “Terms and Conditions” under which Salary Scheme is offered to

my / our organization and employees. I / We agree that my / our employer has full right to reserve any instruction given by them to credit my account for any amount within a

period of three working days and I / we will not dispute or hold the Bank responsible for such debits in my / our account. I / We understand that it is my / our responsibility to

inform (in writing) the Bank immediately on termination of my / our employment with my / our current employer, whereupon I / we will cease to enjoy any or all benefits under

Salary account scheme. I / We understand that the Bank reserves the right to convert my / our account into a regular savings bank account and further ceasing to be

categorised as a account under corporate salary scheme. Accordingly there will be a change in minimum balance requirement and applicable charges per regular savings

bank account. (g) That I / we shall not hold the Bank liable and responsible for furnishing of the processed information / data / products thereof to other Banks / Financial

Institutions / Credit Providers / Users registered as above. (h) That I / we have to complete further application for specific liability products / services from the Bank as

prescribed from time to time, and that such further applications shall be regarded as an integral part of this application (and vice versa), and that unless otherwise disclosed in

such further forms as prescribed, the particulars and information set forth herein as well as the documents referred or provided herewith are true, correct, complete and up-

to-date in all respects. (i) That such further applications will require incorporation of the application form number, and / or such details as the Bank may prescribe, to facilitate

data management. (j) That I / we authorize the Bank to issue a Debit cum ATM Card to me / us. (k) That the issue and usage of the Debit cum ATM Card is governed by the

terms and conditions as in force from time to time and I / we agree to be bound by the same. (l) That the terms and conditions of Debit cum ATM Card are liable to be amended

by the Bank from time to time. (m) That I / we unconditionally and irrevocably authorize the Bank, to debit my / our Account annually with an amount equivalent to the fee and

charges for use of the Debit cum ATM Card. (n) I/We, the joint holder(s),agree that in case of death of any one or more of the joint depositor(s), the proceeds may be paid to the

survivor(s), on request before due date as per the mode of operation. The Bank can levy penal charges, if any, as may be permissible by either regulatory guidelines or

provisions of BCSBI code or both, applicable as on the date of request. (o) That continuation of the account with the Bank is at the sole discretion of the Bank and in case the

Bank is dissatisfied with the conduct of the account / account holder, the Bank has the right to close the account after giving me / us one month's notice or withdraw the

concessions in to or any service granted to me / us or charge the Bank's applicable rates/charges for such services. (p) That the Bank may at its absolute discretion,

discontinue any of the services completely or partially without any notice to me / us. (q) That in case of return of Account Opening Amount (AOA) cheque, for any reason

whatsoever, the Bank would close the account without any reference to me / us. (r) That on receipt of written application from any of the Authorised Signatory(ies) and / or

survivor or survivors of us, the Bank at its sole discretion and subject to such terms and conditions, grant a loan / advance / renew / enhance against the security / collateral

issued in joint names. (s) That DCB – On The Go facility will be offered to customers whose account is an individually operated resident account. (t) That DCB mobile Banking

will not be available to Non Resident Accounts. (u) I / We hereby understand that among all other things, minimum balance requirement for variants of savings bank account

under various scheme codes would be applicable and is in line with such updated information as available on the Bank's website www.dcbbank.com from time to time. (v) I /

We agree that the non-callable deposit/s cannot be closed by me/us before expiry of the term of such deposit/s. (w) I/We agree that the DCB Bank shall deduct applicable

TDS (Tax Deducted at Source) as per the Income Tax Provisions.

11

Signature of Primary Applicant

³åJ¸ "àì¤ƒ>A¡à¹ã¹ Ñ¬àÛ¡¹Signature of Joint Applicant 2Signature of Joint Applicant 1

"à³àìA¡ / "à³àìƒ¹ìA¡ &Î&³&Î Ît¡A¢¡t¡à ìšø¹o A¡¹à¹ \>¸ "à³à¹ / "à³àìƒ¹ "¸àA¡àl¡üì–i¡ l¡ü[À[Jt¡ "à³à¹ / "à³àìƒ¹ ë³à¤àÒüº >´¬¹[i¡ ¤¸¤Òà¹ A¡¹ç¡>¡ú

"à³à¹ / "à³àìƒ¹ t¡=¸Î³èÒ l¡üšì¹ l¡ü[À[Jt¡ ¤¸t¡ãt¡ ">¸ ëA¡à>* l¡üì„ìÅ¸ ¤à "àÒüì>¹ šøìÚà\>ãÚt¡à ¤¸t¡ãt¡ ">¸ ëA¡à=à* ¤¸¤Òà¹ A¡¹à Òì¤ >à ¤åìc¡ [>ìÚÒü "à[³ ¤¸àìS¡ "à[³ / "à³¹à t¡=¸Î³èÒ \³à A¡ì¹[á¡ú

"à[³ / "à³¹à &t¡‡à¹à [>ÆW¡Út¡à šøƒà> A¡¹[á ë™ "à³à¹ / "à³àìƒ¹ ">¸ ëA¡àì>à ¤¸àìS¡ [¤&Î[¤[l¡& "¸àA¡àl¡ü–i¡ ì>Òü ú

DCB Suraksha Fixed Deposit / [l¡[Î[¤ Îå¹Û¡à [ó¡Gl¡ [l¡ìšà[\i¡:

I/We have been given to understand that my/our information submitted to the Bank herewith shall not be used for any purpose other than mentioned above, or as per requirements of law.

DCB Basic Savings Bank Deposit Account (BSBDA) / [l¡[Î[¤ ë¤[ÎA¡ ëÎ[®¡}Î ¤¸àS¡ [l¡ìšà[\i¡ "¸àA¡àl¡ü–i¡ ([¤&Î[¤[l¡&):

I/We confirm that all the details provided are correct and I/We agree to the terms and conditions of the Bank. I/We also understand that all my/our accounts can be accessed from the unique Customer ID post consolidation of multiple Customer ID's if any.

(i) I/we hereby confirm that I/we do not hold BSBD account in any other bank.

"à[³ / "à³¹à [¤&Î[¤[l¡& "¸àA¡àl¡ü–i¡ ëJàºà¹ 30 [ƒì>¹ ³ì‹¸, ™[ƒ =àìA¡ t¡àÒìº [¤ƒ¸³à> ëÎ[®¡}Î ¤¸àS¡ "¸àA¡àl¡ü–i¡[i¡ ¤Þê¡ A¡¹à¹ ƒà[Úâ« [>[Zá¡ú

Customer ID Merger: I/We understand and agree that all my/our Accounts will now be consolidated under a single DCB Bank Customer ID after merging the multiple Customer IDs. Post such merging, only one Customer ID will remain active. I/We, am/are aware that DCB Bank Personal Internet Banking or DCB Bank Business Internet Banking, if availed, will now be accessible only under the retained Customer ID and all the Accounts will be consolidated to this Customer ID. I/We am/are aware that Tax Deducted at Source (TDS) on interest earned on DCB Bank Fixed Deposit Account(s) under erstwhile Customer IDs will also stand consolidated and TDS shall now be applicable on the basis of the unique Customer ID in accordance with the provisions of the Income Tax Act, 1961 and the Bank will furnish one TDS Certificate for all my/our Accounts.

§ Consent for Authentication: I/We, the holder of the above stated Aadhaar number, hereby give my/our consent to the Bank to obtain my/our Aadhaar number, Name and Fingerprint/Iris for authentication with UIDAI. The Bank has informed me/us that my/our identity information would only be used for demographic authentication / validation / e- KYC purpose and also informed that my/our biometrics will not be stored / shared and will be submitted to CIDR (Central Identities Data Repository) only for the purpose of authentication.

DCB Suraksha Fixed Deposit is available only for resident Indian individuals aged between 18 to 54 years. Maximum life insurance cover available is ̀ 50 lakh across all DCB Suraksha Fixed Deposits in the name of the primary applicant. Insurance cover shall cease on account holder attaining the age of 55 years. The insurance cover will be available only to the primary account holder. In case of premature withdrawal, insurance cover shall cease to exist. In case of partial withdrawal, insurance cover shall reduce to the extent of partial withdrawal. It is required to provide PAN, nomination and email ID to open DCB Suraksha Fixed Deposit. Waiting period of 45 days shall apply for all non-accidental deaths. Suicide exclusion shall apply for a period of one year from the coverage start date. Insurance cover on this DCB Suraksha Fixed Deposit is provided by Aditya Birla Sun Life Insurance Company limited ('Insurance Provider'), which is valid for the deposit period mentioned in this application form, unless communicated otherwise. Insurance cover provided on and during the renewal of the DCB Suraksha Fixed Deposit (if any) is at the sole discretion of the Bank / Insurance Provider.

"à[³ / "³à¹à ¤¸àìS¡ ">¸ ëA¡àì>à ëÎ[®¡}Î "¸àA¡àl¡ü–i¡ Jåºìt¡ šà¹ì¤à >à ëÎÒü [¤ÈìÚ "à[³ / "à³¹à ÎìW¡t¡> &¤} "¤Kt¡¡ú

"à[³ / "à³¹à [>ÆW¡Út¡à šøƒà> A¡¹[á ë™ šøƒv¡ Î³Ñz [¤¤¹o Î´šèo¢ Î[k¡A¡ &¤} "à[³ / "à³¹à ¤¸àìS¡¹ [>Ú³ &¤} Åt¢¡à¤ºãìt¡ Î´¶[t¡ šøƒà> A¡¹[á¡ú &áàØl¡à* "à[³ / "à³¹à "à¹* ¤åc¡ìt¡ ëšì¹[á ë™ "à³à¹ / "à³àìƒ¹ Î³Ñz "¸àA¡àl¡ü–i¡ &A¡à[‹A¡ NøàÒA¡ "àÒü[l¡-&¹ &A¡ãA¡¹ì>¹ šì¹ ">>¸ NøàÒA¡ "àÒü[l¡ ë=ìA¡ "¸àìGÎ A¡¹à ™àì¤¡ú

(ii) I/we undertake to close the existing savings bank account in the Bank, if any, within 30 days of opening BSBD account.

(iii) I/we am/are aware that I/we will not be eligible to open any other savings bank account in the Bank.

[l¡[Î[¤ Îå¹Û¡à [ó¡Gl¡ [l¡ìšà[\i¡ ëA¡¤º³ày 18 ë=ìA¡ 54 ¤á¹ ¤ÚÎã ®¡à¹t¡ãÚ >àK[¹A¡ìƒ¹ ¤à ¤à[Î–ƒàìƒ¹ \>¸ l¡üšº§¡¡ú ³åJ¸ "àì¤ƒ>A¡à¹ã¹ >àì³ Î³Ñz [Ò[Î[¤ Îå¹Û¡à [ó¡Gl¡ [l¡ìšà[\i¡Î³èÒ \åìØl¡ Îì¤¢àZW¡ 50 ºÛ¡ i¡àA¡à¹ \ã¤> ¤ã³à A¡®¡à¹ l¡üšº§¡¡ú 55 ¤á¹ ¤ÚÎã "¸àA¡àl¡ü–i¡‹à¹A¡ìƒ¹ ëÛ¡ìy ¤ã³à A¡®¡à¹[i¡ ¤Þê¡ ÒìÚ ™àì¤¡ú ¤ã³à A¡®¡à¹[i¡ ëA¡¤º³ày ³åJ¸ "¸àA¡àl¡ü–i¡‹à¹ìA¡¹ \>¸ l¡üšº§¡¡ú ™[ƒ ë³Úàìƒ¹ šèì¤¢ šøt¡¸àÒà¹ A¡¹à ÒÚ, t¡àÒìº ¤ã³à A¡®¡à¹[i¡¹ ëA¡àì>à "[Ñzâ« =àA¡ì¤ >à¡ú "à}[ÅA¡ šøt¡¸àÒàì¹¹ ëÛ¡ìy, ¤ã³à A¡®¡à¹ "à}[ÅA¡ šøt¡¸àÒàì¹¹ š[¹³ào ÒùàÎ A¡¹ì¤¡ú [l¡[Î[¤ Îå¹Û¡à [ó¡Gl¡ [l¡ìšà[\i¡ ëJàºà¹ \>¸ š¸à>, ³ì>à>Ú> &¤} Òüì³º "àÒü[l¡ šøƒà> A¡¹ìt¡ Òì¤¡ú Î³Ñz "-ƒåQ¢i¡>à\[>t¡ ³õtå¡¸¹ ëÛ¡ìy 45 [ƒ> šì¹ "àì¤ƒ> A¡¹ìt¡ Òì¤¡ú "àuÒt¡¸à\[>t¡ ³õtå¡¸ ¤¸t¡ãt¡ A¡®¡àì¹\ Ç¡¹ç¡¹ t¡à[¹J ë=ìA¡ &A¡ ¤áì¹¹ \>¸ "àì¤ƒ> A¡¹à ™àì¤¡ú &Òü [l¡[Î[¤ Îå¹Û¡à [ó¡Gl¡ [l¡ìšà[\ìi¡¹ l¡üš¹ ¤ã³à A¡®¡à¹ "à[ƒt¡¸ [¤Øl¡ºà Îà> ºàÒüó¡ ÒüXå¸ì¹X (¤ã³à šøƒà>A¡à¹ã) šøƒà> A¡ì¹, ™à &Òü "àì¤ƒ> ó¡³¢[i¡ìt¡ l¡ü[À[Jt¡ [l¡ìšà[\ìi¡¹ ë³ÚàƒA¡àìº¹ \>¸ í¤‹, ™[ƒ ë™àKàì™àK >à A¡¹à ÒÚ¡ú [l¡[Î[¤ Îå¹Û¡à [ó¡Gl¡ [l¡ìšà[\i¡ šå>>¢¤ãA¡¹ìo¹ Î³Ú &¤} ¤ã³à A¡®¡àì¹¹ ë³Úàƒ (™[ƒ =àìA¡) &A¡³ày ¤¸àS¡ / ¤ã³à šøƒà>A¡à¹ã¹ [¤ë¤W¡>à¹ [®¡[v¡ìt¡ šøƒà> A¡¹à ÒÚ¡ú

šø³àoãA¡¹ìo¹ \>¸ Î´¶[t¡ šøƒà>: "à[³ / "à³¹à, l¡üšì¹ ¤[o¢t¡ "à‹à¹ >´¬ì¹¹ ‹à¹A¡, Òül¡ü"àÒü[l¡&"àÒü-&¹ Îàì= šø³àoãA¡¹ìo¹ l¡üì„ìÅ¸ "à³à¹ / "à³àìƒ¹ "à‹à¹ >´¬¹, >à³ &¤} [ó¡Uà¹[šø–i¡ / "àÒü[¹Å šà*Úà¹ \>¸ &t¡‡à¹à ¤¸àS¡ìA¡ Î´¶[t¡ šøƒà> A¡¹[á¡ú ¤¸àS¡ "à³àìA¡ / "à³àìƒ¹ìA¡ \à[>ìÚìá ë™ "à³à¹ / "à³àìƒ¹ š[¹W¡Ú t¡=¸Î³èÒ ëA¡¤º³ày \>t¡à[wA¡ šø³àoãA¡¹o / î¤‹A¡¹o / Òü-ìA¡*ÚàÒü[Î-&¹ l¡üì„ìÅ¸ ¤¸¤Òê¡t¡ Òì¤ &¤} &áàØl¡à* "à¹* \à[>ìÚìá ë™ "à³à¹ / "à³àìƒ¹ ¤àìÚàì³[i¡öA¡Î³èÒ Î}¹[Û¡t¡ / ëÅÚà¹ A¡¹à Òì¤ >à &¤} ëA¡¤º³ày šø³àoãA¡¹ìo¹ l¡üì„ìÅ¸ [Î"àÒü[l¡"à¹ (ìÎ–i¡öàº "àÒüìl¡[–i¡[i¡\ ël¡i¡à ë¹[Ñšì¹i¡[¹)-ìt¡ \³à ëƒ*Úà Òì¤¡ú

NøàÒA¡ "àÒü[l¡ ³¸àì>\à¹: "à[³ / "à³¹à ¤åc¡ìt¡ ëšì¹[á &¤} Î´¶[t¡ šøƒà> A¡¹[á ë™ "à³à¹ / "à³àìƒ¹ Î³Ñz "¸àA¡àl¡ü–i¡\[>t¡ &A¡à[‹A¡ NøàÒA¡ "àÒü[l¡ ™åv¡û¡ ÒìÚ &A¡[i¡ [l¡[Î[¤ ¤¸àS¡ NøàÒA¡ "àÒü[l¡-&¹ "‹ãì> &A¡ã®è¡t¡ Òì¤¡ú &Òü \àt¡ãÚ &A¡ãA¡¹ì>¹ šì¹, ëA¡¤º³ày &A¡[i¡ NøàÒA¡ "àÒü[l¡ Î[yû¡Ú =àA¡ì¤¡ú "à[³ / "à³¹à, ÎìW¡t¡> ë™ [l¡[Î[¤ ¤¸àS¡ šàìÎ¢à>àº Òü–i¡à¹ì>i¡ ¤¸à[S¡} "=¤à [l¡[Î[¤ ¤¸àS¡ [¤\ì>Î Òü–i¡à¹ì>i¡ ¤¸à[S¡}, ™[ƒ ³ì>à>Ú> A¡¹à ÒÚ t¡àÒìº &J> ëA¡¤º³ày *Òü &A¡[i¡ NøàÒA¡ "àÒü[l¡-&¹ "‹ãì> "¸àìGÎì™àK¸ Òì¤ &¤} Î³Ñz "¸àA¡àl¡ü–i¡ *Òü NøàÒA¡ "àÒü[l¡ìt¡ Î}Òt¡ A¡¹à Òì¤¡ú "à[³ / "à³¹à ÎìW¡t¡> ë™ [l¡[Î[¤ ¤¸àS¡ [ó¡Gl¡ [l¡ìšà[\i¡ "¸àA¡àl¡ü–i¡(P¡[º)-&¹ šè¤¢¤t¢¡ã NøàÒA¡ "àÒü[l¡P¡[ºìt¡ Îåìƒ¹ l¡üš¹ l¡ü;Î ë=ìA¡ A¡¹ áàØl¡ ([i¡[l¡&Î) ë=ìA¡ A¡³àì>à Òì¤ &¤} "àÚA¡¹ "àÒü>, 1961-&¹ [¤‹à>à¤ºã ">åÎàì¹ &J> ">>¸ NøàÒA¡ "àÒü[l¡-&¹ [®¡[v¡ìt¡ [i¡[l¡&Î šøì™à\¸ Òì¤ &¤} ¤¸àS¡ "à³à¹ / "à³àìƒ¹ Î³Ñz "¸àA¡àl¡üì–i¡¹ \>¸ &A¡[i¡ [i¡[l¡&Î Å}Îàšy šøƒà> A¡¹ì¤¡ú

I/We understand that the Bank is relying on this information for the purpose of determining the status of the applicant named above in compliance with FATCA (Foreign Account Tax Compliance Act) / CRS (Common Reporting Standards).

The Bank is not able to offer any tax advice on CRS or FATCA or its impact on the applicant. I/we shall seek advice from professional tax advisor for any tax questions.

"à[³/"à³¹à ¤åc¡ìt¡ ëšì¹[á ë™ &Òü t¡ì=¸¹ l¡üš¹ [>®¢¡¹ A¡ì¹ ¤¸àS¡ &ó¡&[i¡[Î& (ó¡ì¹> "¸àA¡àl¡ü–i¡ i¡¸àG A¡³[šÃìÚ–i¡ "¸àC¡) / [Î"à¹&Î (A¡³> [¹ìšà[i¢¡} Ð¡¸à“¡àl¢¡Î)-&¹ Î´¶[t¡ìt¡ l¡ü[À[Jt¡ "àì¤ƒ>A¡à¹ã¹ "¤Ñ‚à [>‹¢à¹o A¡ì¹¡ú

&Òü ó¡ì³¢¹ ëA¡àì>à t¡ì=¸¹ ¤à Å}Îàšìy¹ ëA¡àì>à ®å¡º Òìº "à[³ / "à³¹à 30 [ƒì>¹ ³ì‹¸ &A¡[i¡ >tå¡> ó¡³¢ \³à [ƒìt¡ Î´¶t¡¡ú

I/We certify that I/we provide the information on this form and to the best of my/our knowledge and belief the certification is true, correct, and complete including the taxpayer identification number of the applicant.

I agree that my personal Know Your Customer (KYC) information may be shared with Central KYC (CKYC) registry or any other competent authority. I hereby give consent to receive information from the Bank / CKYC registry / the Government / Reserve Bank of India or any authority through SMS / email on my registered mobile number / email address. I also agree that non receipt of any such SMS / email shall not make the Bank liable for any nature of loss or damage.

I/We hereby agree and authorize Bank to mark freeze to my account if I/We fail to submit the updated / refresh KYC documents as per Bank's KYC policy and/or operating instructions for my / our account periodically to the Bank.

"à[³ / "à³¹à [>ÆW¡Út¡à šøƒà> A¡¹[á ë™, "à[³ / "à³¹à ¤¸àìS¡ [º[Jt¡®¡àì¤ \à>àì¤à / "¤[Òt¡ A¡¹ì¤à &¤} "šàì¹[i¡}-&¹ [>ìƒ¢Åà¤ºã "àšìl¡i¡ A¡¹ì¤à &¤} / "=¤à "šàì¹[i¡} A¡¹à¹ [>ìƒ¢Åà¤ºã¹ ëA¡àì>à¹ê¡š š[¹¤t¢¡> Ò*Úà¹ Îàì= Îàì= ¤¸àìS¡¹ ë¹A¡ìl¢¡ ">¸ ëA¡àì>à š[¹¤t¢¡>(Î³èÒ) &¤} / "=¤à ¤¸àìS¡¹ A¡àìá =àA¡à "¸àA¡àl¡ü–i¡/Î³èìÒ¹ ">¸ ëA¡àì>à š[¹¤t¢¡>(Î³èÒ)-&¹ [¤ÈìÚ "¤[Òt¡ A¡¹ì¤à¡ú

"à³à¹ ¤¸[v¡û¡Kt¡ "àš>à¹ NøàÒA¡ìA¡ \à>å> (ìA¡*ÚàÒü[Î) t¡=¸ ëA¡–ƒøãÚ ëA¡*ÚàÒü[Î ([ÎìA¡*ÚàÒü[Î) ë¹[\[Ð¡ö ¤à ">¸ ëA¡àì>à l¡üš™åv¡û¡ A¡tõ¢¡šìÛ¡¹ Îàì= ëÅÚà¹ A¡¹à ë™ìt¡ šàì¹ ëÎÒü [¤ÈìÚ "à[³ Î´¶[t¡ šøƒà> A¡¹[á¡ú "à[³ &t¡‡à¹à [>¤[Þê¡t¡ ë³à¤àÒüº >´¬¹ / Òüì³º "¸àìl¡öÎ-& &Î&³&Î / Òüì³º-&¹ ³à‹¸ì³ ¤¸àS¡ / [ÎìA¡*ÚàÒü[Î ë¹[\[Ð¡ö / Î¹A¡à¹ / [¹\à®¢¡ ¤¸àS¡ "ó¡ Òü[“¡Úà "=¤à ëA¡àì>à A¡tõ¢¡šìÛ¡¹ A¡àá ë=ìA¡ t¡=¸ NøÒo A¡¹à¹ \>¸ Î´¶[t¡ šøƒà> A¡¹[á¡ú &áàØl¡à* &Òü \àt¡ãÚ ëA¡à>* &Î&³&Î / Òüì³º >à ëšìÚ ëA¡àì>à¹ê¡š Û¡[t¡ ¤à ëºàA¡Îàì>¹ A¡à¹ìo ¤¸àS¡ìA¡ ƒàÚ¤‡ý¡ A¡¹ì¤à >à &Òü [¤ÈìÚ* "à[³ Î´¶[t¡ šøƒà> A¡¹[á¡ú

¤¸àS¡ [Î"à¹&Î ¤à &ó¡&[i¡[Î& ¤à "àì¤ƒ>A¡à¹ã¹ l¡üš¹ šø®¡à¤ ëó¡ìº &Òü¹A¡³ ëA¡àì>à A¡¹ Î}yû¡à”z š¹à³Å¢ [ƒìt¡ "šà¹K¡ú "à[³ / "à³¹à ëA¡àì>à A¡¹ Î}yû¡à”z šøìÅ—¹ \>¸ ëšÅàƒà¹ A¡¹ Î}yû¡à”z š¹à³Å¢ƒàt¡à¹ š¹à³Å¢ ë>¤¡ú

I/We confirm that, I/We will intimate / notify in writing to the Bank and update operating instructions and / or any other change(s) on Bank's record immediately in the event of any change in the operating instructions and/or any other change(s) with respect to the account/s held with the Bank.

Aadhaar Consent / "à‹à¹ Î´¶[t¡:I/We have voluntarily submitted my/our Aadhaar/UID Number mentioned above and consent to:

§ Seed my/our Aadhaar/UID Number issued by UIDAI, Government of India in my/our name with my/our aforesaid account.

§ Map it at NPCI (National Payments Corporation of India) to enable me/us to receive Direct Benefit Transfer (DBT) from Government of India in my/our above mentioned account. I/We understand that if more than one Benefit Transfer is due to me/us, I/we will receive all Benefit Transfers in this account.

"à³à¹ / "à³àìƒ¹ l¡ü[À[Jt¡ "¸àA¡àl¡üì–i¡ "à³àìA¡ / "à³àìƒ¹ìA¡ ®¡à¹t¡ Î¹A¡à¹ ë=ìA¡ šøàœ¡ [l¡ì¹C¡ ë¤[>[ó¡i¡ i¡öàXó¡à¹ (®¡t¢å¡[A¡¹ šøt¡¸Û¡¹ê¡ìš Ñ‚à>à”z¹ / [l¡[¤[i¡) NøÒìo ÎÛ¡³ A¡¹à¹ \>¸ &>[š[Î"àÒü (>¸àÅ>àº ëšì³–i¡Î A¡ìš¢àì¹Å> "ó¡ Òü[“¡Úà)-ìt¡ &[i¡ ™åv¡û¡ A¡¹ç¡>¡ú "à[³ ¤åc¡ìt¡ ëšì¹[á ë™ "à³à¹ A¡à¹ìo ™[ƒ &ìA¡¹ "[‹A¡ ë¤[>[ó¡i¡ i¡öàXó¡à¹ ÒÚ t¡ì¤ Î³Ñz ë¤[>[ó¡i¡ "à³à¹ / "à³àìƒ¹ &Òü "¸àA¡àl¡üì–i¡ i¡öàXó¡à¹ A¡¹à Òì¤¡ú

I/We agree that as may be required by domestic regulators/tax authorities the Bank may also be required to report, reportable details to CBDT (Central Board of Direct Taxes) or close or suspend my / our account.

"à[³ / "à³¹à &t¡‡à¹à [>ÆW¡Út¡à šøƒà> A¡¹[á ë™ &Òü ó¡ì³¢ "à³à¹ / "à³àìƒ¹ ‡à¹à šøƒv¡ &¤} "à³à¹ / "à³àìƒ¹ ̀ ¡à>t¡ šøƒv¡ t¡=¸ Î´šèo¢¹ê¡ìš Ît¡¸, Î[k¡A¡ &¤} "àš-iå¡-ìl¡i¡ A¡õt¡ &¤} "à¤ìƒ>A¡à¹ã¹ A¡¹ƒàt¡à Å>àv¡û¡A¡¹> >´¬¹ ÎÒ Î´šèo¢¡ú

"à[³ / "à³¹à ëÑ¬ZáàÚ l¡üšì¹àv¡û¡ "à³à¹ / "à³àìƒ¹ "à‹à¹ / Òül¡ü"àÒü[l¡ >´¬¹[i¡ šøƒà> A¡ì¹[á &¤} t¡àìt¡ Î´¶[t¡ šøƒà> A¡ì¹[á:

§ Use my/our Aadhaar details to authenticate me/us from UIDAI. Òül¡ü"àÒü[l¡&"àÒü ë=ìA¡ "à³à¹ / "à³àìƒ¹ šø³àoãA¡¹ìo¹ \>¸ "à³à¹ / "à³àìƒ¹ "à‹à¹ [¤¤¹o ¤¸¤Òà¹ A¡¹ç¡>¡ú

"à³à¹ / "à³àìƒ¹ šè¤¢¤t¢¡ã "¸àA¡àl¡üì–i¡¹ Îàì= "à³à¹ >àì³ ®¡à¹t¡ Î¹A¡à¹, Òül¡ü"àÒü[l¡&"àÒü ‡à¹à \à¹ãAõ¡t¡ "à³à¹ / "à³àìƒ¹ "à‹à¹ / Òül¡ü"àÒü[l¡ >´¬¹[i¡ ™åv¡û¡ A¡¹ç¡>¡ú

§ Use my/our mobile number mentioned in my/our account for sending SMS alerts to me/us

"à[³ / "à³¹à &t¡‡à¹à ¤¸àìS¡¹ ëA¡*ÚàÒü[Î š[º[Î ">å™àÚã "àšìl¡i¡ / [¹ìóø¡Å ëA¡*ÚàÒü[Î >[=šyP¡[º &¤} / "=¤à "à³à¹ / "à³àìƒ¹ "¸àA¡àl¡üì–i¡¹ \>¸ ¤¸àìS¡ [>Ú[³t¡ š[¹W¡à[ºt¡ [>ìƒ¢Åà¤ºã ">å™àÚã >[=šy šøƒàì> ¤¸=¢ Òìº "à³à¹ "¸àA¡àl¡ü–i¡[i¡ìA¡ [óø¡\ [W¡[Òû¡t¡ A¡¹à¹ \>¸ ¤¸àS¡ìA¡ ">åì³à[ƒt¡ A¡¹[á¡ú

"à[³ / "à³¹à Î´¶[t¡ šøƒà> A¡¹[á ë™ ëƒÅãÚ [>Úà³A¡ Î}Ñ‚à / i¡¸àG "ì=à[¹[i¡\-&¹ šøìÚà\> ">å™àÚã, ¤¸àìS¡¹ [Î[¤[l¡[i¡ (ìÎ–i¡öàº ë¤àl¢¡ "ó¡ [l¡ì¹C¡ i¡¸àìGÎ)-ìt¡ šø[t¡ì¤ƒ>, šø[t¡ì¤[ƒt¡ [¤¤¹o ¤à "à³à¹ / "à³àìƒ¹ "¸àA¡àl¡ü–i¡[i¡ ¤Þê¡ ¤à Îà³[ÚA¡®¡àì¤ Ñ‚[Kt¡ A¡¹ìt¡ šàì¹¡ú

I/We agree to submit a new form within 30 days if any information or certification on this form becomes incorrect.

12

Risk Classification for Joint Applicant 1 / g§`wº$ AmdoXH$ Ho$ {bE OmopI_ dJuH$aU 1

ë™ï= "àì¤ƒ>A¡à¹ã 1-&¹ Ñ¬àÛ¡¹ ë™ï= "àì¤ƒ>A¡à¹ã 2-&¹ Ñ¬àÛ¡¹

13

Customer Information & Due Diligence (CIDD) Form - For Primary ApplicantNøàÒìA¡¹ t¡=¸ &¤} [l¡l¡ü [l¡[ºì\X ([Î"àÒü[l¡[l¡) ó¡³¢ - ³åJ¸ "àì¤ƒ>A¡à¹ã¹ \>¸

Information Type / t¡ì=¸¹ ‹¹o Details / [¤¤¹oÎ³èÒ

Countries where business associates located (for Businessmen, only) / ë™ ëƒÅP¡[ºìt¡ ¤¸¤Îà[ÚA¡ ÎÒì™àKã ¹ìÚìá (Ç¡‹å³ày ¤¸¤ÎàÚãìƒ¹ \>¸)

Source of Funds for Credits in the Account

Other (please specify)

Investments

Savings Sale of PropertySalary

Inheritance

Business Proceeds

Professional fee

Wire Transfers Expected Yes

Yes

Into the Account No

No

Value `

Yes No Approximate Value `

Value `From the Account

Foreign Inward Remittances Expected

Country where the Individual / Entity based

Nature of business / Line of activity (in detail)

Expected number of transactions in a month Up to 20 21 to 50 More than 50

Signature of Primary Applicant

Financial Status (Net Worth) More than `10 lakhs upto `25 lakhsUpto `10 lakhs

More than `50 lakhs upto `2 croresMore than `25 lakhs upto `50 lakhs

More than `2 crores

Ñ¬t¡”| / Îwà [®¡[v¡A¡ ëƒÅ

¤¸¤Îà¹ ‹¹o / A¡à™¢A¡ºàš ([¤Ñzà[¹t¡®¡àì¤)

&A¡ ³àìÎ ëº>ìƒì>¹ šøt¡¸à[Åt¡ Î}J¸à 20 š™¢”z 21 ë=ìA¡ 50 50-&¹ "[‹A¡

"à[=¢A¡ "¤Ñ‚à (ì³ài¡ ³èº¸) 10 ºÛ¡ i¡àA¡à š™¢”z 10 ºÛ¡ i¡àA¡à¹ "[‹A¡ ë=ìA¡ 25 ºÛ¡ i¡àA¡à š™¢”z

25 ºÛ¡ i¡àA¡à¹ "[‹A¡ ë=ìA¡ 50 ºÛ¡ i¡àA¡à š™¢”z 50 ºÛ¡ i¡àA¡à¹ "[‹A¡ ë=ìA¡ 2 ëA¡à[i¡ i¡àA¡à š™¢”z

2 ëA¡à[i¡ i¡àA¡à¹ "[‹A¡

"¸àA¡àl¡üì–i¡ ìyû¡[l¡i¡Î³èìÒ¹ \>¸ ó¡à“¡Î³èìÒ¹ l¡ü;Î ëÎ[®¡}Îô ë¤t¡> ¤¸¤Îà[ÚA¡ "àÚ Î´š[v¡ [¤yû¡Ú

[¤[>ìÚàKÎ³èÒ


l¡üv¡¹à[‹A¡à¹ Îèìy šøàœ¡ ëšÅàKt¡ [ó¡

šøt¡¸à[Åt¡ *Ú¸à¹ i¡öàXó¡à¹ "¸àA¡àl¡ü–i¡ ³‹¸[Ñ‚t¡ Òò¸à >à ³èº¸ i¡àA¡àÚ

"¸àA¡àl¡ü–i¡ ë=ìA¡ Òò¸à >à ³èº¸ i¡àA¡àÚ

šøt¡¸à[Åt¡ ó¡ì¹> Òü>*Úàl¢¡ ë¹[³i¡¸àX Òò¸à >à

³åJ¸ "àì¤ƒ>A¡à¹ã¹ Ñ¬àÛ¡¹

"à>å³à[>A¡ ³èº¸ i¡àA¡àÚ

Customer Information & Due Diligence (CIDD) Form - For Joint Applicant 1NøàÒìA¡¹ t¡=¸ &¤} [l¡l¡ü [l¡[ºì\X ([Î"àÒü[l¡[l¡) ó¡³¢ - ë™ï= "àì¤ƒ>A¡à¹ã 1-&¹ \>¸





Investments


Inheritance

Business Proceeds

Professional fee


Yes

Into the Account No

No

Value `







Signature of Joint Applicant 1



More than `2 crores






2 ëA¡à[i¡ i¡àA¡à¹ "[‹A¡








™ï= "àì¤ƒ>A¡à¹ã 1-&¹ Ñ¬àÛ¡¹


For Bank Use Only / ëA¡¤º³ày ¤¸àìS¡¹ ¤¸¤Òàì¹¹ \>¸Any of the Signatories / Beneficial Owners of the entity a Political / Public Figure or related to a Political / Public Figure Yes No

if yes, please give position

Does it seem that the initial Deposit and/or the declared transaction profile is in line with the status/occupation declared? Yes No

_______________________________________________ Employee signature

I Confirm that I have carried out proper Due Diligence and KYC verification. I am satisfied with the profile of the prospective Customer. / "à[³ [>ÆW¡Út¡à šøƒà> A¡¹[á ë™ "à[³ ™=à™=®¡àì¤ [l¡l¡ü [l¡[\ìºX &¤} ëA¡*ÚàÒü[Î ™àW¡àÒüA¡¹o A¡ì¹[á¡ú "à[³ Î´±à¤¸ NøàÒìA¡¹ ìšøàó¡àÒüìº Î”ñÊ¡¡úDetails of Staff sourcing the account / A¡³¢ã "¸àA¡àl¡ü–i¡ ëJàºà¹ [¤¤¹oEmployee Name:

Employee Designation:

Date: YYYYMMDDBranch:

If yes, please describe / _____________________________________™[ƒ =àìA¡, t¡àÒìº ">åNøÒ A¡ì¹ ¤o¢>à

Are there any other concerns for higher AML risks? / l¡üZW¡t¡¹ &&³&º-&¹ cåò¡[A¡ [>ìÚ [A¡ ëA¡àì>à [W¡”zà¹ [¤ÈÚ "àìá?

Yes No

HRMS Number:

Ñ¬àÛ¡¹A¡à¹ã / ¹à\î>[t¡A¡ &A¡[i¡ Îâ«à¹ Ñ¬â«à[‹A¡à¹ã ³à[ºA¡Ko / [¤J¸àt¡ ¤¸[v¡û¡ ¤à ¹à\î>[t¡A¡ Î´š[A¢¡t¡ ¤¸[v¡û¡ / [¤J¸àt¡ ¤¸[v¡û¡-&¹ ³ì‹¸ ë=ìA¡ ì™ ëA¡àì>à &A¡\> Òò¸à >à

™[ƒ Òò¸à ÒÚ, t¡àÒìº "àš>à¹ "¤Ñ‚à> ¤à šƒ šøƒà> A¡¹ç¡>

ìƒìJ ³ì> ÒÚ ë™ šøà=[³A¡ [l¡ìšà[\i¡ &¤}/"=¤à [¤¤õt¡ ëº>ìƒì>¹ ìšøàó¡àÒüº[i¡¹ [Ñ‚[t¡/ìšÅà¹ Îàì= [³º ¹ìÚìá? Òò¸à

Òò¸à

>à

>à

A¡³¢W¡à¹ã¹ >à³

&ÒüW¡"à¹&³&Î >´¬¹

A¡³¢W¡à¹ã¹ šƒ

t¡à[¹J ÅàJà A¡³¢W¡à¹ã¹ Ñ¬àÛ¡¹

14

Customer Information & Due Diligence (CIDD) Form - For Joint Applicant 2NøàÒìA¡¹ t¡=¸ &¤} [l¡l¡ü [l¡[ºì\X ([Î"àÒü[l¡[l¡) ó¡³¢ - ë™ï= "àì¤ƒ>A¡à¹ã 2-&¹ \>¸





Investments


Inheritance

Business Proceeds

Professional fee


Yes

Into the Account No

No

Value `







Signature of Joint Applicant 2



More than `2 crores






2 ëA¡à[i¡ i¡àA¡à¹ "[‹A¡








™ï= "àì¤ƒ>A¡à¹ã 2-&¹ Ñ¬àÛ¡¹


Signatures and Photographs / Ñ¬àÛ¡¹Î³èÒ &¤} á[¤Î³èÒ

Approved by BM / BSOM (Name, signature with HRMS Number) with seal*Incase of Thumb Impression, “Sign in BM/BSOM presence”

Please affixa recent

photograph.">åNøÒ A¡ì¹ "àš>à¹ Îà´ß[t¡A¡t¡³ á[¤ á[¤

Î}™åv¡û¡ A¡¹ç¡>

Please signin “Black Ink”within the box.

“Signatureshall be

consideredfor all Cheque

clearancesand any futurecommunicationwith the Bank”">åNøÒ A¡ì¹ ¤ìG¹ ³ì‹¸ ''A¡àìºà

A¡à[º'' [ƒìÚ Ñ¬àÛ¡¹ ¤à ÎÒü A¡¹ç¡>¡ú

''Î³Ñz ëW¡ìA¡¹ áàØl¡šìy¹ &¤} ®¡[¤È¸ìt¡ ¤¸àìS¡¹

Îàì= ëA¡àì>à ë™àKàì™àK A¡¹à¹ \>¸ Ñ¬àÛ¡¹ [¤ì¤W¡>à A¡¹à

Òì¤''

">åNøÒ A¡ì¹ "àš>à¹ Ñ¬ãAõ¡[t¡ šy[i¡ [>ìt¡

®å¡ºì¤> >à

Please do notforget to collect

yourAcknowledgment

slip

15

YYYYMMDDDate:Thumb Impression / [i¡šÎÒü Signature / Ñ¬àÛ¡¹

Please affix a recent

photograph

">åNøÒ A¡ì¹ "àš>à¹ Îà´ß[t¡A¡t¡³ á[¤ á[¤ Î}™åv¡û¡ A¡¹ç¡>

Sign across the photo

á[¤[i¡¹ l¡üš¹ [ƒìÚ Ñ¬àÛ¡¹ ¤à ÎÒü A¡¹ç¡>

Primary Applicant / ³åJ¸ "àì¤ƒ>A¡à¹ã

t¡à[¹J

[Îº ÎÒ [¤&³ / [¤&Î*&³ (>à³, &ÒüW¡"à¹&³&Î >´¬¹ ÎÒ Ñ¬àÛ¡¹) ‡à¹à ">åì³à[ƒt¡ *[i¡šÎÒü-&¹ ëÛ¡ìy ''[¤&³ / [¤&Î*&³-&¹ l¡üš[Ñ‚[t¡ìt¡ Ñ¬àÛ¡¹ ¤à ÎÒü A¡¹ç¡>''



photograph




Joint Applicant 1 / ë™ï= "àì¤ƒ>A¡à¹ã 1

t¡à[¹J



photograph




Joint Applicant 2 / ë™ï= "àì¤ƒ>A¡à¹ã 2

t¡à[¹J

16

Confirmation / ">åì³àƒ> “I confirm having met the Applicant/s in person.” / ''"àì¤ƒ>A¡à¹ã¹ Îàì= "à³à¹ ¤¸[v¡û¡Kt¡®¡àì¤ ÎàÛ¡à; ÒìÚìá ëÎÒü [¤ÈìÚ "à[³ [>ÆW¡Út¡à šøƒà> A¡¹[á¡ú''

"à³à¹ l¡üš[Ñ‚[t¡ìt¡ &Òü ó¡³¢[i¡ "àì¤ƒ>A¡à¹ã ‡à¹à Ñ¬àÛ¡[¹t¡ ÒìÚìá ëÎÒü [¤ÈìÚ* "à[³ [>ÆW¡Út¡à šøƒà> A¡¹[á¡ú &Òü "¸àA¡àl¡ü–i¡ ëJàºà¹ ó¡ì³¢ l¡ü[À[Jt¡ _________________________________ >´¬ì¹ A¡º A¡ì¹ "à[³

ëi¡[ºìó¡à> >´¬¹[i¡* ™àW¡àÒü A¡ì¹[á¡ú

I also confirm that the form has been signed by the applicant is in my presence. I have also verified the Tel. No. _________________________________ by calling the no.

mentioned in this account opening form.

"à[³ [>ÆW¡Út¡à šøƒà> A¡¹[á ë™ Åøã / Åøã³t¡ã __________________________________________________________________________________________________________-&¹ Îàì=

c [l¡[Î[¤ ¤¸àS¡ [º[³ìi¡l¡ -&¹, ____________________________________ ÅàJàÚ "à³à¹ ¤¸[v¡û¡Kt¡®¡àì¤ ÎàÛ¡à; ÒìÚìá¡ú c ¤t¢¡³à> "à¤à[ÎA¡ [k¡A¡à>à, c Ñ‚àÚã [k¡A¡à>à, c "[ó¡ìÎ¹ [k¡A¡à>à ("àì¤ƒ> ó¡ì³¢

l¡ü[À[Jt¡ ë™ ëA¡àì>à [k¡A¡à>à) &¤} &¹ ³à‹¸ì³ &Òü "¸àA¡àl¡ü–i¡ ëJàºà¹ ó¡³¢[i¡ìt¡ šøƒv¡ š[¹W¡Ú &¤} [k¡A¡à>à¹ [>ÆW¡Út¡à šøƒà> A¡¹[á &¤} "àì¤ƒ>A¡à¹ã/Ko ‡à¹à šøƒv¡ ³èº >[=šyP¡[º¹ Îàì= >[=šìy¹ ">å[º[š (ì™®¡àì¤ šøì™à\¸)

™àW¡àÒü A¡¹à ÒìÚìá ëÎÒü [¤ÈìÚ [>ÆW¡Út¡à šøƒà> A¡¹[á¡ú

I confirm having met Mr. / Ms. __________________________________________________________________________________________________________, in person at

c DCB Bank Limited, ____________________________________ Branch, c Current Residential Address, c Permanent Address, c Office Address (anyone address

as mentioned in the application form) and hereby confirm the identity and address as provided in this account opening form and also confirm having verified the copy

of the documents (as applicable) against originals as produced by the applicant/s.

For OfficeUse Only

Ç¡‹å³ày "[ó¡ìÎ¹ ¤¸¤Òàì¹¹ \>¸

Acknowledgement / Ñ¬ãAõ¡[t¡Please provide this number for future reference

Nomination Form Received: Yes No

Date: YYYYMMDDSignature of Bank Official

Branch:Employee code:

1st Applicant’s Name:

Joint Applicant 1:

Joint Applicant 2:

Name of the Bank Official:

Name of the Nominee:

DCB Bank Limited M026 / Jan 20 / 2.8481-Ver 1.1-March 2014

DCB Customer Care

■ Call: 1800 123 53631800 209 5363

Email: [email protected]

Web: www.dcbbank.com

Please call DCB Customer Care to enquire about your account application status


Name of Bank Official: Mr. Mrs. Ms.

Employee No.:

YYYYMMDDDate:

Signature of Bank Official

¤¸àìS¡¹ A¡³¢A¡t¢¡à¹ >à³ Åøã Åøã³t¡ã Aå¡³à¹ã t¡à[¹J

A¡³¢W¡à¹ã >}.¤¸àìS¡¹ A¡³¢A¡t¢¡à¹ Ñ¬àÛ¡¹

>[³ì>Å> ó¡³¢ KõÒãt¡ Òò¸à >à

®¡[¤È¸ìt¡ ë¹ó¡àì¹ìX¹ \>¸ ">åNøÒ A¡ì¹ &Òü >´¬¹[i¡ šøƒà> A¡¹ç¡>

1³ "àì¤ƒ>A¡à¹ã¹ >à³

ë™ï= "àì¤ƒ>A¡à¹ã 1

ë™ï= "àì¤ƒ>A¡à¹ã 2

>[³[>¹ >à³

¤¸àìS¡¹ A¡³¢A¡t¢¡à¹ >à³

A¡³¢ã ëA¡àl¡ t¡à[¹J ÅàJà¤¸àìS¡¹ A¡³¢A¡t¢¡à¹ Ñ¬àÛ¡¹

"àš>à¹ "¸àA¡àl¡üì–i¡¹ "àì¤ƒì>¹ [Ñ‚[t¡ Î´šìA¢¡ [\`¡àÎà A¡¹à¹ \>¸ ">åNøÒ A¡ì¹ [l¡[Î[¤ NøàÒA¡ š[¹ìÈ¤à ëA¡ì–ƒø A¡º A¡¹ç¡>

Account Opening Form - "¸àA¡àl¡ü–i¡ ëJàºà¹ ó¡³ - DCB Bank

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Transcript of Account Opening Form - "¸àA¡àl¡ü–i¡ ëJàºà¹ ó¡³ - DCB Bank