Account Opening Form PnUSz vóus iá Only for Resident Non-Individuals C v õâà Á]US uû ºPÒ AÀ»õuÁºPÐUS mk
Indicative List of ocuments that can be provided for Know our Customer (KC) / E[PÒ ÁõiUøP õíøµ öu xöpõòð[pò ( PJ ]) uøáupõp öpõkupu Ti BÁn[PÎß GkzxU Põmk mi À Sole Proprietor / HUF / Partnership Firm uû E ø õíº/ Ga³GL / [Suõµº {ÖÁÚ Sales Tax Registration / ÂØ øú Á vä Udhyog Aadhar emorandum / Ez õu Buõº ö µsh Service Tax Registration / \øá Á vä IEC (Importer Exporter Code) issued to the proprietary concern by office of GFT / iâgl i A¾Á»P E ø õíº {ÖÁÚzvØS ÁÇ[Q I] (CÓUS v&høö v õíº Gs) Proprietorship eclaration / E ø õíº AÔ Utility bills such as electricity, water, and landline telephone bills. If Proprietorship then it should be in the name of the proprietary concern and in name of the proprietor (last 3 months) / ªß\õµ, uspº, P ÁÈ öuõø» ] ÀPÒ õßó ß õmk ÀPÒ. E ø õíº {ÖÁÚ õp C uõà Ax E ø õíº {ÖÁÚzvß ö À C UP Ásk ØÖ E ø õí ß (Ph u 3 õu[pò) ö À C UP Ásk. Complete Income Tax Return (not just the acknowledgement) in the name of the sole proprietor where the firm's income is reflected, duly authenticated / acknowledged by the Income Tax authorities / uû E ø õí ß ö À EÒÍ Êø õú Á õú Á (öáö J øp ^mk mk À») uõupà. Á õú Á AvPõ PÍõÀ øó õp A[RP UP mh/ J øp ÁÇ[P mh {ÖÁÚzvß Á Áõ Põmh mhx. Certificate / Registration document issued by Sales Tax / Service Tax / Professional Tax authorities / \øá Á / öuõèàøó Á AvPõ PÒ ÁÇ[Q \õßôuì/ Á õú Á zxøó vä BÁn Certificate / Licence issued by the municipal authorities under Shop and Establishment Act / Pøh ØÖ {ÖÁÚa \mhzvß i õ Pµõm] AvPõ PÒ ÁÇ[Q \õßôuì / ø»ö\ßì License / Certificate of practice issued in the name of the proprietary concern by any professional body incorporated under a statute / õ{»zvß RÇõP {ÖÁÚ õp vä ö\ u HuõÁx öuõèàøó Aø õà E ø õíº {ÖÁÚzvß ö À ÁÇ[P mh öuõèà ø»ö\ßì/ \õßôuì CST / VAT / GST Certificate (Provisional / Final) / CST / VAT / GST ]Gìi/ Áõm/ ]Gìi \õßôuì (uøpõ¼p/ CÖv) PAN Card for HUF is mandatory / Ga³GL &US õß Põºk Pmhõ Identity & Address of karta along with HUF declaration duly signed by all the adult co-parceners and guardian of minor co-parceners with date of birth of minor / GÀ»õ Á x Á u Cøn õºmúºpò ØÖ Á xus ÁµõuÁ ß Ó u uv²hß Á xus Áµõu xøn õºmú ß õxpõỺ øó õp øpö õ ªmh Ga³GL AÔ hß PºzuõÂß Aøh õí ØÖ PÁ Partnership eed (Registered) / [Suõµº J u ( vä ö\ ux) If deed is notarized additional document for entity proof is required / J u õmh ö\ mi uõà {ÖÁÚzvØPõÚ TkuÀ BÁn Buõµ uøá Partnership eclaration / [Suõµº AÔ Registration under Shop and Establishment Act / Pøh ØÖ {ÖÁÚa \mhzvß RÇõÚ vä Partnership Letter / [Suõµº Piu Power of Attorney (Incase of POA holder photo, Identity and Address proof) / ö õx AvPõµ ( KH BP C US m\zvà øázv Á ß øp h, Aøh õí ØÖ PÁ Buõµ ) Club / Societies / Association / Trust Accounts QÍ / ö\õø\mipò/ \[PÒ/ AÓUPmhøÍ PnUSPÒ Registration Certificate / väa \õßö Certificate of Registration from Registrar of Cooperative societies / Trust / Charity Commissioner (Applicable to all Public Trusts) / Põ&B µiæ ö\õø\mipò / AÓUPmhøÍ / AÓUPmhøÍ Bøn õí ß váõí hª x väa \õßôuì (GÀ»õ ö õx AÓUPmhøÍPÐUS ö õ x ) Certificate of tax Exemption, if any (applicable to Trusts) / Á »US \õßö HuõÁx C uõà (AÓUPmhøÍPÐUS ö õ x ) Trust eed including supplemental deed for change in the trustee / AÓUPmhøÍ À õøózvøpõú xøn J u EÒÎmh AÓUPmhøÍ J u Resolution to open and operate an account / J PnUøPz vó x C USÁuØPõÚ wº õú PAN card / õß Põºk List of anaging Committee embers / embers on Board of Trustees / {ºÁõPU SÊ EÖ ÚºPÒ/ AÓ[PõÁ»º SÊ EÖ ÚºPÎß mi À Bye-Laws / \mh[pò ocuments of identity & address of the persons authorized to operate the account & those signing on the resolution / wº õúzvß «x øpö õ ªk Áõº ØÖ PnUøP C UP A[RP UP mh ºPÎß Aøh õí ØÖ PÁ UPõÚ BÁn[PÒ NOC from other bank in case the firm enjoys credit facility from any other bank / {ÖÁÚ ÁÖ GuõÁx Á[Q ¼ x Phß ö ØÔ uõà A u Á[Q hª x GßK] Annexure R - etails of Beneficial Owners / Ø \ºUøP Bº & ßö Ö E ø õíºpîß ÂÁµ[PÒ FATCA declaration (for all non individual entities as required for both entity and Beneficiary Owner) / GL Hi]H AÔ ({ÖÁÚ ØÖ ßö Ö E ø õíº BQ C Á US uøá õúx i GÀ»õ uû º AÀ»õu {ÖÁÚ[PÐUS) For opening of accounts of Government or its epartments: / Aµ\õ[P AÀ»x AuÝøh xøópðus PnUSPÒ vó uøs: a) ocument showing name of the person to act on behalf of the entity / {ÖÁÚzvØPõP ö\ À k ß ö øµu Põmk BÁn b) Proof of Possession of Aadhaar Number / PAN / Official Valid ocument for proof of identity and address in respect of the person holding an attorney (authorized signatory) to transact on its behalf / uúupõp ÁºzuøÚ ö\ ÁÇUPÔbº (A[RP UP mh øpö õ uõµº) øázv US øµ ö õözu Áøµ Aøh õí ØÖ PÁ BuõµzvØPõÚ ö\ྠi õs A¾Á»P BÁn / õß / Buõº Gs øázv uøpõú Buõµ c) ocument to establish the legal existence of such entity / Ax õßó {ÖÁÚ \mh ºÁ õp C UQÓx Gß øu {¹ US BÁn Pvt. / Public Ltd. Company øµ. / ÎU ¼m. {ÖÁÚ Registration Certificate / väa \õßôuì OA & AOA / G KH ØÖ HKH Certificate of Incorporation / {ÖÁÚ väa \õßö PAN / õß Licenses issued by any Government Authorities / HuõÁx Aµ\õ[P Bøn [PÒ ÁÇ[Q ø»ö\ßìpò Importer - Exporter Code Certificate / CÓUS v & HØÖ v Gs öpõsh \õßôuì Board Resolution to open and operate an account / J PnUøP vó x C USÁuØPõÚ SÊÂß wº õú NOC from other bank in case the company enjoys credit facility from any other bank / {ÖÁÚ ÁÖ GuõÁx Á[Q ¼ x Phß ö ØÔ uõà A u Á[Q hª x GßK] List of latest irectors of the Company with contact details and address / {ºÁõPU SÊ EÖ ÚºPÒ / AÓ[PõÁ»º SÊ EÖ ÚºPÎß mi À IR 12 & ROC required if change in directors from those appearing in OA & AOA / G KH ØÖ HKH&ÂÀ Ch ö Ö C USÚºPÎÀ õøó HØ mhõà iibº 12 ØÖ BK] uøá. FATCA declaration (for all non individual entities as required for both entity and Beneficiary Owner) / GL Hi]H AÔ ({ÖÁÚ ØÖ ßö Ö E ø õíº BQ C Á US uøá õúx i GÀ»õ uû º AÀ»õu {ÖÁÚ[PÐUS) ocuments of identity & address of the persons authorized to operate the account & those signing on the resolution / wº õúzvß «x øpö õ ªk Áõº ØÖ PnUøP C UP A[RP UP mh ºPÎß Aøh õí ØÖ PÁ UPõÚ BÁn[PÒ Annexure R - etails of Beneficial Owners / Ø \ºUøP Bº & ßö Ö E ø õíºpîß ÂÁµ[PÒ Company Identification Number (CIN) / {ÖÁÚ Aøh õí Gs (]IGß) NOC from other bank in case the firm enjoys credit facility from any other bank / {ÖÁÚ ÁÖ HuõÁx Á[Q ¼ x Phß Á\v ö ØÔ uõà A u Á[Q ß GßK] Annexure R - etails of Beneficial Owners / Ø \ºUøP Bº & ßö Ö E ø õíºpîß ÂÁµ[PÒ FATCA declaration (for all non individual entities as required for both entity and Beneficiary Owner) / GL Hi]H AÔ ({ÖÁÚ ØÖ ßö Ö E ø õíº BQ C Á US uøá õúx i GÀ»õ uû º AÀ»õu {ÖÁÚ[PÐUS) Please Note: / u Äö\ x PÁÛUPÄ : 1) Identity and Address proof (Official Valid ocument) to be obtained for Proprietor, Partners, Authorized Signatories & Beneficial owners / E ø õíº, [SuõµºPÒ, A[RP UP mh øpö õ uõµºpò, ßö Ö E ø õíºpîhª x Aøh õí ØÖ PÁ UPõÚ Buõµ (A¾Á»P Ÿv õp ö\ྠi õs BÁn ) ö Ó h Ásk. 2) CPV is required all Current Accounts which includes Govt Accounts / Aµ\õ[P PnUSPÒ Em h GÀ»õ h U PnUSPÐUS ]  uøá 3) Official Valid ocument: Passport, riving License, Voter id, Proof of Possession of Aadhaar Number, Job Card issued by NREGA, Letter by National Population Register / A¾Á»P Ÿv õp ö\ྠi õs BÁn : PhÄa ^mk, KmkÚº E, ÁõUPõͺ Aøh õí Amøh, Buõº Gs øázv uøpõú Buõµ, GßBºâH ÁÇ[Q Áø» Amøh, u] UPÒöuõøP v Ák ÁÇ[Q Piu
Rupay Platinum - Scheme Code List / ¹ ÍõmiÚ & vmh Gs mi À Codes Scheme escription Rupay Platinum GsPÒ vmh ÂÍUP ¹ ÍõmiÚ CA201 CB Classic Current Account i] UÍõ]U Pµßm AUPÄßm B CA202 Premium Current Account Ÿª Pµßm AUPÄßm B CA210 CB Personal Current Account i] ö º\ÚÀ Pµßm AUPÄßm B CA212 CB Excel Current Account i] GUöéÀ Pµßm AUPÄßm B CA213 CB Privilege Current Account i] ÂÀ»ä Pµßm AUPÄßm B CA218 Trade - Current Account i µm & Pµßm AUPÄßm B Codes Scheme escription Rupay Platinum GsPÒ vmh ÂÍUP ¹ ÍõmiÚ CA219 CB New Classic Current Account i] {³ UÍõêU Pµßm AUPÄßm B CA221 CB Golden Current Account i] PõÀhß Pµßm AUPÄßm B CA224 CB Elite Current Account i] Gø»m Pµßm AUPÄßm B CA225 CB PayLess Current Account i] ö»ì Pµßm AUPÄßm B CA227 CB SmartGain Current Account i] ì õºmöp ß Pµßm AUPÄßm B CA229 CB Business Saver Account i] ]öúì \Áº AUPÄßm B Instruction for filling Account Opening Form / PnUSz vóus iázøu {µ ÁuØPõÚ AÔÄøµ Please fill the form preferably in BLACK ink only u Äö\ x iázøu 'P ' ø À mk {µ Ä Hint boxes give tips and highlight important points across the form SÔ U Pmh[PÒ SÔ PøÍ ÁÇ[SQßÓÚ. iázvà UQ õú P zxupøí öuîáõpu PõmkQßÓÚ. Please write your NAE as it appears in all your support documents u Äö\ x E[PÒ ö øµ }[PÒ AÎUS GÀ»õ BÁn[Pξ C øu õ» Á SÔ hä Please countersign in full for any overwriting / alteration HuõÁx v zu / õøó ö\ uõà uäö\ x AuÚ P Êø õp E[PÒ øpö õ zøu ChÄ. A B C Please use in CAPITAL LETTERS only u Äö\ x öpõmøh GÊzxUPÎÀ mk GÊuÄ Please tick the appropriate boxes u Äö\ x ö õ zu õú Pmh[PøÍ uºä ö\ Ä Specify the addresses along with City, State and PIN Code Pµ, õ{» ØÖ ß Põk Ehß PÁ ø U SÔ hä ALL PHOTOCOPIES of documents to be SELF-ATTESTE by the applicant BÁn[PÎß GÀ»õ µvpî¾ Âsn uõµº øpö õ ªh Ásk
Bank Use only (* Fields are andatory) Á[Q ß õmiøs mk (* Ch[PÒ Pmhõ õúøá) Application No.: IN Âsn Gs: IGßi Customer I: ÁõiUøP õíº Ii Account No.: PnUS Gs *Segment Code: Source Code: Label Code: Scheme Code: *ö\uö ßm Põm \õºì Põm» Ò Põm vmhzvß Põm Account anager Code: Employee Code: Please open account at Branch PnUS»õÍ ß Põm FÈ ß Põm QøÍ À PnUSz vóupä u Äö\ x Branch SOL: ate: QøÍ GìKGÀ uv Current / Pµßm Customer I only ÁõiUøP õíº Ii mk New Classic {³ UÍõêU Relationship Form / EÓÄ iá Applicant s / Company s Profile - Âsn uõµ ß / {ÖÁÚzvß Áµ»õÖ *Account Type: *PnUS ÁøP Existing Customer I (If applicable): HØPÚ Á²Ò ÁõiUøP õíº Ii (ö õ vúõà) Name of the Applicant / Company: Âsn uõµº / {ÖÁÚzvß ö º ate of Incorporation / Registration: {ÖÁÚ õp vä ö\ u/ vä ö\ u uv *GST Number: *âgìi Gs Premium Ÿª Normal C À õúx Company Identification Number (CIN): {ÖÁÚ Aøh õí Gs (]IGß) Office Address: A¾Á»P PÁ BSA i GìH Privilege ÂÀ»ä Elite Gø»m Excel GuöéÀ RERA BºBºH Insti Prime B ñq>r àmb_ SmartGain ì õºmöp ß Simplified (for low risk customers) GÎø õúx (SøÓ u A õ öpõsh ÁõiUøP õíºpðus) KC Number: PJ ] Gs *Permanent Account Number (PAN): *{µ uµu PnUS Gs( õß) Others (please specify) ØÓøÁ (u Äö\ x SÔ hä ) Small ]Ô x OTP based e-kc Ki Ai øh»õúx & PJ ] PAN for the FIR to be shared {ÖÁÚzvß õß Gsøn Qº xöpõòí Ásk Landmark: {»USÔ±k: State: õ{» Telephone: (with ST Code) öuõø» ]: (Gìii Põm Ehß) Preferred Email Id: uºä ö\ ² ªßÚg\À Ii Registered Address: vä ö\ u PÁ City: Pin: Pµ ß Country: õk *Preferred obile No.: * uºä ö\ ² ö õø À Gs Same as Office Address A¾Á»P PÁ ø õßó u If email address provided, Physical Statement will not be send ªßÚg\À PÁ öpõkup mhõà, PõQu AÔUøP AÝ hõx Landmark: {»USÔ±k: State: õ{» Telephone: (with ST Code) öuõø» ]: (Gìii Põm Ehß) Preferred Email Id: uºä ö\ ² ªßÚg\À Ii Constitution: Proprietorship \mh \õ\ú E ø õíº {ÖÁÚ Others (Please specify) ØÓøÁ (u Äö\ x SÔ hä ) City: Pin: Pµ ß Partnership [Suõµº {ÖÁÚ HUF Ga³GL Country: õk *Preferred obile No.: * uºä ö\ ² ö õø À Gs Pvt. Ltd. øµ. ¼m. Public Ltd. ÎU ¼m. Trust AÓUPmhøÍ Societies ö\õø\mipò Clubs UÍ PÒ Nature of Business: öuõè¼ß ußø Occupation: öuõèà anufacturing EØ zv *escription of Business: *öuõèà ÂÍUP anufacturing EØ zv Builder / eveloper Àhº / öhá» º Credit Facilities / Phß Á\vPÒ I / We enjoy credit facilities with other bank(s) õß / õ[pò ÁÖ Á[Q À(PÒ) Phß ö ØÖÒ Íõ No Objection Certificate (NOC) Ö À»õ \õßö (GßK]) Trading i µi[ Importer / Exporter CÓUS v õíº / HØÖ v õíº Services \øápò Goverment / Semi-Government / Local Bodies Aµ\õ[P / ö\ª PÁºßö ßm / EÒÍõm] Aø Import / Export CÓUS v / HØÖ v Self Employed (Non Professional / Trader) _ öuõèà ö\ Áº (öuõèà{ nº / ÁºzuPº AÀ»õuÁº) Real Estate À Gì hm I / We do not enjoy credit facilities with other bank(s) õß / õ[pò ÁÖ Á[Q À(PÒ) Phß ö ÓÂÀø» Bank / Á[Q Name of the Facility / Á\v ß ö º Limit gr_m Others (Please specify) ØÓøÁ (u Äö\ x SÔ hä ) Jeweller øpupøh E ø õíº Others (Please specify) ØÓøÁ (u Äö\ x SÔ hä ) ROI BºKI Takeover hukẠNo B CÀø» No B CÀø» NOC to be attached incase customer(s) are enjoying credit facility with other bank(s) ÁõiUøP õíº(pò) ÁÖ Á[Q À(PÒ) Phß Á\vPÒ ö ØÔ uõà GßK] CønUP h Ásk. 4
Authorised Signatory 1 / A[RP UP mh øpö õ uõµº 1 *Account Type: *PnUS ÁøP OTP based e-kc KC Number: Ki Ai øh»õúx & PJ ] PJ ] Gs Existing Customer I: No (Please fill the below details) HØPÚ Á²Ò ÁõiUøP õíº Ii B CÀø» (u Äö\ x R DzÒÍ ÂÁµ[PøÍ {µ Ä ) *Name: r. rs. s. r. Prof. Capt. *ate of Birth: *ö º v v v S õ. µõ. P. * Ó u uv (First Name / uà ö º ) (iddle Name / k ö º ) (Last Name / Pøh] ö º ) arital Status: Single arried *other s aiden Name: v n {ø» uû º v n õúẠ*uõ ß PßÛ ö º *Card: ebit Card required No Rupay Platinum (Optional) Please refer page no. 2 for eligible scheme code *Põºk: öh m Põºk uøá B CÀø» ¹ ÍõmiÚ ( Ai øh»õúx) usv ö Ö Põøh AÔ u Äö\ x UP 2&I õºupä. Nationality: Indian Others (Please specify) u] C v º ØÓøÁ (u Äö\ x SÔ hä ) Short Name: _ UP õú ö º: *Gender: ale Female Third Gender * õ¼ú Bs ö s ßÓõ õ¼úzuẠ*Father / Spouse Full Name: *u øu / PnÁ ß Ê ö º *Residential Status: *Si US {ø» *Permanent Account Number (PAN): Form 60 *{µ uµ PnUS Gs( õß) iá 60 *Aadhaar Number: *Buõº Gs Passport Number: PhÄa ^mk Gs riving Licence: KmkÚº E Voter Identity Card: ÁõUPõͺ Aøh õí Amøh NREGA Job Card: GßBºâH Áø» Amøh Others: (any document notified by the central government) ØÓøÁ: ( zv Aµ\õ[P AÔÂzu i HuõÁx BÁn ) Identification Number: Aøh õí Gs aximum 19 characters. This name would appear on ebit Card / AvP m\ 19 GÊzxUPÒ: C u ö º öh m Põºiß «uõp uõßö *Country of Birth: *Place of Birth: Please fill FATCA * Ó u õk * Ó u Ch eclaration Form *Citizenship: *Residence for Tax Purposes: if you are U.S.A. or other country *Si² ø *Á aö\¾zx õupzvøpõú Ãk citizen / resident U.S. Person: No Category: General BC OBC SC ST Others u Äö\ x }[PÒ ².Gì.H. AÀ»x ².Gì. º B CÀø» Ä ö õx Ä G ] K ] Gì] Gìi ØÓøÁ ÁÖ õmk Si PÚõP / Religion: Hindu uslim Christian Sikh Buddhist Jain Parsi Others Á] ÁµõP C uõà u C x ì½ QÔìuÁº ^UQ º zu \ n õºê ØÓøÁ GL Hi]H *other s Full Name: AÔ iázøu *uõ ß Ê ö º {µ Ä. *Proof of Address: *PÁ UPõÚ Buõµ Passport PhÄa ^mk CB On The Go (obile Banking) i] & Bß u Põ (ö õø À [Q[) Resident Individual Si US uû º Simplified easures Account ocument Type Code PnUS GÎuõUP mh háiuøppò BÁn ÁøP Põm Communication Address: upáà öuõhº PÁ Normal C À õúx Simplified (for low risk customers) GÎø õúx (SøÓ u A õ öpõsh ÁõiUøP õíºpðus) riving Licence KmkÚº E Internet Banking Cßhºö m [Q[ Non Resident Indian C v õâà Si UPõu C v º UI (Aadhaar) ²Ii (Buõº) Foreign National öáî õmiúº our 12 digit unique identification number / E[PÒ 12 C»UP J ØÓ Aøh õí Gs Others ØÓøÁ Small ]Ô x Expiry ate: Põ»õÁv uv Expiry ate: Põ»õÁv uv Voter Identity Card ÁõUPõͺ Aøh õí Amøh Person of Indian Origin C v ÁÈz uõßô º NREGA Job Card GßBºâH Áø» Amøh Card can be issue to Individual / Proprietorship / HUF / Partnership Firm / Pvt. Ltd. Co only. Indemnity Annexure required for Pvt. Ltd. Co and ode of Payment should be Any One. Type of card would be based upon the product uû º / E ø õíº / Ga³GL / [Suõµº {ÖÁÚ / øµ. ¼m. {ÖÁÚ[PÐUS mk Põºk ÁÇ[P k. [Suõµº {ÖÁÚ / øµ. ¼m. {ÖÁÚ[PÐUS Ø \ºUøP uøá ØÖ n ö\¾zx øó ' õµõáx J ÁµõP' C UP Ásk. Põºiß ÁøP vmhzøu Ai øh õpu öpõshuõp C US. If PAN is not available please fill in Form 60 õß Gs QøhUPõÂmhõÀ iá 60&I {µ Ä Required if Passport or riving licence provide as Identity / Address proof PhÄa ^mk/ KmkÚº E Aøh õí/ PÁ UPõÚ Buõµ õp öpõkup mhõà uøá` Landmark: {»USÔ±k: State: õ{» Telephone: (with ST Code) öuõø» ]: (Gìii Põm Ehß) Preferred Email Id: uºä ö\ ² ªßÚg\À Ii Permanent Address: {µ uµ PÁ City: Pin: Pµ ß Country: õk *Preferred obile No.: * uºä ö\ ² ö õø À Gs Same as Communication Address upáà öuõhº PÁ õßó u Landmark: {»USÔ±k: State: õ{» City: Pin: Pµ ß Country: õk Telephone: (with ST Code) öuõø» ]: (Gìii Põm Ehß) 5
Authorised Signatory 2 / A[RP UP mh øpö õ uõµº 2 *Account Type: *PnUS ÁøP OTP based e-kc KC Number: Ki Ai øh»õúx & PJ ] PJ ] Gs Existing Customer I: No (Please fill the below details) HØPÚ Á²Ò ÁõiUøP õíº Ii B CÀø» (u Äö\ x R DzÒÍ ÂÁµ[PøÍ {µ Ä ) *Name: r. rs. s. r. Prof. Capt. *ate of Birth: *ö º v v v S õ. µõ. P. * Ó u uv (First Name / uà ö º ) (iddle Name / k ö º ) (Last Name / Pøh] ö º ) arital Status: Single arried *other s aiden Name: v n {ø» uû º v n õúẠ*uõ ß PßÛ ö º *Card: ebit Card required No Rupay Platinum (Optional) Please refer page no. 2 for eligible scheme code *Põºk: öh m Põºk uøá B CÀø» ¹ ÍõmiÚ ( Ai øh»õúx) usv ö Ö Põøh AÔ u Äö\ x UP 2&I õºupä. Nationality: Indian Others (Please specify) u] C v º ØÓøÁ (u Äö\ x SÔ hä ) Short Name: _ UP õú ö º: *Gender: ale Female Third Gender * õ¼ú Bs ö s ßÓõ õ¼úzuẠ*Country of Birth: * Ó u õk *Citizenship: *Si² ø U.S. Person: No Category: ².Gì. º B CÀø» Ä Religion: u *other s Full Name: *uõ ß Ê ö º *Father / Spouse Full Name: *u øu / PnÁ ß Ê ö º *Residential Status: *Si US {ø» *Permanent Account Number (PAN): Form 60 *{µ uµ PnUS Gs( õß) iá 60 *Aadhaar Number: *Buõº Gs Passport Number: PhÄa ^mk Gs riving Licence: KmkÚº E Voter Identity Card: ÁõUPõͺ Aøh õí Amøh NREGA Job Card: GßBºâH Áø» Amøh Others: (any document notified by the central government) ØÓøÁ: ( zv Aµ\õ[P AÔÂzu i HuõÁx BÁn ) Identification Number: Aøh õí Gs *Proof of Address: *PÁ UPõÚ Buõµ Hindu C x Passport PhÄa ^mk CB On The Go (obile Banking) i] & Bß u Põ (ö õø À [Q[) uslim ì½ Resident Individual Si US uû º Simplified easures Account ocument Type Code PnUS GÎuõUP mh háiuøppò BÁn ÁøP Põm Communication Address: upáà öuõhº PÁ Normal C À õúx Simplified (for low risk customers) GÎø õúx (SøÓ u A õ öpõsh ÁõiUøP õíºpðus) riving Licence KmkÚº E General ö õx Ä Christian QÔìuÁº Internet Banking Cßhºö m [Q[ Sikh ^UQ º *Place of Birth: * Ó u Ch *Residence for Tax Purposes: *Á aö\¾zx õupzvøpõú Ãk BC G ] Non Resident Indian C v õâà Si UPõu C v º UI (Aadhaar) ²Ii (Buõº) OBC K ] Buddhist zu aximum 19 characters. This name would appear on ebit / AT Card / AvP m\ 19 GÊzxUPÒ: C u ö º öh m Põºiß «uõp uõßö SC Gì] our 12 digit unique identification number / E[PÒ 12 C»UP J ØÓ Aøh õí Gs Others ØÓøÁ Small ]Ô x Expiry ate: Põ»õÁv uv Expiry ate: Põ»õÁv uv Jain \ n Foreign National öáî õmiúº Voter Identity Card ÁõUPõͺ Aøh õí Amøh ST Gìi Parsi õºê Others ØÓøÁ Others ØÓøÁ Person of Indian Origin C v ÁÈz uõßô º NREGA Job Card GßBºâH Áø» Amøh Card can be issue to Individual / Proprietorship / HUF / Partnership Firm / Pvt. Ltd. Co only. Indemnity Annexure required for Pvt. Ltd. Co and ode of Payment should be Any One. Type of card would be based upon the product uû º / E ø õíº / Ga³GL / [Suõµº {ÖÁÚ / øµ. ¼m. {ÖÁÚ[PÐUS mk Põºk ÁÇ[P k. [Suõµº {ÖÁÚ / øµ. ¼m. {ÖÁÚ[PÐUS Ø \ºUøP uøá ØÖ n ö\¾zx øó ' õµõáx J ÁµõP' C UP Ásk. Põºiß ÁøP vmhzøu Ai øh õpu öpõshuõp C US. Please fill FATCA eclaration Form if you are U.S.A. or other country citizen / resident u Äö\ x }[PÒ ².Gì.H. AÀ»x ÁÖ õmk Si PÚõP / Á] ÁµõP C uõà GL Hi]H AÔ iázøu {µ Ä. If PAN is not available please fill in Form 60 õß Gs QøhUPõÂmhõÀ iá 60&I {µ Ä Required if Passport or riving licence provide as Identity / Address proof PhÄa ^mk/ KmkÚº E Aøh õí/ PÁ UPõÚ Buõµ õp öpõkup mhõà uøá` Landmark: {»USÔ±k: State: õ{» Telephone: (with ST Code) öuõø» ]: (Gìii Põm Ehß) Preferred Email Id: uºä ö\ ² ªßÚg\À Ii Permanent Address: {µ uµ PÁ City: Pin: Pµ ß Country: õk *Preferred obile No.: * uºä ö\ ² ö õø À Gs Same as Communication Address upáà öuõhº PÁ õßó u Landmark: {»USÔ±k: State: õ{» City: Pin: Pµ ß Country: õk Telephone: (with ST Code) öuõø» ]: (Gìii Põm Ehß) 6
Authorised Signatory 3 / A[RP UP mh øpö õ uõµº 3 *Account Type: *PnUS ÁøP OTP based e-kc KC Number: Ki Ai øh»õúx & PJ ] PJ ] Gs Existing Customer I: No (Please fill the below details) HØPÚ Á²Ò ÁõiUøP õíº Ii B CÀø» (u Äö\ x R DzÒÍ ÂÁµ[PøÍ {µ Ä ) *Name: r. rs. s. r. Prof. Capt. *ate of Birth: *ö º v v v S õ. µõ. P. * Ó u uv (First Name / uà ö º ) (iddle Name / k ö º ) (Last Name / Pøh] ö º ) arital Status: Single arried *other s aiden Name: v n {ø» uû º v n õúẠ*uõ ß PßÛ ö º *Card: ebit Card required No Rupay Platinum (Optional) Please refer page no. 2 for eligible scheme code *Põºk: öh m Põºk uøá B CÀø» ¹ ÍõmiÚ ( Ai øh»õúx) usv ö Ö Põøh AÔ u Äö\ x UP 2&I õºupä. Nationality: Indian Others (Please specify) u] C v º ØÓøÁ (u Äö\ x SÔ hä ) Short Name: _ UP õú ö º: *Gender: ale Female Third Gender * õ¼ú Bs ö s ßÓõ õ¼úzuẠ*Country of Birth: * Ó u õk *Citizenship: *Si² ø U.S. Person: No Category: ².Gì. º B CÀø» Ä Religion: u *other s Full Name: *uõ ß Ê ö º *Father / Spouse Full Name: *u øu / PnÁ ß Ê ö º *Residential Status: *Si US {ø» *Permanent Account Number (PAN): Form 60 *{µ uµ PnUS Gs( õß) iá 60 *Aadhaar Number: *Buõº Gs Passport Number: PhÄa ^mk Gs riving Licence: KmkÚº E Voter Identity Card: ÁõUPõͺ Aøh õí Amøh NREGA Job Card: GßBºâH Áø» Amøh Others: (any document notified by the central government) ØÓøÁ: ( zv Aµ\õ[P AÔÂzu i HuõÁx BÁn ) Identification Number: Aøh õí Gs *Proof of Address: *PÁ UPõÚ Buõµ Hindu C x Passport PhÄa ^mk CB On The Go (obile Banking) i] & Bß u Põ (ö õø À [Q[) uslim ì½ Resident Individual Si US uû º Simplified easures Account ocument Type Code PnUS GÎuõUP mh háiuøppò BÁn ÁøP Põm Communication Address: upáà öuõhº PÁ Normal C À õúx Simplified (for low risk customers) GÎø õúx (SøÓ u A õ öpõsh ÁõiUøP õíºpðus) riving Licence KmkÚº E General ö õx Ä Christian QÔìuÁº Internet Banking Cßhºö m [Q[ Sikh ^UQ º *Place of Birth: * Ó u Ch *Residence for Tax Purposes: *Á aö\¾zx õupzvøpõú Ãk BC G ] Non Resident Indian C v õâà Si UPõu C v º UI (Aadhaar) ²Ii (Buõº) OBC K ] Buddhist zu aximum 19 characters. This name would appear on ebit / AT Card / AvP m\ 19 GÊzxUPÒ: C u ö º öh m Põºiß «uõp uõßö SC Gì] our 12 digit unique identification number / E[PÒ 12 C»UP J ØÓ Aøh õí Gs Others ØÓøÁ Small ]Ô x Expiry ate: Põ»õÁv uv Expiry ate: Põ»õÁv uv Jain \ n Foreign National öáî õmiúº Voter Identity Card ÁõUPõͺ Aøh õí Amøh ST Gìi Parsi õºê Others ØÓøÁ Others ØÓøÁ Person of Indian Origin C v ÁÈz uõßô º NREGA Job Card GßBºâH Áø» Amøh Card can be issue to Individual / Proprietorship / HUF / Partnership Firm / Pvt. Ltd. Co only. Indemnity Annexure required for Pvt. Ltd. Co and ode of Payment should be Any One. Type of card would be based upon the product uû º / E ø õíº / Ga³GL / [Suõµº {ÖÁÚ / øµ. ¼m. {ÖÁÚ[PÐUS mk Põºk ÁÇ[P k. [Suõµº {ÖÁÚ / øµ. ¼m. {ÖÁÚ[PÐUS Ø \ºUøP uøá ØÖ n ö\¾zx øó ' õµõáx J ÁµõP' C UP Ásk. Põºiß ÁøP vmhzøu Ai øh õpu öpõshuõp C US. Please fill FATCA eclaration Form if you are U.S.A. or other country citizen / resident u Äö\ x }[PÒ ².Gì.H. AÀ»x ÁÖ õmk Si PÚõP / Á] ÁµõP C uõà GL Hi]H AÔ iázøu {µ Ä. If PAN is not available please fill in Form 60 õß Gs QøhUPõÂmhõÀ iá 60&I {µ Ä Required if Passport or riving licence provide as Identity / Address proof PhÄa ^mk/ KmkÚº E Aøh õí/ PÁ UPõÚ Buõµ õp öpõkup mhõà uøá` Landmark: {»USÔ±k: State: õ{» Telephone: (with ST Code) öuõø» ]: (Gìii Põm Ehß) Preferred Email Id: uºä ö\ ² ªßÚg\À Ii Permanent Address: {µ uµ PÁ City: Pin: Pµ ß Country: õk *Preferred obile No.: * uºä ö\ ² ö õø À Gs Same as Communication Address upáà öuõhº PÁ õßó u Landmark: {»USÔ±k: State: õ{» City: Pin: Pµ ß Country: õk Telephone: (with ST Code) öuõø» ]: (Gìii Põm Ehß) 7
Authorised Signatory 4 / A[RP UP mh øpö õ uõµº 4 *Account Type: *PnUS ÁøP OTP based e-kc KC Number: Ki Ai øh»õúx & PJ ] PJ ] Gs Existing Customer I: No (Please fill the below details) HØPÚ Á²Ò ÁõiUøP õíº Ii B CÀø» (u Äö\ x R DzÒÍ ÂÁµ[PøÍ {µ Ä ) *Name: r. rs. s. r. Prof. Capt. *ate of Birth: *ö º v v v S õ. µõ. P. * Ó u uv (First Name / uà ö º ) (iddle Name / k ö º ) (Last Name / Pøh] ö º ) arital Status: Single arried *other s aiden Name: v n {ø» uû º v n õúẠ*uõ ß PßÛ ö º *Card: ebit Card required No Rupay Platinum (Optional) Please refer page no. 2 for eligible scheme code *Põºk: öh m Põºk uøá B CÀø» ¹ ÍõmiÚ ( Ai øh»õúx) usv ö Ö Põøh AÔ u Äö\ x UP 2&I õºupä. Nationality: Indian Others (Please specify) u] C v º ØÓøÁ (u Äö\ x SÔ hä ) Short Name: _ UP õú ö º: *Gender: ale Female Third Gender * õ¼ú Bs ö s ßÓõ õ¼úzuẠ*Father / Spouse Full Name: *u øu / PnÁ ß Ê ö º *Residential Status: *Si US {ø» *Permanent Account Number (PAN): Form 60 *{µ uµ PnUS Gs( õß) iá 60 *Aadhaar Number: *Buõº Gs Passport Number: PhÄa ^mk Gs riving Licence: KmkÚº E Voter Identity Card: ÁõUPõͺ Aøh õí Amøh NREGA Job Card: GßBºâH Áø» Amøh Others: (any document notified by the central government) ØÓøÁ: ( zv Aµ\õ[P AÔÂzu i HuõÁx BÁn ) Identification Number: Aøh õí Gs aximum 19 characters. This name would appear on ebit / AT Card / AvP m\ 19 GÊzxUPÒ: C u ö º öh m Põºiß «uõp uõßö *Country of Birth: *Place of Birth: Please fill FATCA * Ó u õk * Ó u Ch eclaration Form *Citizenship: *Residence for Tax Purposes: if you are U.S.A. or other country *Si² ø *Á aö\¾zx õupzvøpõú Ãk citizen / resident U.S. Person: No Category: General BC OBC SC ST Others u Äö\ x }[PÒ ².Gì.H. AÀ»x ².Gì. º B CÀø» Ä ö õx Ä G ] K ] Gì] Gìi ØÓøÁ ÁÖ õmk Si PÚõP / Religion: Hindu uslim Christian Sikh Buddhist Jain Parsi Others Á] ÁµõP C uõà u C x ì½ QÔìuÁº ^UQ º zu \ n õºê ØÓøÁ GL Hi]H *other s Full Name: AÔ iázøu *uõ ß Ê ö º {µ Ä. *Proof of Address: *PÁ UPõÚ Buõµ Passport PhÄa ^mk CB On The Go (obile Banking) i] & Bß u Põ (ö õø À [Q[) Resident Individual Si US uû º Simplified easures Account ocument Type Code PnUS GÎuõUP mh háiuøppò BÁn ÁøP Põm Communication Address: upáà öuõhº PÁ Normal C À õúx Simplified (for low risk customers) GÎø õúx (SøÓ u A õ öpõsh ÁõiUøP õíºpðus) riving Licence KmkÚº E Internet Banking Cßhºö m [Q[ Non Resident Indian C v õâà Si UPõu C v º UI (Aadhaar) ²Ii (Buõº) Foreign National öáî õmiúº our 12 digit unique identification number / E[PÒ 12 C»UP J ØÓ Aøh õí Gs Others ØÓøÁ Small ]Ô x Expiry ate: Põ»õÁv uv Expiry ate: Põ»õÁv uv Voter Identity Card ÁõUPõͺ Aøh õí Amøh Person of Indian Origin C v ÁÈz uõßô º NREGA Job Card GßBºâH Áø» Amøh Card can be issue to Individual / Proprietorship / HUF / Partnership Firm / Pvt. Ltd. Co only. Indemnity Annexure required for Pvt. Ltd. Co and ode of Payment should be Any One. Type of card would be based upon the product uû º / E ø õíº / Ga³GL / [Suõµº {ÖÁÚ / øµ. ¼m. {ÖÁÚ[PÐUS mk Põºk ÁÇ[P k. [Suõµº {ÖÁÚ / øµ. ¼m. {ÖÁÚ[PÐUS Ø \ºUøP uøá ØÖ n ö\¾zx øó ' õµõáx J ÁµõP' C UP Ásk. Põºiß ÁøP vmhzøu Ai øh õpu öpõshuõp C US. If PAN is not available please fill in Form 60 õß Gs QøhUPõÂmhõÀ iá 60&I {µ Ä Required if Passport or riving licence provide as Identity / Address proof PhÄa ^mk/ KmkÚº E Aøh õí/ PÁ UPõÚ Buõµ õp öpõkup mhõà uøá` Landmark: {»USÔ±k: State: õ{» Telephone: (with ST Code) öuõø» ]: (Gìii Põm Ehß) Preferred Email Id: uºä ö\ ² ªßÚg\À Ii Permanent Address: {µ uµ PÁ City: Pin: Pµ ß Country: õk *Preferred obile No.: * uºä ö\ ² ö õø À Gs Same as Communication Address upáà öuõhº PÁ õßó u Landmark: {»USÔ±k: State: õ{» City: Pin: Pµ ß Country: õk Telephone: (with ST Code) öuõø» ]: (Gìii Põm Ehß) 8
Initial Payment etails / öuõhup ö ßm ÂÁµ[PÒ Payment By Cheque / / Pay Order No.: ated: n ö\¾zx Áº Põ \õø» / ii / Bºhº Gs uv mhx rawn on: (Bank) Amount `: GkUP mh uv (Á[Q) öuõøp ¹. Amount in words: öuõøp ÁõºzøuPÎÀ ebit to CB Bank A/c No.: PÈUP Ási i] Á[Q PnUS Gs Services / \øápò Cheque Book: No Physical Statement: Põ \õø» zup B CÀø» EhÀ AÔUøP Email Statement: aily Weekly onthly Quarterly early ªßÚg\À AÔUøP vú Áõµõ vµ õuõ vµ Põ»õsk Á hõ vµ Since I / we have registered for email statement of account, I / we hereby give my / our consent to the Bank to send physical statement of account only once a year on completion of financial year. / PnUQß ªßÚg\À AÔUøPUS õß / õ[pò vä ö\ xòíuõà, {v õsk {øóáøh ux BskUS J øó PnUQß AÔUøPø PõQu AÔUøPø Á[Q GÚUS/ G[PÐUS AÝ Gß uøs õß / õ[pò Cuß» \ u öu ÂUQ Óõ. SS Banking & Alert Facility: Alerts facility enables you to receive alerts on your Email and / or obile regarding large debit, large credit, SI failure, balance below AQB and balance update. New alerts may be added from time to time. GìG Gì [Q[ ØÖ ö\ v Á\v: ö\ v Á\v ö GkzuÀ, ö ÁµÄ, GìI ö\ ¼Ç, HU³ &US SøÓÁõÚ C ØÖ C ø vuõusuà öuõhº õp E[PÒ À PÁ ØÖ / AÀ»x ö õø ¼À ö\ vpøí ö Óa ö\ ². Please Note: Authorised signatory/ies of the Firm / Company / are eligible for free obile alert facility subject to compliance of terms and conditions as stipulated by the Bank from time to time. u Äö\ x PÁÛUPÄ : {ÖÁÚ / P ö Û ß A[RP UP mh øpö õ uõµº / PÒ C»Á\ ö õø À ö\ v Á\vø ö Ó usv ö ØÓÁºPÒ BÁº. Cx AÆÁ õx Á[Q {ºn US ÂvøÓPÒ ØÖ { uøúpðus Em mhx. Phone Banking õß [Q[ Utility Bills ß õmk ÀPÒ Internet Banking applicable to Individual and Hindu Undivided Family (HUF) accounts, and for all other constitutions BIB form needs to be attached with the form. uû º ØÖ C x UP hõu Sk (Ga²GL ) PnUSPÐUS Cßhºö m [Q[ ö õ x. ØÓ GÀ»õ \mh \õ\ú[pðus iázxhß I iá CønUP h Ásk. Preferred Language Options: English Hindi arathi Gujarati Tamil Telugu uºä ö\ ² ö õè Áõ PÒ B[Q» C v µõzv Sáµõzv uªì öu¾[s Bharat QR & UPI services are digital payment collection service offered by CB Bank to all current account holders. (Please visit our website www.dcbbank.com for detailed terms & conditions and schedule of charges). To avail Bharat QR & UPI services, please select occupation. Transaction charges apply. õµz U³Bº ØÖ ² I \øápò BQ øá i] [U GÀ»õ h U PnUS øázv õ US ÁÇ[S iâmhà na \P \øá õs. ( ÁõÚ ÂvøÓPÒ ØÖ { uøúpò ØÖ Pmhn[PÎß AmhÁønPÐUS u Äö\ x G[PÒ Cøn uí www.dcbbank.com &US Á øp uµä ). õµz U³Bº ØÖ ² I \øápøí ö Ó u Äö\ x J öuõèø» uºä ö\ Ä. ÁºzuøÚU Pmhn[PÒ ö õ x. edical Stores & Pharmacies xu PøhPÒ ØÖ up[pò Grocery Stores and Supermarkets ÎøPU PøhPÒ ØÖ ` º õºuöpmpò Electronics Shop G»UmµõÛUì Pøh Computer Hardware & Software shop P ³mhº íõºk Áº ØÖ \õl m Áº Pøh Home Furnishing & Appliances Ãmk ö õ mpò ØÖ A øí ß\ì iscellaneous and Specialty Retail Stores»Âu õúøá ØÖ Â \å ]À»øÓ A[Põi Jewellers & Watches øpupøh ØÖ ÁõmaPÒ Liquour Shop xupøh Travel & Transport _ØÖ»õ ØÖ õusáµzx Hotels & Stay íõmhà ØÖ u[s {ø» [PÒ Eateries & Restaurants EnÄ {ø» [PÒ ØÖ EnÁP[PÒ Hospitals zxá øúpò Schools & Educational Services ÒÎPÒ ØÖ PÀÂa \øápò Colleges, Universities & Professional Schools PÀ PÒ, ÀPø»U PÇP[PÒ ØÖ öuõèàøó ÒÎPÒ Courier & Post T º ØÖ u õà Professional Services öuõèàøó \øápò Agricultural Services ÂÁ\õ a \øápò Utilities electric, gas, water & sanitary ß õmk ªß\õµ, Pì, uspº, _Põuõµ Govt. Services Aµ\õ[P \øápò Fuel ealers G ö õ Ò ÂØ øú õíºpò Financial Institution & Services {v {ÖÁÚ[PÒ ØÖ \øápò Charitable and Social Service Organizations AÓUPmhøÍ ØÖ \ P \øá Aø PÒ Religious Trust & Organizations u AÓUPmhøÍPÒ ØÖ Aø PÒ Investment: Life Insurance utual Fund Wealth anagement General Insurance u½k B²Ò Põ k µì µ {v ö\õzx {ºÁõP ö õx Põ k 2-Way Sweep eposit etails: Facility required: No (please tick appropriate options) 2&ÁÈ õøö øá ÂÁµ[PÒ: uøá õú Á\v: B CÀø» (u Äö\ x ö õ zu õú Áõ PøÍ uºä ö\ Ä ) Reverse Sweep (Transfer of funds from this (SB / CA) Account to Term eposit Account) Áºì ìã (C u (Gì / ]H) PnUQ¼ x hº öh õ]m PnUQØS {vø õøöqóx) Sweep (Transfer of funds from Term eposit Account to this (SB / CA) Account) ìã ( hº öh õ]m PnUQ¼ x C u (Gì / ]H) PnUQØS {vø õøöqóx) Both Cµsk Please Note: Reverse Sweep to Fixed eposit account shall happen only, if the balance in this (SB/CA) account exceeds threshold limit and Sweep shall happen if the balance in this (SB/CA) 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. FF facility is available only when initial funding is provided for the account. u Äö\ x PÁÛUPÄ : C u (Gì / ]H) PnUQÀ EÒÍ C Áµ AÍøÁ Ph uõà mk {µ uµ øá PnUQÀ Áºì ìã øhö Ö. C u (Gì / ]H) PnUQÀ EÒÍ C Áµ AÍÄUS SøÓ uõà ìã øhö Ö. GÀ»õ øá PÐ uõúõp x Á\v EhÚõÚ Ö u½mkz vmhzvß RÇõP C US. C u Á\v AÆÁ õx ØÖ u õ ¼ x ØöÓõ u õ US ÁÖ h»õ. C u PnUQØPõÚ öuõhup {v AÎUP k õx mk GL GL i Á\v QøhUS. Tax eduction at Source / BuõµzvÀ Á U PÈÄ TS to be deducted if applicable: No TS Exemption submission date : ö õ vúõà iigì PÈUP k B CÀø» iigì »UøPa \ º US uv If No, TS Exemption Reference No. CÀø»ö ÛÀ, iigì »US õºøá Gs Enclose TS Certificate for exemption. / »UQØPõÚ iigì \õßôuøç CønUPÄ. Nomination etails (Form A 1) / Áõ _ { Ú ÂÁµ[PÒ ( iá ih 1) Address: PÁ, I / we want to nominate the following person B, õß / õ[pò ßÁ øµ { ªUP  Q Óõ. Nominee Name: Áõ ]ß ö º onthly Quarterly early õuõ vµ Põ»õsk Á hõ vµ Applicable only for Individual and Proprietorship Accounts uû º ØÖ E ø õíº PnUSPÐUS mk ö õ x. No, I / we do not want to nominate anyone CÀø», õß / õ[pò ßÁ øµ { ªUP  ÂÀø». I / we nominate the following person to whom in the event of my / our / minors death the amount of the deposit / in the account may be returned by CB Bank Limited / GÚx / G[PÍx / Á xus ÁµõuÁ US CÓ HØ k m\zvà PnUQÀ / øá À C US öuõøpø i] [U ¼ªöhm AÎUP õß / õ[pò ßÁ øµ { ªUQ Óõ. Please note: All cheques should be CROSSE and in favour of CB Bank Limited A/c (our Name) u Äö\ x PÁÛUPÄ : AøÚzx Põ \õø»pð SÖUSU Põimk 'i] [U ¼ªöhm H/] (E[PÒ ö º)' GßÖ GkUP Ásk Please fill separate Business Internet Banking (BIB) form u Äö\ x uû õú ]öúì Cßhºö m [Q[ ( I ) iázøu {µ Ä Form 15G / 15H, etc. to be submitted at the beginning of every financial year and while making fresh deposits during the year. JÆöÁõ {v õsiß xáupzv¾ ØÖ A u Bsiß õx v øá PÒ øáus õx 15â / 15Ga õßóáøøóa \ º UP Ásk. 9
Relationship with Applicant, if any Age: ears ate of Birth: Âsn uõµ hß HuõÁx EÓÄ C uõà, Ax Á x BskPÒ Ó u uv * As the nominee is a minor on this date, I / we appoint (Name & Address) * C u uv À Áõ _ Á xus ÁµõuÁµõP C uõà, õß / õ[pò (ö º ØÖ PÁ ) { ªUQ Óõ 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. Áõ _ Á xus ÁµõuÁµõP C US õx GÚUS / G[PÐUS CÓ HØ mhõà Áõ _UPõP PnUQÀ EÒÍ / øá z öuõøpø ÁÇ[P. In case you have specified a nominee above, please indicate if you wish to make mention of the nominee name on the passbook, statement & CA issued in respect of your account and / or the passbook issued to you }[PÒ» J Áõ ø\ SÔ mi uõà, E[PÒ PnUQØS ÁÇ[P mh PnUS zup, AÔUøP, i]h ØÖ / AÀ»x PnUS zupzvà Áõ ]ß ö øµ SÔ h Ásk õ Gß øuu PõmhÄ. No B CÀø» I / We do hereby declare that what is stated above is true to the best of my / our knowledge and belief.» ö\õà» mhøá GÚx / G[PÍx AÔÄUS UøPUS» mháøµ Esø GßÖ õß / õ[pò Cuß» AÔÂUQ Óõ. Nomination under Section 45ZA of the Banking Regulation Act, 1949 and Rule 2(1) of the Banking Companies (Nomination) Rules 1985 in respect of bank deposits. Á[Q øá PøÍ ö õözu Áøµ Á[Q JÊ[SøÓa \mh, 1949&ß 45CémH ØÖ Á[Q {ÖÁÚ[PÐUPõÚ (Áõ _ { Ú ) ÂvøÓPÒ 1985&ß Âv 2(1)&ß RÇõP Áõ _ { ªUP kqóx Witness(es) / \õm](pò): Name: ö º Name: ö º Signature(s) / Thumb Impression(s) of Applicant øpö õ (PÒ) / ö µÀ µøp(pò) Thumb impression is required to be attested by 2 witnesses. In case of signature, no witness is required. ö µÀ µøpus 2 \õm]pò \õßóîup Ásk. øpö õ GßÓõÀ, \õm] uøá Àø». Signature: øpö õ Address: PÁ Signature: øpö õ Address: PÁ Place: ate: Place: ate: Ch uv Ch uv * 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. * Áõ _ Á xus Á uẠGßÓõÀ Aizx ÂhÄ. ** øá / PnUS Á xus ÁµõuÁ ß ö À øáup mi uõà Á xus ÁµõuÁ UPõP ö\ À h E ø øhzu J º øpö õ ªh Ásk. Term eposit etails / hº øá ß ÂÁµ[PÒ (* Fields are andatory / SvPÒ Pmhõ õúøá ) Type of eposit øá ß ÁøP Interest Payout Frequency Ámi öpõkus Põ» CøhöÁÎ Fixed eposit (F) {µ uµ øá (GL i) onthly Interest Payout (IC) õuõ vµ Ámi ö\¾zxuà (G I]) Quarterly Interest Payout (QIC) Põ»õsk Ámi öpõkupz uupx (U³I]) Non-callable F AøÇUP i õu GL i Half early Interest Payout (only applicable for F) Aøµ õsk Ámi öpõkupz uupx (GL i&us mk ö õ x ) Simple Interest (for deposits less than 6 months) GÎ Ámi (6 õu[pðus SøÓÁõÚ øá PÐUS) On aturity vºa] ß õx ONL Simple Interest payable for deposits of less than 6 months tenor 6 õu[pðus SøÓÁõÚ Põ»zvØS GÎ Ámi mk öpõkupz uupx Amount of eposit øá z öuõøp Please issue Fixed eposit in the name(s) of u Äö\ x &ß ö À(PÒ) {µ uµ øá ÁÇ[PÄ by Cash / ebit to Account No.: öµõup / PÈUP Ási PnUS Gs Amount ` öuõøp ¹. (Rupees (¹ õ only) mk ) eposit Period ays onths ears (inimum 7 days maximum 10 years) øá UPõÚ Põ» õmpò õu[pò BskPÒ (SøÓ ux 7 õmpò, AvP m\ 10 BskPÒ) Interest Payment Instructions Ámi öpõkus AÔÄøµPÒ *aturity Instruction s (Tick any one) / vºa] AÔÄøµPÒ (HuõÁx JßøÓ uºä ö\ Ä ) ode of Operation C US øó *Payment Instructions (upon closure) / n ö\¾zx AÔÄøµ ( k õx) Senior Citizen No Interest Rate % per annum. zu Si UPÒ B CÀø» Ámi Ãu % BskUS Transfer to CB Bank A/c. No.: AÝ Ási i] [U PnUS Gs Issue emand raft i õsm iµõl m ÁÇ[PÄ Payable at ÁÇ[Pz uupx Auto Renew Principal and Interest A\À ØÖ Ámiø uõúõp x zuà Self _ õp Guardian õxpõỺ Transfer to CB Bank A/c. No.: AÝ Ási i] [U PnUS Gs Issue emand raft i õsm iµõl m ÁÇ[PÄ Either or Survivor õµõáx J Áº AÀ»x E º ÁõÌ Áº By anyone or Survivor õµõáx J Áº AÀ»x E º ÁõÌ Áº Payable at ÁÇ[Pz uupx Auto Renew Principal and Pay Interest A\ø» uõúõp x zuà ØÖ Ámi ÁÇ[SuÀ Former or Survivor øu Áº AÀ»x E º ÁõÌ Áº Through NEFT ö L m» õp Repay Principal and Interest A\À ØÖ Ámiø v U öpõkzuà Jointly TmhõP Through NEFT ö L m» õp Please tick if you wish to receive hard copy of the eposit Confirmation Advice (CA) otherwise the CA will be sent at your registered email I with the Bank. / }[PÒ øá øá EÖv kzx AÔÄøµ ß (i]h) µvø ö Ó Â ÚõÀ u Äö\ x uºäusô hä. CÀ»õÂmhõÀ Ax Á[Q À vä ö\ xòí E[PÒ ªßÚg\À PÁ À AÝ øáup k. ate of Birth (OB) proof required to avail benefits for Senior Citizens. zu Si UPÐUPõÚ ßPøÍ ö Óz uøá õú Ó u uv (ik ) Buõµ 10
Instructions for payment of interest & maturity proceeds for Term eposit through NEFT ö L m» õp hº øá UPõÚ vºa] ö\ ÀøÓPÒ ØÖ Ámi ÁÇ[S AÔÄøµPÒ 1. andatory to attach a cancelled cheque of the bank account mentioned below / R Ç SÔ mh Á[QU PnUQß µzx ö\ u Põ \õø» JßøÓ Cøn x Pmhõ 2. Beneficiary Name (As per Beneficiarys Bank record - should be same as applicant name): / ß ö Ö Á ß ö º ( ß ö Ö Á ß Á[Q v Ámiß i & Âsn uõ ß ö º J µ õv õp C UP Ásk ) Bank Name: Branch Name: Á[Q ß ö º QøÍ ß ö º Account Number: Account Type: Savings Current PnUS Gs PnUS ÁøP \ª h IFS Code: Overdraft Others (please specify) IGL Gì Põm KÁº iµõl m ØÓøÁ (u Äö\ x SÔ hä ) Terms and conditions / ÂvøÓPÒ ØÖ { uøúpò: 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 persons 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. õß / õ[pò ßÁ ÂvøÓPÒ ØÖ { uøúpðus Cn[Q huq Óõ : 1. ß ö øµ \ õp Aøh õí Põnz uáöáuõà AÀ»x Pmk õmkus A õø mh {PÌÄ AÀ»x HuõÁx ö\ À AÀ»x õß / õ[pò öpõkzu upáà Põµn õp ö Ö Á[Q / QøÍ x༠ªÀ»õu ÁµÄ øáup kuà AÀ»x GßÚõÀ / G[PÍõÀ öpõkup mh uáóõú upáà AÀ»x ö Ö Á[Q / QøÍ À Em Ó upáà öuõhº ]ìh ö\ ¼ÇzuÀ AÀ»x Bº I (C v \ºÆ Á[Q) BºiâGì / ö L m Põµn õp ]ìh QøhUPõv zuà AÀ»x C»US Á[Q ß ö\ À AÀ»x ö Ó k õx uáóõp xöpõòí kuà AÀ»x ÁÇ[SuÀ AÀ»x AÝ uà AÀ»x ÁºzuøÚ À HØ k øç AÀ»x ÁÇ[Põuuß ö\ v AÀ»x AÝ uà, ÁÇ[Su¼À HØ k uõ u Põµn õp AÀ»x HØ k \u[pò AÀ»x HuõÁx CÇ UPõP, HuõÁx PõµnzvØPõP Á[Qø ö õö ØPa ö\ i õx Gß øu öuîáõp x öpõòí kqóx ØÖ GÚx / G[Íx ö\õ u A õ ØÖ ö õö À AÝ kqóx Gß x xöpõòí kqóx. 2. BºiâGì / GßGL i Ásk PõÒ AÁØøÓ {ºÁQUS Bº I ß JÊ[SøÓPÒ ØÖ ÁÈPõmkuÀPÐUS Em mhx Gß øu õß / õ[pò xöpõòq Óõ. 3. ÚõÍ ß PnUS Gs upáàpøíu öpõsh mk ÁµÄ øáup k, AuØS ÚõÍ ß ö º ÂÁµ[PÒ ß kzu hõx Gß øu õß / õ[pò J UöPõÒQ Óõ. CB iamond Khushiyali eposit etails / i] h sm Sæ õ¼ øá ÂÁµ[PÒ onthly Instalment Amount / õuõ vµ uáøn öuõøp onthly Instalments to be collected through õuõ vµ uáønpò Cuß» õp \P UP k ` ¹. eposit Period ays onths ears (eposit period is minimum 14 days and maximum 10 years) øá Põ» õmpò õu[pò BskPÒ (øá Põ» SøÓ ux 14 õmpò ØÖ AvP m\ 10 BskPÒ) Senior Citizen No Interest Rate %. zu Si UPÒ B CÀø» Ámi Ãu on «uõp ebit to Account No. PÈUP Ási PnUS Gs of every month JÆöÁõ õu This facility is not available for fixed deposits with maturity instruction as Auto Renew Principal & Pay Interest A\ø» uõúõp x zx Ámiø ÁÇ[SÁøu vºa] AÔÄøµ õpu öpõsh {µ uµ øá PÐUS C u Á\v QøhUPõx. K can be created in the name of the Primary Applicant only ußø Âsn uõµ ß ö À mk i Pi E ÁõUP k. aturity Instructions vºa] AÔÄøµPÒ Transfer to CB A/c No.: AÝ Ási i] PnUS Gs CI for Firm / Company - {ÖÁÚzvØPõÚ ]Iii Information / upáà Countries where business associates located (for Businessmen, only) / öuõèà Eu õíºpò EÒÍ õkpò (öuõè»v ºPÐUS mk ) Source of Funds for Credits in the Account PnUQÀ ÁµÄ øá uøpõú {v Buõµ[PÒ Expected Annual Turnover (`) Gvº õºup k Á hõ vµ ÁµÄ&ö\»Ä (¹.) Expected number of transactions in a month J õuzvà Gvº õºup k ÁºzuøÚPÒ Wire Transfers Expected Gvº õºup k u v» AÝ k øá Foreign Inward Remittances Expected per ear JÆöÁõ Bsk Gvº õºup k öáî õmi¼ x AÝ uàpò etails / ÂÁµ[PÒ Savings Salary Business Proceeds Sale of Property \ª PÒ \ Í öuõèà ö\ ÀøÓPÒ ö\õzx ÂØ øú Investments Inheritance Professional fee u½kpò µ øµ õp ö ÖuÀ öuõèàøóu Pmhn Other (please specify) ØÓøÁ (u Äö\ x SÔ hä ) Upto ` 1 Lakh Upto ` 10 Lakhs Upto ` 50 Lakhs ¹. 1»m\ Áøµ ¹. 10»m\ Áøµ ¹. 50»m\ Áøµ Upto ` 1 Crore Upto ` 5 Crores Upto ` 10 Crores ¹. 1 Põi Áøµ ¹. 5 Põi Áøµ ¹. 10 Põi Áøµ Upto ` 25 Crores ore than ` 25 Crores ¹. 25 Põi Áøµ ¹. 25 PõiUS AvP Up to 20 21 to 50 ore than 50 20 Áøµ 21 uà 50 Áøµ 50&US AvP Into the Account No Value ` PnUQÀ B CÀø» v ¹. From the Account No Value ` PnUQ¼ x B CÀø» v ¹. No Approximate Value ` B CÀø» uõµõ õú v ¹. 11
For Bank Use Only / Á[Q ß õmiøs mk Any of the Signatories / Beneficial Owners of the entity a Political / Public Figure or related to a Political / Public Figure B No CÀø» if yes, please give position B GÛÀ, u ö\ x {ÖÁÚzvß øpö õ uõµºpò / ßö Ö E ø õíºpîà õµõáx J Áº Aµ] ÀÁõv / µ» º AÀ»x Aµ] ÀÁõv / µ» º öuõhº õúẠ{ø»ø z öu ÂUPÄ oes it seem that the initial eposit and/or the declared transaction profile is in line with the status/occupation declared? I authorise opening of account as per details specified in the account opening form. AÔÂUP mh {ø» / öuõè¾hß öuõhup øá ØÖ / AÀ»x AÔÂUP mh ÁºzuøÚ²hß Jzx õqóuõ? PnUS vóus iázvà öpõkzxòí ÂÁµ[PÎß i PnUSz vóup õß A[RPõµ AÎUQ Óõ. Approved Elite Account Number / A[RP UP mh Gø»m PnUS Gs: No B CÀø» by / BÀ BCSO / Branch Head ]GìKG / QøÍ uø»ø AvPõ Risk Classification / A õ ÁøP õk Risk Category: Low edium High A õ Ä SøÓÄ kzuµ AvP Basis of Categorisation: ÁøP õmiß Ai øh Politically Exposed Person (PEP) / Related to PEP Aµ] À µ» õú º ( ) / öuõhº õúẠomiciled in Risk Country A õ õmià ÁõÌ Áº Trust AÓUPmhøÍ Sleeping Partner High Risk Profession / Activity Others (Please specify): ì½ [ õºmúº E º A õ öuõèà / ö\ À õk ØÓøÁ (u Äö\ x SÔ hä ) Information: Politically Exposed Person due to position / status as: upáàpò: ßÁ {ø» / A uìuõà Aµ] À µ» õú º If omiciled in Risk Country - Country Name: A õ õmià ÁõÌ uõà & õmiß ö º Nature of Business / Occupation: öuõè¼ß ußø Registration / Application Form for CB Business Internet Banking i] ]öúì Cßhºö m [Q[&UPõÚ vä / Âsn iá Signed in my presence with seal Name & Signatures of the Officer along with Signature Code Number øpö õ Põm hß AvPõ ß ö º ØÖ øpö õ zvøµ²hß Gß ßÛø» À øpö õ ªmhõº. *Kindly fill the following details. / u Äö\ x ßÁ ÂÁµ[PøÍ {µ Ä Branch: Sol I: Customer (Cust.) I: QøÍ GìKGÀ Ii ÁõiUøP õíº (ÁõiUøP õíº) Ii Account Name: PnUQß ö º 1. User details and access levels to be provided in Business Internet Banking (BIB) (a) wherever applicable Note: Transaction limits will be in multiple of Rs. 5 lakhs only (e.g.: 5 lakhs, 10 lakhs, 15 lakhs up to a maximum of 100 lakhs). These limits will be absolute and will be applicable for all relationships with the CB Bank Limited ('Bank') and across payment methods. ö õ x Ch[PÎÀ i] ]öúì Cßhºö m [Q[&À ( I ) (a) ß kzx Áº ÂÁµ[PÒ ØÖ AqSuÀ AÍÄPÒ öpõkup h Ásk. SÔ : ÁºzuøÚ Áµ PÒ ¹. 5»m\zvß ö UP õp mk õp (G.Põ.: AvP m\ 100»m\ Áøµ 5»m\, 10»m\, 15»m\ ) C US. C u Áµ PÒ Êø õúøá ØÖ i] [U ¼ªöhm (Á[Q) ØÖ GÀ»õ n ÎUS øóus ö õ x. aker-checker Facility / UPº&ö\UPº Á\v Tick below if Single User Facility is required / JØøÓ ß kzx Áº Á\v õp C uõà R Ç uºäusô hä We understand that aker-checker facility in BIB is a risk control mechanism of the Bank. However, due to our business / process compulsions, we are consciously opting for transaction facility with single user at our own risk, responsibility and liability. We hereby agree and undertake that the Bank will not be held liable and responsible under any circumstances, in case of any losses incurred by me / us as a result of using the transaction facility with single user. I À UPº &ö\upº Á\v Gß x Á[Q ß A õ U Pmk õmk ö õôøó Gß øu õ[pò xöpõòq Óõ. GÛÝ, G[PÒ ]öúì / ö\ ÀøÓ Pmhõ [PÒ Põµn õp, G[PÒ ö\õ u A õ, ö õö À JØøÓ ß kzx Áº ÁºzuøÚUPõP õ[pò EnºÄ ºÁ õp uºä ö\ Q Óõ. JØøÓ ß kzx Áº ÁºzuøÚ Á\vø ß kzxáuß»úõp GÚUS / G[PÐUS HuõÁx CÇ PÒ HØ k m\zvà G uöáõ `Ǽ¾ Á[Qø ö õö ØPa ö\ i õx Gß øu õ[pò Cuß» J UöPõÒQ Óõ ØÖ HØÖUöPõÒQ Óõ. We confirm that the ode of Operation for our above mentioned Customer I is single user. We hereby agree and undertake that the same will remain unchanged till our written notice of revocation of the said authorisation to the Bank.» SÔ mh ÁõiUøP õíº IiUPõÚ ö\ À õmk øó JØøÓ ß kzx Áº Gß øu õ[pò EÖv kzxq Óõ. Á[QUS AÎzu ö\õà» k A[RP zuø» v ö Ó G[PÒ GÊzx ºÁ õú AÔ öpõkus Áøµ Ax õóõ À C US Gß øu õ[pò J UöPõÒQ Óõ ØÖ HØÖU öpõòq Óõ. User Name 1: ß kzx Á ß ö º 1 User I: Úõͺ PÁ (User I shall be alpha or alphanumeric word / phrase of customer's choice, consisting in. 6 to ax. 10 characters. No special characters are allowed. For example: ABCE123) ( Úõͺ PÁ BÀ õ AÀ»x BÀ õ{³ U Áõºzøu/ÁõiUøP õíº uºâß i õú SøÓ ux 6 uà AvP m\ 10 GÊzxUPÒ öpõshuõp C US  \å GSzxUPÒ AÝ vup hõx. GkzxUPõmhõP:H ]i123) obile No.: ö õø À Gs Email I: ªßÚg\À PÁ Each user should have separate email id & mobile number. JÆöÁõ ß kzx Á uû õú ªßÚg\À PÁ ØÖ ö õø À Gsøn ß kzu Ásk. View Access: Rights / Role to be provided for transaction access, if required: Initiator (aker) Authorizer (Checker) AqSuø» ö ÓÄ uøá mhõà ÁºzuøÚ AqSu¾US E ø PÒ/ [S AÎUP k öuõh[s Áº (ö\ Áº) A[RP Áº ( \õuøú õíº) aximum Transaction (Txn) limit (Amount in lakhs): Per Txn Per ay Per transaction limit cannot be greater than per day limit. AvP m\ ÁºzuøÚ ( ÁºzuÚø) Áµ (öuõøp»m\[pîà): JÆöÁõ ÁºzuøÚ JÆöÁõ õò JÆöÁõ ÁºzuøÚ Áµ JÆöÁõ õðupõú Áµ US AvP õp C UP i õx. Payment Gateway (PG) limit Access to be provided to the Accounts under this Cust. I: All ö ßm Pm Á ( â) Áµ C u ÁõiUøP õíº PÁ ß RÇõÚ PnUSPÐUS öpõkup mh AqSuÀ: GÀ»õ (PG limit should not exceed 25 lakh, PG limit cannot be greater than per day limit) ( â Áµ 25»m\zxUS AvP õp C UPU Thõx. â Áµ JÆöÁõ õðupõú Áµ ø Âh AvP õp C UPU Thõx) Selective (Please mention the relevant Account number for which access is to be provided.) Account No. 1 uºä ö\ uà (u Äö\ x AqSuÀ öpõkup h Ási \ u mh PnUS Gsøn SÔ hä ) PnUS Gs 1 Account No. 2 PnUS Gs 2 Account No. 4 PnUS Gs 4 Account No. 3 PnUS Gs 3 Signature of User ß kzx Á ß øpö õ 12
User Name 2: ß kzx Á ß ö º 2 User I: Úõͺ PÁ (User I shall be alpha or alphanumeric word / phrase of customer's choice, consisting in. 6 to ax. 10 characters. No special characters are allowed. For example: ABCE123) ( Úõͺ PÁ BÀ õ AÀ»x BÀ õ{³ U Áõºzøu/ÁõiUøP õíº uºâß i õú SøÓ ux 6 uà AvP m\ 10 GÊzxUPÒ öpõshuõp C US  \å GSzxUPÒ AÝ vup hõx. GkzxUPõmhõP:H ]i123) obile No.: ö õø À Gs Email I: ªßÚg\À PÁ Each user should have separate email id & mobile number. JÆöÁõ ß kzx Á uû õú ªßÚg\À PÁ ØÖ ö õø À Gsøn ß kzu Ásk. View Access: Rights / Role to be provided for transaction access, if required: Initiator (aker) Authorizer (Checker) AqSuø» ö ÓÄ uøá mhõà ÁºzuøÚ AqSu¾US E ø PÒ/ [S AÎUP k öuõh[s Áº (ö\ Áº) A[RP Áº ( \õuøú õíº) aximum Transaction (Txn) limit (Amount in lakhs): Per Txn Per ay Per transaction limit cannot be greater than per day limit. AvP m\ ÁºzuøÚ ( ÁºzuÚø) Áµ (öuõøp»m\[pîà): JÆöÁõ ÁºzuøÚ JÆöÁõ õò JÆöÁõ ÁºzuøÚ Áµ JÆöÁõ õðupõú Áµ US AvP õp C UP i õx. Payment Gateway (PG) limit Access to be provided to the Accounts under this Cust. I: All ö ßm Pm Á ( â) Áµ C u ÁõiUøP õíº PÁ ß RÇõÚ PnUSPÐUS öpõkup mh AqSuÀ: GÀ»õ (PG limit should not exceed 25 lakh, PG limit cannot be greater than per day limit) ( â Áµ 25»m\zxUS AvP õp C UPU Thõx. â Áµ JÆöÁõ õðupõú Áµ ø Âh AvP õp C UPU Thõx) Selective (Please mention the relevant Account number for which access is to be provided.) Account No. 1 uºä ö\ uà (u Äö\ x AqSuÀ öpõkup h Ási \ u mh PnUS Gsøn SÔ hä ) PnUS Gs 1 Account No. 2 PnUS Gs 2 Account No. 4 PnUS Gs 4 User Name 3: ß kzx Á ß ö º 3 User I: Úõͺ PÁ (User I shall be alpha or alphanumeric word / phrase of customer's choice, consisting in. 6 to ax. 10 characters. No special characters are allowed. For example: ABCE123) ( Úõͺ PÁ BÀ õ AÀ»x BÀ õ{³ U Áõºzøu/ÁõiUøP õíº uºâß i õú SøÓ ux 6 uà AvP m\ 10 GÊzxUPÒ öpõshuõp C US  \å GSzxUPÒ AÝ vup hõx. GkzxUPõmhõP:H ]i123) obile No.: ö õø À Gs Email I: ªßÚg\À PÁ Account No. 3 PnUS Gs 3 Signature of User ß kzx Á ß øpö õ Each user should have separate email id & mobile number. JÆöÁõ ß kzx Á uû õú ªßÚg\À PÁ ØÖ ö õø À Gsøn ß kzu Ásk. View Access: Rights / Role to be provided for transaction access, if required: Initiator (aker) Authorizer (Checker) AqSuø» ö ÓÄ uøá mhõà ÁºzuøÚ AqSu¾US E ø PÒ/ [S AÎUP k öuõh[s Áº (ö\ Áº) A[RP Áº ( \õuøú õíº) aximum Transaction (Txn) limit (Amount in lakhs): Per Txn Per ay Per transaction limit cannot be greater than per day limit. AvP m\ ÁºzuøÚ ( ÁºzuÚø) Áµ (öuõøp»m\[pîà): JÆöÁõ ÁºzuøÚ JÆöÁõ õò JÆöÁõ ÁºzuøÚ Áµ JÆöÁõ õðupõú Áµ US AvP õp C UP i õx. Payment Gateway (PG) limit Access to be provided to the Accounts under this Cust. I: All ö ßm Pm Á ( â) Áµ C u ÁõiUøP õíº PÁ ß RÇõÚ PnUSPÐUS öpõkup mh AqSuÀ: GÀ»õ (PG limit should not exceed 25 lakh, PG limit cannot be greater than per day limit) ( â Áµ 25»m\zxUS AvP õp C UPU Thõx. â Áµ JÆöÁõ õðupõú Áµ ø Âh AvP õp C UPU Thõx) Selective (Please mention the relevant Account number for which access is to be provided.) Account No. 1 uºä ö\ uà (u Äö\ x AqSuÀ öpõkup h Ási \ u mh PnUS Gsøn SÔ hä ) PnUS Gs 1 Account No. 2 PnUS Gs 2 Account No. 4 PnUS Gs 4 User Name 4: ß kzx Á ß ö º 4 User I: Úõͺ PÁ (User I shall be alpha or alphanumeric word / phrase of customer's choice, consisting in. 6 to ax. 10 characters. No special characters are allowed. For example: ABCE123) ( Úõͺ PÁ BÀ õ AÀ»x BÀ õ{³ U Áõºzøu/ÁõiUøP õíº uºâß i õú SøÓ ux 6 uà AvP m\ 10 GÊzxUPÒ öpõshuõp C US  \å GSzxUPÒ AÝ vup hõx. GkzxUPõmhõP:H ]i123) obile No.: ö õø À Gs Email I: ªßÚg\À PÁ Account No. 3 PnUS Gs 3 Signature of User ß kzx Á ß øpö õ Each user should have separate email id & mobile number. JÆöÁõ ß kzx Á uû õú ªßÚg\À PÁ ØÖ ö õø À Gsøn ß kzu Ásk. View Access: Rights / Role to be provided for transaction access, if required: Initiator (aker) Authorizer (Checker) AqSuø» ö ÓÄ uøá mhõà ÁºzuøÚ AqSu¾US E ø PÒ/ [S AÎUP k öuõh[s Áº (ö\ Áº) A[RP Áº ( \õuøú õíº) aximum Transaction (Txn) limit (Amount in lakhs): Per Txn Per ay Per transaction limit cannot be greater than per day limit. AvP m\ ÁºzuøÚ ( ÁºzuÚø) Áµ (öuõøp»m\[pîà): JÆöÁõ ÁºzuøÚ JÆöÁõ õò JÆöÁõ ÁºzuøÚ Áµ JÆöÁõ õðupõú Áµ US AvP õp C UP i õx. Payment Gateway (PG) limit Access to be provided to the Accounts under this Cust. I: All ö ßm Pm Á ( â) Áµ C u ÁõiUøP õíº PÁ ß RÇõÚ PnUSPÐUS öpõkup mh AqSuÀ: GÀ»õ (PG limit should not exceed 25 lakh, PG limit cannot be greater than per day limit) ( â Áµ 25»m\zxUS AvP õp C UPU Thõx. â Áµ JÆöÁõ õðupõú Áµ ø Âh AvP õp C UPU Thõx) Selective (Please mention the relevant Account number for which access is to be provided.) Account No. 1 uºä ö\ uà (u Äö\ x AqSuÀ öpõkup h Ási \ u mh PnUS Gsøn SÔ hä ) PnUS Gs 1 Account No. 2 PnUS Gs 2 Account No. 4 PnUS Gs 4 Account No. 3 PnUS Gs 3 Signature of User ß kzx Á ß øpö õ 2. Account Holder's eclaration, Request and Authorization / PnUS øázv Á ß AÔÂ, Ásk PõÒ ØÖ A[RPõµ AÎzuÀ: a) We maintain an account with CB Bank Limited in the name of our firm / company as above. ØPsh i õ[pò G[PÒ {ÖÁÚ / P ö Û ß ö À i] [U ¼ªöhm&À PnUS øázv UQ Óõ. b) We have read and understood Bank's Terms and Conditions in relation to the CB Business Internet Banking facility (copy of which was provided to us) and agree to abide by them and to the amendments thereto from time to time made at the sole discretion of the Bank. i] ]öúì Cßhºö m [Q[ Á\vUPõÚ (Auß µv G[PÐUS öpõkup mhx) Á[Q ß ÂvøÓPÒ ØÖ { uøúpøí õ[pò izx xöpõs hõ ØÖ AÁØÖUS ØÖ AÆÁ õx Á[Q ß uû  ÁPzvß Ai øh À AÁØÔÀ ö\ k v zu[pðus Cn[Q hup J UöPõÒQ Óõ. c) We hereby request you to grant us CB Business Internet Banking facility subject to the Bank's Terms and Conditions for CB Business Internet Banking facility to be operated by us (as per list of users mentioned herein above) in terms of our CB Business Internet Banking mandate stated herein above. C[ P» SÔ mh G[PÍx i] ]öúì Cßhºö m [Q[&ß ÂvøÓPÎß i õ[pò (C[ P» SÔ mh i ß kzx Áõ ß mi ¼ß i) C US i] ]öúì Cßhºö m [Q[ Á\vUPõÚ Á[Q ß ÂvøÓPÒ ØÖ { uøúpðus Em mk i] ]öúì Cßhºö m [Q[ Á\vø G[PÐUS ÁÇ[S õö õ[pò Cuß» PmkU öpõòq Óõ. d) We hereby authorize the Bank to recover / debit from our account/s all charges and costs in relation to CB Business Internet Banking facility as and when due and not reimbursed by us to the Bank forthwith. Á[QUS õ[pò ö\¾zuõâmhõà ØÖ ö\¾zu Ási i ØÖ ö\¾zu Ási õx i] ]öúì Cßhºö m [Q[ Á\v öuõhº õú GÀ»õ Pmhn[PøͲ G[PÒ PnUQ¼ x /PÒ Á`¼UP / PÈzxUöPõÒÍ õ[pò Cuß» Á[QUS A[RPõµ ÎUQ Óõ. e) We further request you to provide transaction access to the designated users as per the terms of our CB Business Internet Banking mandate stated herein above. ¾ C[ P» SÔ mh i G[PÒ i] ]öúì Cßhºö m [Q[&USz uøá õú i ÂvøÓPÎß i { ªUP mh ß kzx Áõº ÁºzuøÚ AqSuø» ÁÇ[P õ[pò PmkU öpõòq Óõ. 13