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52 views

Receipt

Uploaded by

kumarchandan34171
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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8/22/24, 2:09 PM Receipt

Account Opening Form


1. TYPE OF ACCOUNT : I wish to open the following type of account SB Basic savings Bank deposit
Account
2. NATURE OF ACCOUNT : OTHER INDIVIDUAL
3. FULL NAME, in CAPITAL Letters(leaving a space between first,
Customer Photo :
middle & last name)
Reference No K390025115121022082401000026 Image Preview
Customer Name Ritesh Kumar
Sex Male
Account No 1512101700009795
Customer ID R48448804
Aadhaar No XXXXXXXX6965
Mobile No 7091821039
4. Mode of Operation : SELF
5. ADDRESS :
Flat No./Bldg. Name
TRIBENI MANDAL, KUSHMAHA, KUSHMAHA,
Street / Road / Locality
BOUNSI, Bounsi, BANKK, BIHAR, 813104
City / District / State with pincode
Tel.No / Fax No.(with STD code) 7091821039
Email [email protected]
6. CUSTOMER PROFILE :
Date of Birth 11-07-2000
Educational Qualification GRADUATE (GENERAL)
Nationality INDIAN
Category OBC
Religion HINDU
PAN / GIR no(if not available, please fill form 60 / 61 at
IRVPK1280C
12)
Occupation Type STUDENT
Designation / Profession Student
Annual Income 60001 - 1 LAC
Annual turnover / Receipt from business(Rs. Lakh)
Classification *
Name of Father / Guardian TRIBENI MANDAL
Marital Status SINGLE
Name of Spouse (if married)
7. KNOW YOUR CUSTOMER (KYC) DOCUMENTS :
ID Proof Address Proof
Type of document UIDAI UIDAI
Document ID No. XXXXXXXX6965 XXXXXXXX6965
Issuing Authority UIDAI UIDAI
Place of Issue

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8/22/24, 2:09 PM Receipt

Date of Issue
Valid up to
I attach the copies of documents opted for and produce the original copies of these documents for verification.
8. Nomination :

I want to nominate as under

Date of Birth Person authorised in case of minor to receive the amount of


Name of the
Relationship Age in case of deposit on behalf of the nominee in event of my / minor's
nominee
minor death during the minority of nominee.
TRIBENI
FATHER
MANDAL
Date:
Place: Signature of declarant
WITNESS IN CASE OF NOMINATION (FOR THUMB IMPRESSION ONLY)

Name & Signature of the first witnesses Name & Signature of the second witnesses
Name:- Name:-
Signature:- Signature:-
Address:- Address:-
To be filled by those who do not have either PAN/GIR: (Select appropriate form)
Form No. 61
Form No. 60
To be filled by a person who has agricultural income
To be filled by person without PAN and is not in receipt of any other income chargeable to
1. Are you assessed to tax? Yes No income tax

2. If yes (i) Details of ward/Circle/Range where the last I hereby declare that my source of income is from
return of income was filed_________ agriculture and i am not required to pay income-tax on
any other income, if any.

Declaration

I Ritesh Kumar do hereby declare that what is stated is true to the best of my knowledge and belief.

Date:
Place: Signature of declarant

Declaration/Undertaking
a) Please seed my Aadhaar / UID Number issued by UIDAI. I hereby give my consent to the Bank to use my
Aadhaar details to authenticate me from UIDAI by using my biometrics for the purpose of Bank account.
b) I declare that I am desirous of receiving entitled benefits or subsidies of welfare schemes funded from the
Consolidated Fund of India in my account directly.
c) I also hereby give my consent to Bank for enabling AePS facility : Yes.
d) I hereby give my consent to download my KYC Records from the Central KYC Registry (CKYCR), only
for the purpose of verification of my identity and address from the database of CKYCR Registry. I
understand that my KYC Record includes my KYC Records /Personal information such as my name,
address, date of birth, PAN number etc.
Date:
Place: Signature of declarant

For Official Use:


Specimen Photograph
Signature /
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8/22/24, 2:09 PM Receipt

Thumb
impression of
the customer

Name Signature GBPA / PF No Date


Rupay Debit Card
issued
Signature Verified
Account Verified
Registration of
Nomination
Punjab National Bank
(Authorized Official) Name_______________GBPA No____________

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