Instruction for filling Account Opening Form / "¸àA¡àl¡ü–i¡ ìJàºà¹ ó¡³¢ šè¹o A¡¹à¹ [>샢Å>à
Please write your NAME as it appears in all your support documents"àš>๠γÑz >[=šìy 뙳>®¡àì¤ šøƒ[Å¢t¡ ">åNøÒ A¡ì¹ [k¡A¡ ëÎÒü®¡àì¤ "àš>๠>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 \>¸ δšèo¢ 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>àγèÒ [>[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 ¤¸¤Ò๠A¡¹ç¡>
ALL PHOTOCOPIES of documents to be SELF-ATTESTED by the applicantγÑz >[=šìy¹ ">å[º[šP¡[ºìt¡ "à줃>A¡à¹ã¹ ѬàÛ¡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 뮡ài¡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>, \캹 [¤º, šàÒüšlô¡ K¸àÎ, ëšàСìšÒül¡ ë³à¤àÒüº (2 ³àìι "[‹A¡ šå¹àì>à [¤º >Ú), δš[v¡ ¤à [³l¡ü[>[Κ¸àº i¡¸àìG¹ ¹[΃, ιA¡à[¹ [¤®¡àK ¤à [š&ÎÒül¡ü ‡à¹à \à[¹Aõ¡t¡ "¤Î¹šøàœ¡ A¡³¢ã샹 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‚àγèÒ, šà¤[ºA¡ ëÎC¡¹ "à“¡à¹ìi¡[A¡}Î, t¡ó¡[κ®å¡v¡û¡ ¤à[o[\¸A¡ ¤¸àS¡Î³èÒ, "à[=¢A¡ šø[t¡Ë¡à>γèÒ &¤} t¡à[ºA¡à®å¡v¡û¡ ëA¡à´šà>ãγèÒ &¤} ιA¡à[¹ "à¤àÎ> ¤¹à„A¡¹o šy ÎÒ A¡³¢ã샹 áå[i¡ &¤} ºàÒüìÎìX¹ Wå¡[v¡û¡šy¡ú (&Òü >[=šyP¡[º \³à ëƒ*Ú๠γìÚ¹ ì=ìA¡ [¤Kt¡ 3 ³àìι ³ì‹¸ ¤t¢¡³à> [k¡A¡à>๠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 뮡ài¡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\¸ ιA¡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¢¡à샹 l¡üš[Ñ‚[t¡ìt¡ "¸àA¡àl¡ü–i¡ *ìš[} ó¡³¢ (&*&ó¡)-& ѬàÛ¡¹ A¡¹ìt¡ Ò줡ú
Letter issued by National Population Register containing details of name and address>à³ * [k¡A¡à>๠[¤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\¸ ιA¡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>๠[¤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\>๠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¡ Сàó¡ 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 ëή¡à¹ "¸àA¡l¡ü–i¡ Òò¸à
Codes Scheme Description Rupay PlatinumëA¡àl¡Î³èÒ ë™à\>๠[¤¤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[¤ Aáà[ÎA¡ Òò¸à
SB113 DCB Free Style Savings Account Yes [l¡[Î[¤ [óø¡ СàÒüº 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\>๠[¤¤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¡¸àŤ¸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[¤ Сåìl¡–i¡ ëÎ[®¡}Î "¸àA¡àl¡ü–i¡ Òò¸à
3
Bank Use only (*Fields are Mandatory)
Ç¡‹å³ày ¤¸àìS¡¹ ¤¸¤Òàì¹¹ l¡üì„ìŸ (* [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. / "à줃> >}.: IND
SOL Code:&Î*&º ëA¡àl¡
Relationship Form / δšA¢¡ 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>๠¤¸àìS¡¹ Îàì= &A¡[i¡ δšA¢¡ Ñ‚àšì>¹ l¡üì„ìŸ "à줃> 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:"à줃>A¡à¹ã 1
Joint Applicant 1:ë™ï= "à줃>A¡à¹ã 1
Joint Applicant 2:ë™ï= "à줃>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¡>)
ClassicAáà[ÎA¡
ShauryaëÅ
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¡ [¤¤¹oγèÒ: ³åJ¸ "à줃>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
Î줢àZW¡ 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.
Î줢àZW¡ 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 ëƒìŹ
>àK[¹A¡ / ¤à[Ζƒà 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>๠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 CodeιºãAõ¡t¡ š[¹³àìš¹ "¸àA¡l¡üì–i¡¹ >[=šìy¹ ëA¡àl¡
Voter Identity Card:
Your unique identification number / "àš>๠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)ιºãAõ¡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 A塳à¹ã l¡à. ìšøàìó¡Î¹ A¡¸àìŸi¡> ">¸à>¸Î³èÒ
*l¡àA¡ >à³
*[Ñ‚[t¡ "šøàœ¡¤ÚÑHþ ¤[¹Ë¡ >àK[¹A¡ ëš>Å>쮡àKã ">¸à>¸ Îà‹à¹o Î}т๠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¡>) à[ÒA¡ "¤Ñ‚à "[¤¤à[Òt¡ [¤¤à[Òt¡
*\–µA¡àºã> ëƒÅ *\–µA¡àºã> ÅÒ¹
*>àK[¹A¡â« *A¡ì¹¹ l¡üì„Ÿ\[>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 ³åκ³à> JøãСà> [ÅJ ë¤ï‡ý¡ í\> šà[΢ ">¸à>¸
*³àt¡à¹ δšèo¢ >à³
*[št¡à¹ / Ѭà³ã¹ / Ñ|ã¹ >à³
*³àt¡à¹ A塳à¹ã >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 뮡ài¡à¹ A¡àl¢¡
&>ì¹Kà \¤ A¡àl¢¡
*[k¡A¡à>๠šø³àošy
Ѭt¡”| "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
γà[œ¡¹ t¡à[¹J
γà[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 뮡ài¡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 >}. &¤} Òü쳺 "àÒü[l¡-ìt¡ γÑz
Ît¡A¢¡t¡àγèÒ ìšø¹o A¡¹à Ò줡ú ë™àK¸ "¸àA¡àl¡ü–i¡Î³èìÒ¹ ëÛ¡ìy &Î&³&Î ë³à¤àÒüº ¤¸à[S¡}ìÚ¹
\>¸ ë³à¤àÒüº >´¬¹[i¡ ¤¸¤Òê¡t¡ Ò줡ú
šyìšø¹ìo¹ [k¡A¡à>๠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¡¸ Ò줡ú
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
State: Telephone: (with STD Code)
*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 Òü쳺 "àÒü[l¡
Ñ‚àÚã [k¡A¡à>à ¤t¢¡³à> [k¡A¡à>๠">å¹ê¡š
ÅÒ¹ [š>
*º¸à“¡³àA¢¡
¹à\¸ ëi¡[ºìó¡à>: (&Î[i¡[l¡ ëA¡àl¡ ÎÒ)
"[ó¡ìι [k¡A¡à>à
ÅÒ¹ [š>
*º¸à“¡³àA¢¡
¹à\¸ ëi¡[ºìó¡à>: (&Î[i¡[l¡ ëA¡àl¡ ÎÒ)
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¡ ëšàС Nø¸à\åìÚi¡ ëšÅàƒà¹ ">¸à>¸
ë³ài¡ ¤à[È¢A¡ "àÚ 50 Òà\àì¹¹ [>ì³— 50 Òà\๠- < 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¡
[>\Ѭ 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= "à줃>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
Simplified (for low risk customers)ιºãAõ¡t¡ ([>³— cåò¡[A¡¹ NøàÒA¡ìƒ¹ \>¸)
Smallëáàìi¡à
OTP based KYC*[i¡[š [®¡[v¡A¡ ëA¡*ÚàÒü[Î
##("[®¡®¡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 ¤Úìι šø³ào šy šøƒà> A¡¹ç¡> * [W¡[Òû¡t¡ Ñ‚à>P¡[º "¤Å¸Òü šè¹o A¡¹ìt¡ Òì¤
Relationship with Primary Applicant:³åJ¸ "à줃>A¡à¹ã¹ Îàì= δšA¢¡
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 ëƒìŹ
>àK[¹A¡ / ¤à[Ζƒà Ò> t¡àÒìº ">åNøÒ A¡ì¹ &ó¡&[i¡[Î& [¤¤õ[t¡ ó¡³¢[i¡ šè¹o A¡¹ç¡>
KYC Number:
(First Name / >àì³¹ šø=³à}Å) (Middle Name / >àì³¹ ³‹¸³à}Å) (Last Name / >àì³¹ ëÅÈà}Å)
Maximum 32 characters.
Î줢àZW¡ 32 [i¡ "Û¡¹ š™¢”z:
*Name:
Existing Customer ID: (If applicable)
Mr. Mrs. Ms. Dr. Prof. Capt. Others
ëA¡*ÚàÒü[Î >´¬¹ [¤ƒ¸³à> NøàÒA¡ "àÒü[l¡: (™[ƒ šøì™à\¸ ÒÚ)
*>à³ Åøã Åøã³t¡ã A塳à¹ã l¡à. ìšøàìó¡Î¹ A¡¸àìŸi¡> ">¸à>¸Î³èÒ
*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 Married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„Ÿ\[>t¡ "à¤àÎÑ‚º
U.S. Person: Yes No
Òül¡ü.&Î.-&¹ >àK[¹A¡ Òò¸à >à
Religion: Hindu Muslim Christian Sikh Buddhist Jain Parsi Others
‹³¢ [Ò–ƒå ³åκ³à> JøãСà> [ÅJ ë¤ï‡ý¡ í\> šà[΢ ">¸à>¸
*Mother’s Full Name:
*Father / Spouse Full Name:
*³àt¡à¹ δšèo¢ >à³
*[št¡à¹ / Ѭà³ã¹ / Ñ|ã¹ >à³
*Mother’s Maiden Name:*³àt¡à¹ A塳à¹ã >à³
*Residential Status: Resident Individual Non Resident Indian Foreign National Person of Indian Origin**"à¤à[ÎA¡ [Ñ‚[t¡ Ѭt¡”| "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 CardÎ줢àZW¡ 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¡>
Required if Passport or
Driving licence provide as Identity /
Address proof™[ƒ šàÎìšài¢¡ ¤à l¡öàÒü[®¡} ºàÒüìÎX š[¹W¡Ú / [k¡A¡à>๠šø³ào [ÒìÎì¤ šøƒà> A¡ì¹ =àìA¡> t¡àÒìº
šøìÚà\>
Others: (any document notified by the central government) / ">¸à>¸: (ìA¡–ƒøãÚ Î¹A¡à¹ ‡à¹à \à¹ãAõ¡t¡ ë™ ëA¡àì>à >[=šy)
Your unique identification number / "àš>๠Òül¡ü[>A¡ "àÒüìl¡[–i¡[ó¡ìA¡Å> >´¬¹
Type of card & cheque book
issuance would be
based upon the product.
šìo¸¹ ‹¹ì>¹ l¡üš¹ [>®¢¡¹ A¡ì¹ A¡àl¢¡
&¤} ëW¡A¡ ¤Òü šøƒà> A¡¹à ÒÚ¡ú
*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>쮡àKã ">¸à>¸ Îà‹à¹o Î}т๠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 뮡ài¡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:γà[œ¡¹ t¡à[¹J
Expiry Date:γà[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 CodeιºãAõ¡t¡ š[¹³àìš¹ "¸àA¡l¡üì–i¡¹ >[=šìy¹ ëA¡àl¡*[k¡A¡à>๠šø³àošy šàÎìšài¢¡ l¡öàÒü[®¡} ºàÒüìÎX Òül¡ü"àÒü[l¡ ("à‹à¹)
NREGA Job Card OthersVoter Identity Card
Î[W¡y 뮡ài¡à¹ A¡àl¢¡ &>ì¹Kà \¤ A¡àl¢¡ ">¸à>¸
*Preferred Email Id:
Permanent Address:
City: PIN:
*Landmark:
Same as Current Address
State: Telephone: (with STD Code)
*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 Òü쳺 "àÒü[l¡
Ñ‚àÚã [k¡A¡à>à ¤t¢¡³à> [k¡A¡à>๠">å¹ê¡š
ÅÒ¹ [š>
*º¸à“¡³àA¢¡
¹à\¸ ëi¡[ºìó¡à>: (&Î[i¡[l¡ ëA¡àl¡ ÎÒ)
Joint Applicant 2 / ë™ï= "à줃>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
Simplified (for low risk customers)ιºãAõ¡t¡ ([>³— cåò¡[A¡¹ NøàÒA¡ìƒ¹ \>¸)
Smallëáàìi¡à
OTP based KYC*[i¡[š [®¡[v¡A¡ ëA¡*ÚàÒü[Î
Relationship with Primary Applicant:³åJ¸ "à줃>A¡à¹ã¹ Îàì= δšA¢¡
"àš[> ™[ƒ Òül¡ü.&Î.&.-&¹ ¤à ">¸ ëA¡àì>à ëƒìŹ
>àK[¹A¡ / ¤à[Ζƒà Ò> t¡àÒìº ">åNøÒ A¡ì¹ &ó¡&[i¡[Î& [¤¤õ[t¡ ó¡³¢[i¡ šè¹o A¡¹ç¡>
Please fill FATCA
Declaration Form if you are U.S.A. or other country citizen / resident
KYC Number:
(First Name / >àì³¹ šø=³à}Å) (Middle Name / >àì³¹ ³‹¸³à}Å) (Last Name / >àì³¹ ëÅÈà}Å)
Maximum 32 characters.
Î줢àZW¡ 32 [i¡ "Û¡¹ š™¢”z:
*Name:
Existing Customer ID: (If applicable)
Mr. Mrs. Ms. Dr. Prof. Capt. Others
ëA¡*ÚàÒü[Î >´¬¹ [¤ƒ¸³à> NøàÒA¡ "àÒü[l¡: (™[ƒ šøì™à\¸ ÒÚ)
*>à³ Åøã Åøã³t¡ã A塳à¹ã l¡à. ìšøàìó¡Î¹ A¡¸àìŸi¡> ">¸à>¸Î³èÒ
*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 Married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„Ÿ\[>t¡ "à¤àÎÑ‚º
U.S. Person: Yes No
Òül¡ü.&Î.-&¹ >àK[¹A¡ Òò¸à >à
Religion: Hindu Muslim Christian Sikh Buddhist Jain Parsi Others
‹³¢ [Ò–ƒå ³åκ³à> JøãСà> [ÅJ ë¤ï‡ý¡ í\> šà[΢ ">¸à>¸
*Mother’s Full Name:
*Father / Spouse Full Name:
*³àt¡à¹ δšèo¢ >à³
*[št¡à¹ / Ѭà³ã¹ / Ñ|ã¹ >à³
*Mother’s Maiden Name:*³àt¡à¹ A塳à¹ã >à³
*Residential Status: Resident Individual Non Resident Indian Foreign National Person of Indian Origin**"à¤à[ÎA¡ [Ñ‚[t¡ Ѭt¡”| "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[¹ìȤà[ƒ
SMS Banking & Alert Facility: / &Î&³&Î ¤¸à[S¡} * Ît¡A¢¡t¡à Îå[¤‹àγèÒ: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 [>샢ìŹ ¤¸=¢t¡à, "¸àA¡àl¡üì–i¡¹ îy³à[ÎA¡ ¤¸àìºìX¹ [>ì³— ¤¸àìºX &¤} ¤¸àìºX "àšìl¡i¡ δš[A¢¡t¡ Òü쳺 &¤} / "=¤à ë³à¤àÒüìº Ît¡A¢¡t¡à šøàœ¡ A¡¹ìt¡ ÎÛ¡³ A¡ì¹¡ú γÚà>å™àÚã >t¡å> Ît¡A¢¡t¡à γèÒ ™åv¡û¡ Òìt¡ šà칡ú
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[\ìСöÅ> 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¡öàС / "¸àìÎà[ÎìÚÅ> / ëÎàÎàÒü[i¡-&¹ ">åì³à[ƒt¡ ѬàÛ¡¹A¡à¹ã/Ko γÚà>å™àÚã ¤¸àS¡ A¡t¢õ¡A¡ [>‹¢à[¹t¡ [>Ú³ &¤} Åt¢¡à¤ºã¹ "‹ãì> [¤>à³è캸 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¤>: γÑz ëW¡A¡
yû¡Î A¡¹à l¡ü[W¡; &¤} '[l¡[Î[¤ ¤¸àS¡ [º[³ìi¡l¡'
"¸àA¡àl¡ü–i¡ ("àš>๠>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 SurvivorѬÚ} 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 ([>샢[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¡ δš[A¢¡t¡ ëA¡àì>à šøW¡à¹³èºA¡ A¡º, &Î&³&Î Ît¡A¢¡t¡à ¤à Òü쳺γèÒ NøÒo A¡¹ìt¡ "[>ZáåA¡¡ú
&Òü "¸àA¡àl¡ü–i¡[i¡ìt¡ "à[³ / "à³¹à "à³à¹ / "à³à샹 "à‹à¹ [ºS¡ A¡¹àìt¡ "[>ZáåA¡¡ú (">åNøÒ A¡ì¹ ë>ài¡ A¡¹ì¤>: "¸àA¡àl¡üì–i¡ ®¡t墡[A¡ šà*Ú๠\>¸ 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 Òü쳺 Òül¡ü[i¡[º[i¡ [¤ºÎ³èÒ
ìó¡à> ¤¸à[S¡} šá–ƒÎÒü ®¡àÈ๠[¤A¡¿ Òü}¹à\ã [Ò[–ƒ ³à¹à[k¡ P¡\¹à[t¡ t¡à[³º ët¡ºåP¡
šàΤÒü [¤º[N—A¡¹> \ã¤> ¤ã³à [³l¡üW塸Úຠó¡à“¡ δšƒ ¤¸¤Ñ‚àš>à ì\>à칺 ÒüXå¸ì¹X
YYYMMDD Y
YYYMMDD Y
Maximum 19 characters. This name would appear on the Debit CardÎ줢àZW¡ 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¡>
Required if Passport or
Driving licence provide as Identity /
Address proof™[ƒ šàÎìšài¢¡ ¤à l¡öàÒü[®¡} ºàÒüìÎX š[¹W¡Ú / [k¡A¡à>๠šø³ào [ÒìÎì¤ šøƒà> A¡ì¹ =àìA¡> t¡àÒìº
šøìÚà\>
Others: (any document notified by the central government) / ">¸à>¸: (ìA¡–ƒøãÚ Î¹A¡à¹ ‡à¹à \à¹ãAõ¡t¡ ë™ ëA¡àì>à >[=šy)
Your unique identification number / "àš>๠Òül¡ü[>A¡ "àÒüìl¡[–i¡[ó¡ìA¡Å> >´¬¹
Type of card & cheque book
issuance would be
based upon the product.
šìo¸¹ ‹¹ì>¹ l¡üš¹ [>®¢¡¹ A¡ì¹ A¡àl¢¡
&¤} ëW¡A¡ ¤Òü šøƒà> A¡¹à ÒÚ¡ú
*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>쮡àKã ">¸à>¸ Îà‹à¹o Î}т๠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 뮡ài¡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:γà[œ¡¹ t¡à[¹J
Expiry Date:γà[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 CodeιºãAõ¡t¡ š[¹³àìš¹ "¸àA¡l¡üì–i¡¹ >[=šìy¹ ëA¡àl¡*[k¡A¡à>๠šø³àošy šàÎìšài¢¡ l¡öàÒü[®¡} ºàÒüìÎX Òül¡ü"àÒü[l¡ ("à‹à¹)
NREGA Job Card OthersVoter Identity Card
Î[W¡y 뮡ài¡à¹ A¡àl¢¡ &>ì¹Kà \¤ A¡àl¢¡ ">¸à>¸
*Preferred Email Id:
Permanent Address:
City: PIN:
*Landmark:
Same as Current Address
State: Telephone: (with STD Code)
*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 Òü쳺 "àÒü[l¡
Ñ‚àÚã [k¡A¡à>à ¤t¢¡³à> [k¡A¡à>๠">å¹ê¡š
ÅÒ¹ [š>
*º¸à“¡³àA¢¡
¹à\¸ ëi¡[ºìó¡à>: (&Î[i¡[l¡ ëA¡àl¡ ÎÒ)
7
Tax Deduction at Source / l¡ü;ìι 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 γìÚ [l¡ìšà[\i¡Î³èìÒ¹ >¤ãA¡¹ì>¹ γÚ
15[\ / 15&ÒüW¡ ó¡³¢ Òüt¡¸à[ƒ \³à [ƒìt¡
Ò줡ú
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®¡à΢ 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 Ò줡ú γÑz [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= γÚà>å™àÚã šõ=A¡ Òìt¡ šà칡ú &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§¡ Ò줡ú
Account Statement: Frequency of statement would be as per the product feature. / "¸àA¡àl¡üì–i¡¹ [¤¤õ[t¡: [¤¤õ[t¡[i¡ šøƒàì>¹ γìÚ¹ "”z¹ šo¸ í¤[ÅìÊ¡¸¹ ‹¹o ">å™àÚã Ò줡ú
2-*ìÚ ÎåÒüš [l¡ìšà[\ìi¡¹ [¤¤¹oγèÒ: 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*Ú๠t¡à[¹J
™[ƒ >à =àìA¡, t¡àÒìº [i¡[l¡&Î \³à¹ ë¹ó¡àì¹X >}.
Term Deposit Details / i¡à³¢ [l¡ìšà[\ìi¡¹ [¤¤¹oγèÒ (* 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>๠[>¤[Þê¡t¡ Òü쳺 "àÒü[l¡ìt¡ [l¡[Î& ìšø¹o A¡¹à Ò줡ú
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*Ú๠\>¸ \–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 ³àìι* A¡³ γìÚ¹
\>¸ \³àAõ¡t¡ [l¡ìšà[\i¡Î³èìÒ¹
\>¸ ιº 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 [>샢Åऺã (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 [>샢Åऺã (ìAáà\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 ³àìι* A¡³ γìÚ¹ \>¸ \³à A¡¹à Òìº)
Îå샹 "‹¢-¤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¡ Î줢àZW¡ 10 ¤á¹)
¤[¹Ë¡ >àK[¹A¡ Îå샹 Ò๠šø[t¡ ¤á¹
Îåƒ šøƒàì>¹ [>샢Åऺã
[l¡[Î[¤ "¸àA¡àl¡ü–i¡ >}.
[l¡³à“¡ l¡öàóô¡i¡ \à¹ãA¡¹> šøìƒÚ
&>Òü&ó¡[i¡-&¹³à‹¸ì³
³èº‹> &¤} Îå샹 "ìi¡à [¹[>l¡ü ³èº‹> &¤} šøìƒÚ Îå샹 "ìi¡à [¹[>l¡ü ³èº‹> &¤} Îå샹 šå>@šøƒà>
"šàì¹Åì>¹ ë³àl¡ ѬÚ} "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): / Ѭâ«ì®¡àKã¹ >à³ (Ѭâ«ì®¡àKã¹ ¤¸àS¡ ë¹A¡l¢¡ ">åÎàì¹ - "à줃>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 \>¸ Îå샹 "=¢ šøƒà> &¤} ³¸àWå¡[¹[i¡ Î}yû¡à”z [>샢Åऺã
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¡ [>샢Åऺã [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¤ºãγèÒ:
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/"à³à샹 ì¤à‹K³¸ ÒìÚìá ë™ ìšø[¹t¡ "=¢ "à³à¹/"à³à샹 [>\Ѭ 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*Ú๠šì¹ ë³ìÎ\[i¡¹ ®å¡º ¤¸àJà\[>t¡ ¤à K”z¤¸ ¤¸àìS¡¹ [yû¡Úà ë=ìA¡ ¤à "à¹[¤"àÒü ([¹\஢¡ ¤¸àS¡ "ó¡ Òü[“¡Úà) "à¹[i¡[\&Î/&>Òü&ó¡[i¡ [ÎìС³ NøàÒìA¡¹ ¤¸àS¡/ÅàJàÚ
"஡¸”z¹ão ë™àKàì™àK ¤¸¤Ñ‚๠">åš[Ñ‚[t¡ ¤à ¤¸=¢t¡à¹ A¡à¹ìo ¤à "à³à¹/"à³à샹 ‡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¡>๠\>¸ ¤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 [>\Ѭ Û¡[t¡ ¤à ëºàA¡Îà> ÒÚ t¡àÒìº Î}™åv¡û¡ ¤¸àS¡ ëA¡àì>஡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>๠[>샢Å>๠ÎàìšìÛ¡¹
[¤ÈÚ¤Ññ¡ú3. "à[³/"à³¹à δ¶[t¡ šøƒà> A¡¹[á ë™ ìyû¡[l¡i¡[i¡ ëA¡¤º³ày Ѭâ«ì®¡àKã "¸àA¡àl¡ü–i¡ >´¬ì¹¹ t¡ì=¸¹ l¡üš¹ šø®¡à¤ ëó¡ºì¤ &¤} Ѭâ«à[‹A¡à¹ã¹ >à³ [¤¤¹oã¹ \>¸ ¤¸¤Òê¡t¡ Òì¤ >à¡ú
¤¸àìS¡¹ >à³ ÅàJ๠>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 / "à줃>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 "à줃>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 ¤¸¤Ò๠A¡¹ì¤à ëÎÒü [¤ÈìÚ "à[³ [>ÆW¡Út¡à &¤} δ¶[t¡ l¡ü®¡ÚÒü šøƒà> A¡¹[á &¤} "à[³ &ÒüΤ [¤[®¡Ä š[¹ìȤà[ƒ¹ γÑz Åt¢¡à¤ºã ë³ì> W¡ºì¤à &¤} "šøàœ¡¤ÚÑHþ šøàœ¡¤ÚÑHþ Ò*Ú๠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 "à줃>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¡(γèÒ)-& 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¡ "à줃>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¡ [¤¤¹oγèÒ
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*Ú๠\>¸ \–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¡ Î줢àZW¡ 10 ¤á¹)
¤[¹Ë¡ >àK[¹A¡ Òò¸à >à Îå샹 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¡ ³àìι
³¸àWå¡[¹[i¡ [>샢Åऺã [l¡[Î[¤ "¸àA¡àl¡ü–i¡ >}.-& i¡öàXó¡à¹
"šàì¹Åì>¹ ë³àl¡ ѬÚ} 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¡
A塳๠/ A塳à¹ã
(">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 ѬàÛ¡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 ѬàÛ¡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 ѬàÛ¡¹(γèÒ) / [i¡š ÎÒü (γèÒ)
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/"à³à샹 ³õt塸 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>๠"¸àA¡àl¡ü–i¡ &¤}/"=¤à "àš>๠\>¸ \à¹ã A¡¹à šàΤåA¡ δš[A¢¡t¡ [¤ÈìÚ ë™³> \à¹ãAõ¡t¡ šàΤåA¡, [¤¤õ[t¡ &¤} [l¡[Î&-ìt¡ >[³[>¹ >à³ l¡üìÀJ A¡¹ìt¡ W¡à> [A¡>à ">åNøÒ A¡ì¹ t¡à [>샢ŠA¡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¡ γÑz t¡=¸à¤ºã "à³à¹/"à³à샹 `¡à> &¤} [¤Å«àÎ ">å™àÚã Ît¡¸¡ú
Yes No
"à줃>A¡à¹ã¹ Îàì= δšA¢¡, ™[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/"à³à샹/>à¤àºìA¡¹ "¤t¢¡³àì> ¤à ³õt塸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 annumÎå샹 Ò๠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
ѬàÛ¡¹
[k¡A¡à>à
Ñ‚à> t¡à[¹J
Risk Classification for Primary Applicant / ³åJ¸ "à줃>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¸ δš[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
10 ëA¡à[i¡ i¡àA¡à š™¢”z
50 ºÛ¡ i¡àA¡à š™¢”z
25 ëA¡à[i¡ i¡àA¡à š™¢”z
1 ëA¡à[i¡ i¡àA¡à š™¢”z
25 ëA¡à[i¡ i¡àA¡à¹ "[‹A¡
ìÅøo㤇ý¡A¡¹ìo¹ [®¡[v¡ ¹à\î>[t¡A¡®¡àì¤ š[¹[W¡t¡ ¤¸[v¡û¡ cåò¡[A¡šèo¢ ëƒìÅ [>¤àÎ i¡öàС [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 - ëƒìŹ >à³
¤¸¤Î๠‹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 [¤[>ìÚàKγèÒ 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= "à줃>A¡à¹ã 1-&¹ còå¡[A¡¹ ìÅøoã[¤>¸àÎ
Risk Classification for Joint Applicant 2 / ë™ï= "à줃>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 ѬàÛ¡¹ A¡¹ìt¡ Ò줡ú
Name:
Signature:
Address:
Place: Date:
>à³
ѬàÛ¡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:
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¸ δš[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
10 ëA¡à[i¡ i¡àA¡à š™¢”z
50 ºÛ¡ i¡àA¡à š™¢”z
25 ëA¡à[i¡ i¡àA¡à š™¢”z
1 ëA¡à[i¡ i¡àA¡à š™¢”z
25 ëA¡à[i¡ i¡àA¡à¹ "[‹A¡
ìÅøo㤇ý¡A¡¹ìo¹ [®¡[v¡ ¹à\î>[t¡A¡®¡àì¤ š[¹[W¡t¡ ¤¸[v¡û¡ cåò¡[A¡šèo¢ ëƒìÅ [>¤àÎ i¡öàС [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 - ëƒìŹ >à³
¤¸¤Î๠‹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 [¤[>ìÚàKγèÒ 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¡)
* 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¸ δš[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
10 ëA¡à[i¡ i¡àA¡à š™¢”z
50 ºÛ¡ i¡àA¡à š™¢”z
25 ëA¡à[i¡ i¡àA¡à š™¢”z
1 ëA¡à[i¡ i¡àA¡à š™¢”z
25 ëA¡à[i¡ i¡àA¡à¹ "[‹A¡
ìÅøo㤇ý¡A¡¹ìo¹ [®¡[v¡ ¹à\î>[t¡A¡®¡àì¤ š[¹[W¡t¡ ¤¸[v¡û¡ cåò¡[A¡šèo¢ ëƒìÅ [>¤àÎ i¡öàС [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 - ëƒìŹ >à³
¤¸¤Î๠‹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 [¤[>ìÚàKγèÒ 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¡)
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¡> &¤} δ¶[t¡ šøƒà> A¡¹[á ë™ "à³à¹ / "à³ìƒ¹ "¸àA¡àl¡üì–i¡¹ Îà³[NøA¡ ëyû¡[l¡i¡ ™[ƒ [¹\஢¡ ¤¸àS¡ "ó¡ Òü[“¡Úà ‡à¹à [>‹¢à[¹t¡ Îã³à "[t¡yû¡³ A¡ì¹, t¡àÒìº "à[³ / "à³¹à ëÎÒü γìÚ šøì™à\¸ δšèo¢ ëA¡*ÚàÒü[Î
>ã[t¡³àºà ">åιo A¡¹à¹ \>¸ δ¶[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 γÑz [\[>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*Ú๠"[‹A¡à¹ Î}¹Û¡o A¡ì¹¡ú
The Branch Manager / ÅàJà ¤¸¤Ñ‚àšA¡
Yours faithfully / "àš>๠ǡ®¡à>勸àÚã,
Sir / Madam / ³ÒàÅÚ / ³ÒàÅÚà,
___________________________________
____________________ Branch / ÅàJà
(Signature of the Customer / )"à줃>A¡à¹ã¹ ѬàÛ¡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¸ ι¤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 / "à³à샹 Î}т๠A¡ìš¢àì¹i¡ [k¡A¡à>à[i¡ìA¡ "à³à¹ / "à³à샹 šyìšø¹ìo¹ [k¡A¡à>à [ÒìÎì¤ Î}¹[Û¡t¡ A¡¹ì¤¡ú
The Branch Manager / ÅàJà ¤¸¤Ñ‚àšA¡
DCB Bank Limited / [l¡[Î[¤ ¤¸àS¡ [º[³ìi¡l¡
Letter From Customer – Opening of Corporate Payroll Account with Mailing Address as Office Address
NøàÒìA¡¹ šÛ¡ ë=ìA¡ šy - "[ó¡ìι [k¡A¡à>๠">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>๠ǡ®¡à>勸àÚã,
Sir / Madam / ³ÒàÅÚ / ³ÒàÅÚà,
___________________________________
(Signature/s of the Customer/s / )NøàÒA¡/Ko-&¹ ѬàÛ¡¹/γèÒ
DCB Bank Limited / [l¡[Î[¤ ¤¸àS¡ [º[³ìi¡l¡
Declaration Regarding Signing in Vernacular Language / By Illiterate / Visually Challenged Person
___________ ___________ ___________ ___________
³àtõ¡®¡àÈàÚ / [>¹Û¡¹ ‡à¹à / ƒõ[Ê¡Òã> ¤¸[v¡û¡-&¹ ‡à¹à ѬàÛ¡¹ δš[A¢¡t¡ [¤¤õ[t¡
Name and signatures of Applicants Name and signature of the Declarant / "à줃>A¡à¹ã¹ >à³ &¤} ѬàÛ¡¹ &¤} ëQàÈìA¡¹ >à³ &¤} ѬàÛ¡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¡[ÎÚຠ¤à ¤¸àìS¡¹ NøàÒA¡)
"à줃>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 δšìA¢¡ _________________________________________
_____________________________ ®¡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 γÑz
Åt¢¡à¤ºã ì³ì> W¡ºà¹ \>¸ δ¶[t¡ šøƒà> A¡ì¹ìá>¡ú l¡üšì¹àv¡û¡ "à줃>A¡à¹ã(Ko) [>ì³— &Jàì> ¤[o¢t¡ ">å™àÚã t¡à¹ / t¡à샹 ѬàÛ¡¹(γèÒ) / [i¡šÎÒü(γèÒ) šøƒà> A¡ì¹ìá> / Î}™åv¡û¡ A¡ì¹ìá>:
Declaration / [¤¤õ[t¡
"à[³/"à³¹à [l¡[Î[¤ ¤¸àS¡ [º[³ìi¡l¡ (''¤¸àS¡'')-&¹ *ìÚ¤ÎàÒüi¡ www.dcbbank.com-& šøƒv¡ "à³à¹ / "à³à샹 "¸àA¡àl¡üì–i¡¹ \>¸ šøì™à\¸ [>Ú³ &¤} Åt¢¡à¤ºã¹ "‹ãì> δ¶[t¡ šøƒà> A¡¹[á¡ú "à[³ / "à³¹à ¤åc¡ìt¡ ëšì¹[á ë™ &Òü Î}yû¡à”z šøì™à\¸ [>Ú³ &¤} Åt¢¡à¤ºã¹ ë™ ëA¡à>* š[¹¤t¢¡ì>¹ / "àšìl¡ìi¡¹ "¸àìGÎ ëA¡¤º³ày ¤¸àìS¡¹ *ìÚ¤ÎàÒüìi¡ l¡üšº§¡ Ò줡ú "à[³ / "à³¹à &t¡‡à¹à ëQàÈoà A¡¹[á &Òü ó¡³¢[i¡ìt¡ šøƒv¡ t¡=¸ "à³à¹ / "à³à샹 `¡à> &¤} [¤Å«àìι l¡üš¹ [®¡[v¡ A¡ì¹ Ît¡¸ &¤} Î[k¡A¡¡ú "à[³ / "à³¹à &t¡‡à¹à &[i¡&³ / ël¡[¤i¡ A¡àl¢¡ \à[¹A¡¹> &¤} ëó¡à> ¤¸à[S¡}, ë³à¤àÒüº ¤¸à[S¡} š[¹ìȤà, Òü–i¡à¹ì>i¡ ¤¸à[S¡} &¤} [¤º ëšì³–i¡ š[¹ìȤà[ƒ¹ [¤‹à> ">åì³à[ƒt¡ A¡¹[á¡ú "à[³ / "à³¹à šøƒv¡ [¤[®¡Ä š[¹ìȤàγèìÒ¹ \>¸ šøì™à\¸ W¡à\¢Î³èÒ Î´šìA¢¡ ÎìW¡t¡> &¤} "à[³ / "à³¹à [>[ÆW¡t¡ ÒìÚ[á &¤} [>ÆW¡Út¡à šøƒà> A¡¹[á ë™ "à[³ / "à³¹à [l¡[Î[¤ ¤¸àS¡ -&¹ ëó¡à> ¤¸à[S¡} š[¹ìȤà, Òü–i¡à¹ì>i¡
¤¸à[S¡} &¤} [¤º ëšì³–i¡ Î}yû¡à”z www.dcbbank.com-& ¤[o¢t¡ ''[>Ú³ * Åt¢¡à¤ºã'' šìØl¡ &¤} ¤åìc¡ [>ìÚ[á &¤} "à[³ / "à³¹à γÚà>å™àÚã šøì™à\¸ γÑz Åt¢¡à[ƒ / Åt¢¡à¤ºã ³à>¸ A¡ì¹ W¡ºì¤à¡ú "à[³ / "à³¹à γÚà>å™àÚã šøì™à\¸ [ÒìÎì¤ šøƒv¡ ë™ ëA¡àì>à / [¤[®¡Ä š[¹ìȤà / š[¹ìȤà[ƒ¹ \>¸ šøì™à\¸ W¡à\¢ "à³à¹ / "à³à샹 "¸àA¡àl¡ü–i¡(γèÒ) ë=ìA¡ ël¡[¤i¡ A¡¹à¹ \>¸ ¤¸àS¡ìA¡ ">åì³à[ƒt¡ A¡¹[á¡ú ³¸àWå¡[¹[i¡ [>샢Åऺ㹠"®¡àì¤, [l¡ìšà[\i¡ šøì™à\¸ [>Ú³ * Åt¢¡à¤ºã ÎÒ Îå샹 Ò๠">å™àÚã &A¡Òü ë³Úà샹 \>¸ "ìi¡à-[¹[>l¡ü A¡¹à Ò줡ú
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t¡=¸ š[¹W¡àº>๠Îå[¤‹àì=¢ "à줃ì>¹ ó¡³¢ >´¬¹ &¤} / "=¤à ¤¸àS¡ [>‹¢à[¹t¡ [¤¤¹o "”z®å¢¡v¡û¡ A¡¹ìt¡ Ò줡ú(d¡) "à³àìA¡ / "à³à샹ìA¡ &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 &¤} ¤¸¤Ò๠γÚà>å™àÚã šøìÚàK\[>t¡ Åt¢¡à¤ºã ‡à¹à [>Ú[”|t¡ Òì¤ &¤} "à[³ / "à³¹à &¹ ‡à¹à "इý¡ Òìt¡ δ¶t¡¡ú (k¡) &Òü ël¡[¤i¡ A¡à³ &[i¡&³ A¡àìl¢¡¹ [>Ú³ &¤} Åt¢¡à¤ºã γÚà>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 / "à³à샹 "¸àA¡àl¡üì–i¡ ël¡[¤i¡ A¡à³ &[i¡&³ A¡àl¢¡ ¤¸¤Òàì¹¹ \>¸ [ó¡ &¤} W¡àì\¢¹ γt塺¸ "=¢¹à[Å ¤à[È¢A¡®¡àì¤ "à³à¹ "¸àA¡àl¡ü–i¡ ì=ìA¡ ël¡[¤i¡ A¡¹ìt¡ šà칡ú(n¡) "à[³ / "à³¹à, ë™ï= ‹à¹A¡(¹à), δ¶[t¡ šøƒà> A¡¹[á ë™ ë™ï= "à³à>t¡A¡à¹ã¹ &A¡ ¤à &A¡à[‹ìA¡¹ ³õt塸¹ ëÛ¡ìy, \ã[¤t¡ "à³>t¡A¡¹ã(샹)ìA¡ Îe¡Úã®è¡t¡ "=¢¹à[Å, ">åì¹à‹ A¡¹à Òìº šø[yû¡Ú๠ë³àl¡ ">å™àÚã [>‹¢à[¹t¡ ë³Úàƒ Î´šèo¢ Ò*Ú๠šè줢Òü šøƒà> A¡¹à ë™ìt¡ šà칡ú &ìÛ¡ìy [>Ú”|A¡ [>샢[ÅA¡à ¤à [¤[Î&Î[¤"àÒü ëA¡àìl¡¹ [¤‹à> ¤à l¡ü®¡Ú ">å™àÚã, ">åì¹à싹 t¡à[¹ìJ¹ ÎàìšìÛ¡, ™[ƒ šøì™à\¸ ÒÚ, t¡àÒìº ¤¸àS¡ \[¹³à>à W¡à\¢Î³èÒ "àƒàÚ A¡¹ìt¡ šà칡ú(o) &A¡³ày ¤¸àìS¡¹ [¤ì¤W¡>๠[®¡[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 δšìA¢¡ ¤¸àS¡ "à³àìA¡ / "à³à샹 &A¡ ³àìι ë>à[i¡Î šøƒà> A¡¹à¹ šì¹ "¸àA¡àl¡ü–i¡[i¡ ¤Þê¡ A¡¹à¹ ¤à γÑz áàØl¡ šøt¡¸àÒ๠A¡¹à¹ "[‹A¡à¹ ¹Û¡à A¡ì¹ ¤à "à³àìA¡ / "à³à샹 ëƒ*Úà ëA¡àì>à š[¹ìÈ¤à ¤à &Òü \àt¡ãÚ š[¹ìȤ๠\>¸ šøì™à\¸ Òàì¹ W¡à\¢Î³èÒ ¤¸àS¡ ƒà¤ã A¡¹ìt¡ šà칡ú(t¡) ¤¸àS¡ t¡à¹ δšèo¢ [¤ì¤W¡>๠[®¡[v¡ìt¡, "à³àìA¡ / "à³à샹 ëA¡à>* [¤`¡[œ¡ šøƒà> áàØl¡àÒü ëA¡à>* š[¹ìȤà δšèo¢ ¤à "à}[ÅA¡®¡àì¤ ¤Þê¡ A¡ì¹ [ƒìt¡ šà칡ú(=) ë™ ëA¡à>* A¡à¹ìo "¸àA¡àl¡ü–i¡ ëJàºà \>¸ "=¢¹à[Ź š[¹³ào (&*&) Î}yû¡à”z ëW¡A¡ ëó¡¹ìt¡¹ ëÛ¡ìy, ¤¸àS¡ "à³à¹ / "à³à샹 ëA¡à>* ë¹ó¡àì¹X áàØl¡àÒü "¸àA¡l¡ü–i¡[i¡ ¤Þê¡ A¡ì¹ ëƒì¤ ¤à [ƒìt¡ šà칡ú(ƒ) ë™ ëA¡àì>à ">åì³à[ƒt¡ ѬàÛ¡¹A¡à¹ã(Ko) &¤} / "=¤à "à³à샹 \ã[¤t¡ ¤à ë¤òìW¡ =àA¡à A¡àì¹à A¡àá ë=ìA¡ [º[Jt¡ "à줃> šøà[œ¡¹ šì¹, ¤¸àS¡ t¡à¹ [>\Ѭ [¤ì¤W¡>๠[®¡[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> γà”z¹àº®¡àì¤ \à[¹ A¡¹ìt¡ šà칡ú(‹) [l¡[Î[¤ - "> ƒ¸ ëKà Îå[¤‹à[i¡ Ѭt¡”|®¡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>¸
γÑz [\[>ìι 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¡ γÚà>å™àÚã l¡üšº§¡ www.dcbbank.com "àšìl¡i¡Aõ¡t¡ t¡ì=¸¹ Îàì= ÎU[t¡šèo¢ Ò줡ú(ó¡) "à[³ / "à³¹à δ¶[t¡ šøƒà> A¡¹[á ë™ &Òü¹ê¡ìš [l¡ìšà[\i¡/γèìÒ¹ ë³Úàƒ ëÅÈ Ò*Ú๠šè줢 >>-A¡ìº¤º [l¡ìšà[\i¡/γèÒ "à³à¹ / "à³à샹 ‡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 δ¶[t¡ šøƒà> A¡¹[á¡ú
"à[³ / "à³¹à ¤åc¡ìt¡ ëšì¹[á &¤} δ¶[t¡ šøƒà> A¡¹[á ë™ [¤>à³è캸 ë³à¤àÒüìº Ît¡A¢¡t¡à Îå[¤‹à¹ \>¸ "àšìl¡i¡ / [>¤Þê¡A¡¹o / ">åì¹à싹 \>¸ šøƒv¡ δ¶[t¡[i¡ "à[³ / "à³¹à [º[Jt¡®¡àì¤ šøt¡¸àÒ๠>à A¡¹à š™¢”z  =àA¡ì¤¡ú [>[ƒ¢Ê¡¹ê¡ìš "¤Kt¡ >à A¡¹à Òìº, ¤¸àS¡ ó¡à³¢ / ëA¡à´šà>ã / i¡öàС / "¸àìÎà[ÎìÚÅ> / ëÎàÎàÒü[i¡-&¹ ">åì³à[ƒt¡ ѬàÛ¡¹A¡à¹ã/Ko-&¹ ">åì¹à‹Aõ¡t¡ >´¬ì¹ &Î&³&Î Ît¡A¢¡t¡àγèÒ ìšø¹o A¡¹ìt¡ =àA¡ì¤¡ú >à³/ γèÒ, [k¡A¡à>à, ë³à¤àÒüº >´¬¹, ">åì³à[ƒt¡ ѬàÛ¡¹A¡à¹ã/Ko ¤à "}Åãƒà¹ ¤à š[¹W¡àºA¡ ¤à i¡öà[С ¤à ó¡à³¢ / ìA¡à´šà>ã / i¡öàС / "¸àìÎàà[ÎìÚÅ> / ëÎàÎàÒü[i¡-&¹ ΃θ샹 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, ѬãA¡à¹ A¡¹[á &¤} δ¶[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¸ "à줃>A¡à¹ã¹ ѬàÛ¡¹Signature of Joint Applicant 2Signature of Joint Applicant 1
"à³àìA¡ / "à³à샹ìA¡ &Î&³&Î Ît¡A¢¡t¡à ìšø¹o A¡¹à¹ \>¸ "à³à¹ / "à³à샹 "¸àA¡àl¡üì–i¡ l¡ü[À[Jt¡ "à³à¹ / "à³à샹 ë³à¤àÒüº >´¬¹[i¡ ¤¸¤Ò๠A¡¹ç¡>¡ú
"à³à¹ / "à³à샹 t¡=¸Î³èÒ l¡üšì¹ l¡ü[À[Jt¡ ¤¸t¡ãt¡ ">¸ ëA¡à>* l¡üì„ìŸ ¤à "àÒüì>¹ šøìÚà\>ãÚt¡à ¤¸t¡ãt¡ ">¸ ëA¡à=à* ¤¸¤Ò๠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 / "à³à샹 ">¸ 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¡ γÑz [¤¤¹o δšèo¢ Î[k¡A¡ &¤} "à[³ / "à³¹à ¤¸àìS¡¹ [>Ú³ &¤} Åt¢¡à¤ºãìt¡ δ¶[t¡ šøƒà> A¡¹[á¡ú &áàØl¡à* "à[³ / "à³¹à "à¹* ¤åc¡ìt¡ ëšì¹[á ë™ "à³à¹ / "à³à샹 γÑz "¸àA¡àl¡ü–i¡ &A¡à[‹A¡ NøàÒA¡ "àÒü[l¡-&¹ &A¡ãA¡¹ì>¹ šì¹ ">>¸ NøàÒA¡ "àÒü[l¡ ë=ìA¡ "¸àìGÎ A¡¹à ™à줡ú
(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[Ζƒà샹 \>¸ l¡üšº§¡¡ú ³åJ¸ "à줃>A¡à¹ã¹ >àì³ Î³Ñz [Ò[Î[¤ Îå¹Û¡à [ó¡Gl¡ [l¡ìšà[\i¡Î³èÒ \åìØl¡ Î줢àZW¡ 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 ™à줡ú ¤ã³à A¡®¡à¹[i¡ ëA¡¤º³ày ³åJ¸ "¸àA¡àl¡ü–i¡‹à¹ìA¡¹ \>¸ l¡üšº§¡¡ú ™[ƒ ë³Úà샹 šè줢 šøt¡¸àÒ๠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> &¤} Òü쳺 "àÒü[l¡ šøƒà> A¡¹ìt¡ Ò줡ú γÑz "-ƒåQ¢i¡>à\[>t¡ ³õt塸¹ ëÛ¡ìy 45 [ƒ> šì¹ "à줃> A¡¹ìt¡ Ò줡ú "àuÒt¡¸à\[>t¡ ³õt塸 ¤¸t¡ãt¡ A¡®¡àì¹\ Ç¡¹ç¡¹ t¡à[¹J ë=ìA¡ &A¡ ¤áì¹¹ \>¸ "à줃> A¡¹à ™à줡ú &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 "à줃> ó¡³¢[i¡ìt¡ l¡ü[À[Jt¡ [l¡ìšà[\ìi¡¹ ë³ÚàƒA¡à캹 \>¸ 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¡>๠[®¡[v¡ìt¡ šøƒà> A¡¹à ÒÚ¡ú
šø³àoãA¡¹ìo¹ \>¸ δ¶[t¡ šøƒà>: "à[³ / "à³¹à, l¡üšì¹ ¤[o¢t¡ "à‹à¹ >´¬ì¹¹ ‹à¹A¡, Òül¡ü"àÒü[l¡&"àÒü-&¹ Îàì= šø³àoãA¡¹ìo¹ l¡üì„ìŸ "à³à¹ / "à³à샹 "à‹à¹ >´¬¹, >à³ &¤} [ó¡Uà¹[šø–i¡ / "àÒü[¹Å šà*Ú๠\>¸ &t¡‡à¹à ¤¸àS¡ìA¡ δ¶[t¡ šøƒà> A¡¹[á¡ú ¤¸àS¡ "à³àìA¡ / "à³à샹ìA¡ \à[>ìÚìá ë™ "à³à¹ / "à³à샹 š[¹W¡Ú t¡=¸Î³èÒ ëA¡¤º³ày \>t¡à[wA¡ šø³àoãA¡¹o / A¡¹o / Òü-ìA¡*ÚàÒü[Î-&¹ l¡üì„ìŸ ¤¸¤Òê¡t¡ Òì¤ &¤} &áàØl¡à* "à¹* \à[>ìÚìá ë™ "à³à¹ / "à³à샹 ¤àìÚàì³[i¡öA¡Î³èÒ Î}¹[Û¡t¡ / ëÅÚ๠A¡¹à Òì¤ >à &¤} ëA¡¤º³ày šø³àoãA¡¹ìo¹ l¡üì„ìŸ [Î"àÒü[l¡"๠(ìΖi¡öຠ"àÒüìl¡[–i¡[i¡\ ël¡i¡à ë¹[Ñšì¹i¡[¹)-ìt¡ \³à ëƒ*Úà Ò줡ú
NøàÒA¡ "àÒü[l¡ ³¸àì>\à¹: "à[³ / "à³¹à ¤åc¡ìt¡ ëšì¹[á &¤} δ¶[t¡ šøƒà> A¡¹[á ë™ "à³à¹ / "à³à샹 γÑz "¸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¡ Ò줡ú &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¡ šàì΢à>ຠÒü–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¤ &¤} γÑz "¸àA¡àl¡ü–i¡ *Òü NøàÒA¡ "àÒü[l¡ìt¡ Î}Òt¡ A¡¹à Ò줡ú "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¡ Îå샹 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>ऺã ">åÎàì¹ &J> ">>¸ NøàÒA¡ "àÒü[l¡-&¹ [®¡[v¡ìt¡ [i¡[l¡&Î šøì™à\¸ Òì¤ &¤} ¤¸àS¡ "à³à¹ / "à³à샹 γÑz "¸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¢¡} С¸à“¡àl¢¡Î)-&¹ δ¶[t¡ìt¡ l¡ü[À[Jt¡ "à줃>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¡ δ¶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 [>샢Åऺã "àšìl¡i¡ A¡¹ì¤à &¤} / "=¤à "šàì¹[i¡} A¡¹à¹ [>샢Åऺ㹠ëA¡àì>à¹ê¡š š[¹¤t¢¡> Ò*Ú๠Îàì= Îàì= ¤¸àìS¡¹ ë¹A¡ìl¢¡ ">¸ ëA¡àì>à š[¹¤t¢¡>(γèÒ) &¤} / "=¤à ¤¸àìS¡¹ A¡àìá =àA¡à "¸àA¡àl¡ü–i¡/γèìÒ¹ ">¸ ëA¡àì>à š[¹¤t¢¡>(γèÒ)-&¹ [¤ÈìÚ "¤[Òt¡ A¡¹ì¤à¡ú
"à³à¹ ¤¸[v¡û¡Kt¡ "àš>๠NøàÒA¡ìA¡ \à>å> (ìA¡*ÚàÒü[Î) t¡=¸ ëA¡–ƒøãÚ ëA¡*ÚàÒü[Î ([ÎìA¡*ÚàÒü[Î) ë¹[\[Сö ¤à ">¸ ëA¡àì>à l¡üš™åv¡û¡ A¡tõ¢¡šìÛ¡¹ Îàì= ëÅÚ๠A¡¹à ë™ìt¡ šàì¹ ëÎÒü [¤ÈìÚ "à[³ δ¶[t¡ šøƒà> A¡¹[á¡ú "à[³ &t¡‡à¹à [>¤[Þê¡t¡ ë³à¤àÒüº >´¬¹ / Òü쳺 "¸àìl¡öÎ-& &Î&³&Î / Òü쳺-&¹ ³à‹¸ì³ ¤¸àS¡ / [ÎìA¡*ÚàÒü[Î ë¹[\[Сö / ιA¡à¹ / [¹\஢¡ ¤¸àS¡ "ó¡ Òü[“¡Úà "=¤à ëA¡àì>à A¡tõ¢¡šìÛ¡¹ A¡àá ë=ìA¡ t¡=¸ NøÒo A¡¹à¹ \>¸ δ¶[t¡ šøƒà> A¡¹[á¡ú &áàØl¡à* &Òü \àt¡ãÚ ëA¡à>* &Î&³&Î / Òü쳺 >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 δ¶[t¡ šøƒà> A¡¹[á¡ú
¤¸àS¡ [Î"à¹&Î ¤à &ó¡&[i¡[Î& ¤à "à줃>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 δ¶[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 / "à³à샹 l¡ü[À[Jt¡ "¸àA¡àl¡üì–i¡ "à³àìA¡ / "à³à샹ìA¡ ®¡à¹t¡ ιA¡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>ຠëšì³–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¤ γÑz ë¤[>[ó¡i¡ "à³à¹ / "à³à샹 &Òü "¸àA¡àl¡üì–i¡ i¡öàXó¡à¹ A¡¹à Ò줡ú
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 / "à³à샹 ‡à¹à šøƒv¡ &¤} "à³à¹ / "à³à샹 ̀ ¡à>t¡ šøƒv¡ t¡=¸ δšèo¢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 ëѬZáàÚ l¡üšì¹àv¡û¡ "à³à¹ / "à³à샹 "à‹à¹ / Òül¡ü"àÒü[l¡ >´¬¹[i¡ šøƒà> A¡ì¹[á &¤} t¡àìt¡ δ¶[t¡ šøƒà> A¡ì¹[á:
§ Use my/our Aadhaar details to authenticate me/us from UIDAI. Òül¡ü"àÒü[l¡&"àÒü ë=ìA¡ "à³à¹ / "à³à샹 šø³àoãA¡¹ìo¹ \>¸ "à³à¹ / "à³à샹 "à‹à¹ [¤¤¹o ¤¸¤Ò๠A¡¹ç¡>¡ú
"à³à¹ / "à³à샹 šè¤¢¤t¢¡ã "¸àA¡àl¡üì–i¡¹ Îàì= "à³à¹ >àì³ ®¡à¹t¡ ιA¡à¹, Òül¡ü"àÒü[l¡&"àÒü ‡à¹à \à¹ãAõ¡t¡ "à³à¹ / "à³à샹 "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 / "à³à샹 "¸àA¡àl¡üì–i¡¹ \>¸ ¤¸àìS¡ [>Ú[³t¡ š[¹W¡à[ºt¡ [>샢Åऺã ">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 δ¶[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¡ (ìΖi¡öຠë¤àl¢¡ "ó¡ [l¡ì¹C¡ i¡¸àìGÎ)-ìt¡ šø[t¡ì¤ƒ>, šø[t¡ì¤[ƒt¡ [¤¤¹o ¤à "à³à¹ / "à³à샹 "¸àA¡àl¡ü–i¡[i¡ ¤Þê¡ ¤à Îà³[ÚA¡®¡àì¤ Ñ‚[Kt¡ A¡¹ìt¡ šà칡ú
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= "à줃>A¡à¹ã 1-&¹ ѬàÛ¡¹ ë™ï= "à줃>A¡à¹ã 2-&¹ ѬàÛ¡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¸ "à줃>A¡à¹ã¹ \>¸
Information Type / t¡ì=¸¹ ‹¹o Details / [¤¤¹oγèÒ
Countries where business associates located (for Businessmen, only) / ë™ ëƒÅP¡[ºìt¡ ¤¸¤Îà[ÚA¡ ÎÒì™àKã ¹ìÚìá (Ç¡‹å³ày ¤¸¤ÎàÚã샹 \>¸)
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
Ѭt¡”| / Îwà [®¡[v¡A¡ ëƒÅ
¤¸¤Î๠‹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
[¤[>ìÚàKγèÒ
">¸à>¸ (">åNøÒ A¡ì¹ l¡üìÀJ A¡¹ç¡>)
l¡üv¡¹à[‹A¡à¹ Îèìy šøàœ¡ ëšÅàKt¡ [ó¡
šøt¡¸à[Åt¡ *ڸ๠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¸ "à줃>A¡à¹ã¹ ѬàÛ¡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= "à줃>A¡à¹ã 1-&¹ \>¸
Information Type / t¡ì=¸¹ ‹¹o Details / [¤¤¹oγèÒ
Countries where business associates located (for Businessmen, only) / ë™ ëƒÅP¡[ºìt¡ ¤¸¤Îà[ÚA¡ ÎÒì™àKã ¹ìÚìá (Ç¡‹å³ày ¤¸¤ÎàÚã샹 \>¸)
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 Joint Applicant 1
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
Ѭt¡”| / Îwà [®¡[v¡A¡ ëƒÅ
¤¸¤Î๠‹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
[¤[>ìÚàKγèÒ
">¸à>¸ (">åNøÒ A¡ì¹ l¡üìÀJ A¡¹ç¡>)
l¡üv¡¹à[‹A¡à¹ Îèìy šøàœ¡ ëšÅàKt¡ [ó¡
šøt¡¸à[Åt¡ *ڸ๠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
™ï= "à줃>A¡à¹ã 1-&¹ ѬàÛ¡¹
"à>å³à[>A¡ ³èº¸ i¡àA¡àÚ
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 δ±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¡”z๠[¤ÈÚ "àìá?
Yes No
HRMS Number:
ѬàÛ¡¹A¡à¹ã / ¹à\î>[t¡A¡ &A¡[i¡ Îâ«à¹ Ѭâ«à[‹A¡à¹ã ³à[ºA¡Ko / [¤J¸àt¡ ¤¸[v¡û¡ ¤à ¹à\î>[t¡A¡ δš[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>๠"¤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¡/ìšÅ๠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 ѬàÛ¡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= "à줃>A¡à¹ã 2-&¹ \>¸
Information Type / t¡ì=¸¹ ‹¹o Details / [¤¤¹oγèÒ
Countries where business associates located (for Businessmen, only) / ë™ ëƒÅP¡[ºìt¡ ¤¸¤Îà[ÚA¡ ÎÒì™àKã ¹ìÚìá (Ç¡‹å³ày ¤¸¤ÎàÚã샹 \>¸)
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 Joint Applicant 2
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
Ѭt¡”| / Îwà [®¡[v¡A¡ ëƒÅ
¤¸¤Î๠‹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
[¤[>ìÚàKγèÒ
">¸à>¸ (">åNøÒ A¡ì¹ l¡üìÀJ A¡¹ç¡>)
l¡üv¡¹à[‹A¡à¹ Îèìy šøàœ¡ ëšÅàKt¡ [ó¡
šøt¡¸à[Åt¡ *ڸ๠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
™ï= "à줃>A¡à¹ã 2-&¹ ѬàÛ¡¹
"à>å³à[>A¡ ³èº¸ i¡àA¡àÚ
Signatures and Photographs / ѬàÛ¡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>๠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
''γÑz ëW¡ìA¡¹ áàØl¡šìy¹ &¤} ®¡[¤È¸ìt¡ ¤¸àìS¡¹
Îàì= ëA¡àì>à ë™àKàì™àK A¡¹à¹ \>¸ ѬàÛ¡¹ [¤ì¤W¡>à A¡¹à
Òì¤''
">åNøÒ A¡ì¹ "àš>๠ѬãAõ¡[t¡ šy[i¡ [>ìt¡
®å¡ºì¤> >à
Please do notforget to collect
yourAcknowledgment
slip
15
YYYYMMDDDate:Thumb Impression / [i¡šÎÒü Signature / ѬàÛ¡¹
Please affix a recent
photograph
">åNøÒ A¡ì¹ "àš>๠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¸ "à줃>A¡à¹ã
t¡à[¹J
[κ 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¡ ѬàÛ¡¹ ¤à ÎÒü A¡¹ç¡>''
YYYYMMDDDate:Thumb Impression / [i¡šÎÒü Signature / ѬàÛ¡¹
Please affix a recent
photograph
">åNøÒ A¡ì¹ "àš>๠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¡>
Joint Applicant 1 / ë™ï= "à줃>A¡à¹ã 1
t¡à[¹J
YYYYMMDDDate:Thumb Impression / [i¡šÎÒü Signature / ѬàÛ¡¹
Please affix a recent
photograph
">åNøÒ A¡ì¹ "àš>๠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¡>
Joint Applicant 2 / ë™ï= "à줃>A¡à¹ã 2
t¡à[¹J
16
Confirmation / ">åì³àƒ> “I confirm having met the Applicant/s in person.” / ''"à줃>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¡ "à줃>A¡à¹ã ‡à¹à ѬàÛ¡[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¡ìι [k¡A¡à>à ("à줃> 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>๠[>ÆW¡Út¡à šøƒà> A¡¹[á &¤} "à줃>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¡ìι ¤¸¤Òàì¹¹ \>¸
Acknowledgement / ѬãAõ¡[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
DCB Bank Limited / [l¡[Î[¤ ¤¸àS¡ [º[³ìi¡l¡
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 A塳à¹ã t¡à[¹J
A¡³¢W¡à¹ã >}.¤¸àìS¡¹ A¡³¢A¡t¢¡à¹ ѬàÛ¡¹
>[³ì>Å> ó¡³¢ KõÒãt¡ Òò¸à >à
®¡[¤È¸ìt¡ ë¹ó¡àì¹ìX¹ \>¸ ">åNøÒ A¡ì¹ &Òü >´¬¹[i¡ šøƒà> A¡¹ç¡>
1³ "à줃>A¡à¹ã¹ >à³
ë™ï= "à줃>A¡à¹ã 1
ë™ï= "à줃>A¡à¹ã 2
>[³[>¹ >à³
¤¸àìS¡¹ A¡³¢A¡t¢¡à¹ >à³
A¡³¢ã ëA¡àl¡ t¡à[¹J ÅàJसàìS¡¹ A¡³¢A¡t¢¡à¹ ѬàÛ¡¹
"àš>๠"¸àA¡àl¡üì–i¡¹ "à줃ì>¹ [Ñ‚[t¡ δšìA¢¡ [\`¡àÎà A¡¹à¹ \>¸ ">åNøÒ A¡ì¹ [l¡[Î[¤ NøàÒA¡ š[¹ìȤà ëA¡ì–ƒø A¡º A¡¹ç¡>
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