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ac-open_HARSH[1]

This document is an application form for opening a Post Office Savings Bank account for individuals, detailing personal information, account type, and KYC documentation. It includes sections for applicant details, operating instructions, first deposit information, and nomination. The form also requires signatures and verification from post office officials for processing.

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sahildobariya555
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54 views2 pages

ac-open_HARSH[1]

This document is an application form for opening a Post Office Savings Bank account for individuals, detailing personal information, account type, and KYC documentation. It includes sections for applicant details, operating instructions, first deposit information, and nomination. The form also requires signatures and verification from post office officials for processing.

Uploaded by

sahildobariya555
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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RECURRING PR.

NO:

POST OFFICE SAVINGS BANK


ACCOUNT OPENING/PURCHASE OF CERTIFICATE APPLICATION FORM FOR INDIVIDUALS
For Office Use
Post Office: MOTIFALOD BO Date:1 3 / 1 2 / 2024 SOL ID:
Account/Registration CIFID(1)
No. 43 7 2 5 0 2 8 4
CIFID(2) CIFID(3)
For Applicant(s)
*1. I/We request you to open:- Savings/Basic Savings/RD/TD Year//MIS/SCSS/PPF/SSA or issue NSC(8th/9th issue) or KVP
in my/our name.

*2. Full Name of applicant/Guardian (in case of minor/Lunatic A/C), in CAPITAL Letters (leave space between words)
Mr./Mrs./Ms./Other First Name Middle Name Last name Gender ( M/F)
1 MR SAHIL VINODBHAI DOBARIYA M
2
3

*3. Full Name of father/husband/Mother, in CAPITAL Letters : VINODBHAI RAMJIBHAI DOBARIYA

*4. Residential Address


First Applicant 2nd Applicant 3rd Applicant
Flat No./Bldg. name 5
Street/Road/Locality/Village NILAM NAGAR-2
Tehsil/Post Office SHYAMDHAM CHOWK
City and District SURAT
State GUJARAT
Pin Code 395010
Tel./Mobile No.(optional) 8200492997
Email (optional)

*5. Applicant’s Date of Birth (dd/mm/yy) PAN Number orForm 60/61) CIF ID (if already exists)
1 17/01/2003 GWHPD7273R 437250284
2
3

*6. Operating Instruction (please tick √ the empty box)


Single/Self Either or Survivor (Joint-B) Jointly (Joint-A) Through literate agent

*7. Detail of Know Your Customer (KYC) documents submitted:-


Photo ID Address Proof
Applicant Applicant
1 2 3 1 2 3
Type of Document PAN ADHAR
Document No. GWHPD7273R 317153470018
Valid up to (if any)

*8. Detail of First deposit:- Amount Rs.(figures) :100/- .(words:) RUPEES ONE HUNDRED ONLY
Mode of Deposit: CASH

9. Nomination:- I/We nominate the person(s) named below under Section 4 of the Government Savings Bank Act, 1873 (5 of
1873) to be the sole recipient (s) of the amount standing at the credit of the account in the event of my/our death.
Name & address of Date of Birth Share of Name & address of person who may receive the said amount
nominee(s) (in case of nomination during the minority of the nominee(s)
minor)
VINODBHAI 100% 5,NILAM NAGAR-2,SHYAMDHAM CHOWK,NANA VARACHH,SURAT
DOBARIYA
RELATION: FATHER
Signature of witness in case depositor wish to make nomination

Name & Address of witness: RITESHBHAI NAVINBHAI PATEL


*Mandatory Fields to be filled by customer.
10. AADHAR NUMBER:-886097669556

11. Please open Minor A/C through Guardian/Lunatic Account through Guardian/Blind/Physically Handicapped/Illiterate
through Agent/Pensioner/BPL/SB Basic Savings Account/Sanchayaka Account/Others

12. In case of minor/Lunatic Account, please fill Name of Guardian, his Residential Address and Relationship
with Minor

13. In case of other than Minor/Lunatic, please enter Name of Sanchayka/Government Welfare Scheme and
PPO/BPL/Registration/Enrollment number:-

14. Amount of Monthly Installment (In case of RD Account):-Rs.(in figures) (in words)

15. In case of NSC/KVP:- Please issue (No. of NSC/KVP & Den.)

16. In case services of SAS/PPF/MPKBY Agent are taken:- Name of Agent Authority No. Valid Up
to .

17. Standing Instructions if any :-

18. I/We authorize Agent (name) to receive


Passbook/Certificates on my/our behalf.

Declarations

I/We hereby declare that I/We have clearly understood POSB General Rules 1981 and Post Office Savings Account Rules 1981/ Post Office
Recurring Deposit Rules 1981/ Post Office Time Deposit Rules 1981/ Monthly Income Account Rules 1987/ Senior Citizens Savings Scheme
Rules, 2004 and Sukanya Samriddhi Account Rules 2014, PPF Rules 1968, NSC(VIII) and (XI) issue Rules, KVP Rules (amended from time to
time) governing the accounts/Certificates under this scheme and to abide by such rules framed by the Central Government as may be applicable
to the account from time to time. I hereby declare that I am not maintaining any other Public Provident Fund Account and I will not exceed
maximum deposit limit fixed from time to time in self as well as my minor accounts (combining all accounts) where I am a guardian.

DATE:

Signature/Thumb Impression:-
1st Applicant 2nd Applicant 3rd Applicant

Space for affixing photo of applicants

All Fields to be entered into system by Counter PA.


******************************************************************************************************************************************************
For Office Use only
Certified that I have verified the documents submitted with this application form and confirm that KYC norms are fully
complied with. Following numbers of NSC/KVP issued (in case of NSC/KVP Application):-

Signature of BPM Signature of SPM Signature of Postmaster


Date Stamp

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